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As I mentioned up at the top of the broadcast, we've come to Baltimore today to continue with Fallout, that's our coverage of the financial crisis and, increasingly, its aftermath.
Out here, away from Wall Street and Washington, is where the loop gets closed. Where the connections between the crisis and the real world are made.
You can get a pretty good snapshot of the Baltimore economy if you spend an afternoon in the emergency room at Johns Hopkins Bayview Medical Center.
Hugh Hill: We had a number of fractures. We had a number of elderly people who had fallen and injured themselves. We had strokes. We had a couple of heart attacks.
Dr. Hugh Hill's in the middle of a 12-hour shift at Bayview.
He's on his way to seeing maybe 170 patients today.
Between the university and its hospital system, Johns Hopkins is the biggest private employer in Baltimore.
For years, until the tech boom and the migration of a lot of those higher skill, higher paying jobs closer to Washington D.C., Baltimore was the economic engine for the whole state of Maryland.
Hill: The southeast corner of Baltimore is the area where the famous Bethlehem Steel plant was. And there was a lot of heavy industry in the area both associated with Bethlehem Steel and Bethlehem itself. And even though they've closed down and the local GM plant has closed down, there is still industry here and there's still a patient population here that depend on that industry.
Those patients depend on Bayview so much that the hospital's been filled almost to capacity. Ninety percent of the beds are taken.
Hill: His lungs are probably very tight, his bronchial tubes have tightened down.
More than half of the patients admitted to Bayview come in first through the ER.
And Hill says the crush has only gotten worse as the credit crisis and the economy have collided.
Hill: It shows up here in that people are coming in who have jobs that they are desperate not to lose. They don't want to report that the injury was on the job. It happens because they come in, they've lost their job, health care starts to go down, depression sets in. And it is noticeable here.
Walter Deshcenaux: One of the things that is going to be happening that will affect Hopkins and other facilities is our ability to pay doctors through the Medicaid program as adequately as we'd like.
Like a lot of other states, as consumer spending has slowed and tax revenues have dried up, Maryland's been having some money problems.
Walter Deshcenaux runs the legislature's non-partisan budget office.
The state's looking for almost $400 million in cuts for this fiscal year.
Deshcenaux: Well, it's like the old saying about Frank Sutton, the bank robber. You go where the money is. And one of the biggest chunks of money that is identified with a single program in any state is going to be the Medicaid program.
Overall, health care spending in Maryland's going to lose $85 million this year.
That's an amount that Hugh Hill the ER doctor says he's resigned to, but still.
Hill: In this particular crisis, there may be some other people hurt before us. Folks that can't make payments on mortgages and wind up out in the street. And in any kind of a recession, you worry about people who become jobless. But one of the spinoff results is that more and more people wind up in the emergency room, because it is the one place that they can go.
It's also, especially in states that're cutting their budgets, one of the most expensive ways there is to get health care.