One Long Monday Night in the Greatest Healthcare System on Earth

[McCamy Taylor]

“’(E)ven if Obamacare were a perfect piece of legislation, and it’s not , we can’t afford a trillion dollars of new federal spending,’ said Romney.”
http://www.politico.com/news/stories/0312/74404.html

Dear Mr. Romney. We cannot afford not to do something about the nation’s uninsured problem. Case in point:

My husband was making pork with garlic sauce when the knife slipped and he sliced open his index finger. The one he uses every day as a massage therapist. I took one look at the gaping, bleeding wound and said “That might need stitches.” Within minutes, my husband, my adult son and I were in the car heading for the closest hospital emergency room. Let’s call it Hospital X.

Just to set the stage, I should tell you that I am a family physician. I have group insurance through my employer. So, this is not going to be a sad story about how my family had to choose between health care and eating. This is a report from the trenches of our nation’s beleaguered urban emergency rooms.

Usually, I go to Hospital Y, which is a bit farther down the road. But the last two times I had been to Y’s (busting at the seams) emergency room, the physicians had treated my abdominal pain without actually touching my abdomen. Apparently, the Y ER doctors were too busy to perform the two minute exam, because both of them (on different nights) ordered blood work and CT scans in lieu of examining me.

Hospital X was closer. And, on the two occasions that my family had been there in the past, its ER was not nearly as crowded. Unfortunately, that was about ten years ago, before the uninsured crisis drove three area hospitals out of business, and the ER volume at those left standing went through the roof.

We were triaged right away. The RN on duty knew her job. She told my husband to apply pressure to the wound and have a seat in the waiting area. That was where the fun began. For, sometime in the last decade, Hospital X’s emergency room had become just another after work walk in clinic for those without health insurance.

The waiting area with packed with people. One woman, with abdominal pain and “bad nerves” had been there for three hours. Bad sign. Abdominal pain usually takes priority over a laceration. After waiting for hours to be seen, Bad Nerves was mad as hell and not going to take it anymore. Her friend suggested that they visit one of the city’s other emergency rooms, but Bad Nerves said she had outstanding bills at all of those.

I could tell that Hospital X’s ER was understaffed, when a woman came in shouting that her husband was in the car having chest pain. The only visible hospital employee, the RN doing triage, had to leave her post, get a wheelchair, go outside to their car and wheel the husband back to the patient care area, leaving triage unattended for about 20 minutes. Keep in mind that X is a huge urban hospital that does transplants, cardiac bypass and high risk obstetrics. Oddly, we did not miss the triage nurse, because no one in the ER waiting room that night, except for my husband with the sliced finger and the young man with a sport’s injury and the guy in the car having chest pain actually seemed to be having an emergency. They were all there to visit the after work walk in clinic that was required (by federal law) to treat anyone who showed up regardless of ability to pay.

We waited about three hours to be seen. Did I mention that slicing your index finger is very painful? But my husband was stoic. Eventually, we were seen. The care was fine. We went home and my husband’s finger is healing well. Happy ending? I don’t think so. Ninety percent of the people in that waiting room could have been treated more quickly, more cheaply and more effectively in an office. But doctors’ offices demand payment, either in the form of cash or insurance. So, they wait until after work and visit the “walk in clinics” also known as the nation’s hospital emergency rooms. There is only so much that emergency rooms can do for chronic conditions, so the care is half assed by necessity. Half assed and as expensive as hell—

Oh, I almost forgot to mention. About five years ago, we were out of town and my son had an asthma attack in the middle of the night. Since we did not have his inhaler, we took him to a local emergency room where he received one nebulizer treatment, got a prescription for an inhaler and was sent on his way. The bill for that visit? Over $5000. Half assed and as expensive as hell---

Which just about sums up the state of heath care in the U.S. right now. We spend over twice as much person per year (half of it coming from the government) as western European countries and Canada, and yet our health indicators, such as life expectancy and infant mortality are at third world levels.

The moral of my story? Spending a few pennies to insure more Americans will not break the bank, because the bank is already broken. Insuring more Americans is the only way we will put the bank—and our broken health care system---back together. If 30 million more Americans---many of them with chronic conditions like diabetes and high blood pressure---can get insurance, our hospitals will stop hemorrhaging money, everyone's health care bills will go down, and we will stop dropping like flies from preventable illness.

[NV Whino]

1. I was thrown into the health care system 3 years ago

I learned it is broken so deeply and in so many ways, it will be impossible to fix.

Fortunately I was only physically and not mentally impaired so I screamed and raised a rucus until I got the care I needed. I don't know how older or mentally impaired people can negotiate the system.

[EFerrari]

2. The last two times I walked in somewhere

once to an ER and once to a low cost clinic, walked out after waiting more than 8 hours (17 at the SFG ER) because I was too sick to sit there any more. I'm not doing that to myself again so that leaves ice, aspirin and chamomile tea.

[kentuck]

3. If you can survive emergency room healthcare....

...then it just isn't your time to go...

[Prophet 451]

4. In fairness

I live in the UK and if you came to A&E (accident & emergency) with a cut on your finger, you might be waiting a similar time simply because other people are in more urgent need of care and the NHS has been underfunded for decades. That said, since it was a relatively minor injury, you might also have been stitched up by a student doctor (meaning they've finished training but they have to be mentored by a doctor for two years before they're allowed to practice alone) with five minutes spare.

Either way though, it wouldn't have cost you a penny beyond what you pay in taxes.

[former9thward]

5. The problem with your story is that the Health Care law will not change a thing in it.

The same people who are uninsured now will remain uninsured. Do you think that just because there is a mandate that people will actually buy it? They don't buy it now because they can't afford it. Just because there is a mandate does not mean they will suddenly be able to afford it. Yes I know there may be some 'subsidies' to help people buy insurance but those will not be enough from the figures I have seen for people to afford individual or family coverage.

[daleanime]

14. I believe that that was part of what the OP was talking about....

the problem is far from fixed.

[frazzled]

6. Spot on: we really can't afford NOT to

Each of us probably has a story like this one, gained from painful hours in an emergency-room waiting room, surveying a sea of humanity suffering from everything from gas to gunshot wounds, the shortage of staff, the waste of resources and money.

My story was a few years ago, and took place at a prestigious big-city hospital associated with a storied university. It was several months after a bicycle accident my husband had had, sustaining a fractured shoulder, four broken ribs, a punctured lung, etc. (At that time, the police had taken him to a sleepy suburban hospital near his accident site, early on a Sunday morning, where bagel-slicing accidents were the norm for that time of the week, so he was seen promptly; their efficiency was to send him home with me several hours after doing CT-scans and X-rays, to seek out care with orthopedic and thoracic surgeons in the city. Fun!).

At any rate, he'd weathered those injuries well and seemed to be on the mend. One day he felt ill and feverish, however, and we thought he perhaps had a flu. By next morning, I noticed that the hematoma on his hip (the one thing from the accident none of the doctors had worried about initially: it would heal itself over maybe a year's time, they said) had spread all the way down his leg, which was fiery red and had grown to an enormous size. It was a Friday, and neither his primary care doctor nor orthopedic surgeon was in the office. The two conferred, however, and told him to get over to the hospital ER right away. So we did, and checked in on their new marvy computerized system, which brought up all his records and insurance info in no time; we described the injury and sat down to wait. And wait. For five hours. It was a busy place, and I'm sure our place on the triage list wasn't number one (we saw police bring in what was probably a gunshot victim, plus some other people in obvious distress), so we didn't push it. However, after seeing a later-arriving young woman who had what looked to be a paper cut from the office, who was gabbing on her phone the whole time, go in before us, we decided we better check.

This time we were a little more emphatic, and offered to pull down his pants in the crowded space to show them if they needed. That got a bit of attention, and within a half hour or so we were in. When the attending physician and nurse opened his gown to have a look, I watched as the nurse turned her face away and made a gagging sound and the doctor exclaimed: "Holy sh_t!" I was at least relieved we hadn't waited 5 1/2 hours to be told it was nothing. It was a staph infection, which of course could have killed him had it spread to his organs. They removed blood and fluid for testing and started the hospital admission procedure right away. This, of course, took more time ... on a gurney in the hallway with other very sick people on gurneys waiting for admission (the examining rooms were needed for the hordes of other people still waiting to be seen). But after seven hours total, we were finally up in a swell room in this otherwise swell hospital, hooked up to IV antibiotics, and under good nursing care. I can't even tell you what this whole episode cost: it had to have been a small fortune, but we have good insurance and had to pay next to nothing.

We've got to find a way to make sure that people—all people—have access to good medical care so that emergency rooms can operate as, well, emergency rooms, for real emergencies. Even at this, a big urban hospital will always be overstressed. But getting people access to care for chronic or low-level conditions (at lower cost) so that emergency care can operate more efficiently is not just something nice to wish for—it's a necessity, both healthwise and economically.

[WCGreen]

8. The last few times I had to go to the hospital, I called my Primary Physician to "pre" admit

me to the hospital. They called me back when the bed was available and so I was admitted in my gown and figuring out how to work the TV within fifteen minutes of walking (rolling, I was on a wheel chair) into the ER...

[HiPointDem]

9. Single-payer wouldn't cost the public anymore than the current system does. Cost isn't the

reason we don't have single-payer, politics is.

Health care is deliberately made a scarce good to keep prices high and keep people fearful.

[murphyj87]

12. Single Payer costs much less

Overhead for the Canadian health care system is 1.3%. Overhead for US Medicare is 3%. Overhead for the current US insurance-run system is only 20% to 25% because of the Affordable Care Act, otherwise insurance-run health care overhead would be between 37% and 41%.

Canadian health care costs Canadians $3800 per person per year to cover everyone. American health care costs Americans $7900 per year to leave 38% of Americans with less than adequate access to health care to meet their medical needs, or none at all.

My uncle cut his hand off with a circular saw in a work accident. Within 35 minutes of the accident happening, he was in the operating room having it reattached with microsurgery.

My mother had bypass surgery starting within 4 hours of hitting the ER doors with a first instance of chest pain... turned out she had two 98% obstructed coronary arteries...

Long Canadian waiting lists..... yeah, right......

[kentuck]

15. The only reason we don't have single-payer healthcare...

... is for political reasons, not financial reasons.

[HughBeaumont]

19. These are the high costs of a nation that would rather DIE than admit they're wrong.

[murphyj87]

33. Also....

Last edited Thu May 31, 2012, 04:29 PM - Edit history (2)

Neither my uncle, my mother, nor I (for the 3 major surgeries I've had -nor anyone in my family nor anyone I know or have ever known in Canada) has paid a cent out of pocket for anything medical. The only costs were for renting a TV, phone charges, and parking, not for anything medical.

[Tikki]

10. Most of rmoney and his %1lk don't cut up stuff for their own dinner...their maid/cook does and...

if they happen to cut a bit of the finger on the yacht's rigging they call the concierge doctor
to attend to that problem.

They think the rest of us using the Emergency room is like an after hours field trip or a place
car crash, gun shot victims go.

And all of the above are 'your fault'...NOT THEIRS.

Tikki

[hay rick]

11. K&R

[The Wizard]

13. Our health care costs more than

double that of Japan and France that are considered the best. We're getting hosed.

[Overseas]

16. K&R. Well said.

[Dustlawyer]

17. The author's suggestion at the end makes too much sense, so it will never happen in our system!

[chervilant]

18. I'll be dropping like a fly

because of my chronic unemployment and inability to feed, shelter and clothe myself. Ironically, *ALL* of that supersedes my serious and disintegrating health issues...

[TBF]

20. It speaks to priorities.

Last edited Mon May 28, 2012, 02:38 PM - Edit history (1)

We spend billions of years killing people overseas - yet will not spend that money on healthcare for our own people here.

[dixiegrrrrl]

21. At least your ER had triage....ours did not when Mr. D.'s lung collapsed.

On a Saturday morning.
any after hours calls to our local doc are answered by a machine, saying "go to the ER if this is an Emergency".

We went to our ONLY hospital, the ER was packed, there was NO triage nurse,
there was one very senior citizen woman sitting behind a glass window, situated so that the waiting room was not visible to her, with a sign in clipboard, and, as it turned out, her job was to collect info. and insurance details before anone could be seen.
Mr. d was having great difficulty breathing, and knew from previous lung collapse there was a chance his other lung could also collapse. He was hunched over gasping for air.
I scoped out the waiting room, saw that no one else was showing any signs of distress, no apparent wounds.
I went over to the lady behind the glass, with Mr. d's ID and insurance cards and told her he was a heart patient of local doctor x, ( true) could not breath, ( true) and I was afraid he MIGHT be having a heart attack.
That did the trick.
He was examined and admitted to the ICU.

But since he has no outpatient insurance, the ER billed us 800.00 for the 40 minutes he was there.
The Medicare re-imbursement rate is 114.00.
Turns out the ER is staffed by contracted docs, who also "own" the ambulance service, and they can bill anything they want.

[A Simple Game]

22. You are a family physician and made your husband wait 3 hours

in an emergency room for a cut finger you thought may need stitches? I bet you bring a bag of goodies from work home with you from now on.

If it had been me with the cut finger, I would have told you to use the sewing kit and be done with it in 5 minutes.

P.S. How are the fiction writing web sites doing?

[McCamy Taylor]

28. Physician's treating family members is frowned upon, so I try not to do it.

You lose objectivity

[mojowork_n]

29. Maybe you could sterilize the needle

but what about the sutures? If the hand's used for work all the time,
maybe it's worth doing it right?

[datasuspect]

34. there is no dr. i've ever known who has had to spend (or would waste their very expensive time)

time sitting in an ER.

doctors are high priests of the medical caste. they get professional courtesy in lot of ways we mere mortals never see.

[A Simple Game]

36. Yup, I know what you're saying. n/t

[nashville_brook]

23. you hit the nail on the head. if this is to be an economic discussion...BRING IT ON.

[Godot51]

24. National health care

I've lived in Japan since '79 and I have no complaints about the national health care. In fact I'm an atheist who thanks god for it.
If those Americans who oppose national health lived in a country which has it they would be converted in a short time. It's sad, shameful and pointless to promote the "American" way.
Is the health care in Japan perfect? Of course not. What human endeavor is? But it works well enough most of the time for most of the people.
Could it be better? Of course but even the Japanese are all too human so errors are made and waste is created and the innocent suffer. But at least we try.

[bvar22]

25. The really sad thing is that THIS story is repeated...

...thousands and thousands and thousands of times
every single day in the richest nation on Earth.
The people that could CHANGE this don't seem to really care enough to fight.


[font color=firebrick size=3][center]"If we don't fight hard enough for the things we stand for,
at some point we have to recognize that we don't really stand for them."
--- Paul Wellstone[/font][/center]
[center]
[font size=1]photo by bvar22
Shortly before Sen Wellstone was killed[/center][/font]

Bring Them ALL Home.
Medicare for ALL.

[Turbineguy]

26. But, but....

Rush Limbaugh says we have the greatest healthcare system in the world? What should I believe? Him or reality?

[oldernwiser]

32. Actually....

Rush only sees what he wants to see - IMHO, that's usually an intimate view of his very own colon.

Rush, Hannity, and quite a few of the Tea Party oblivious have this odd view that if you don't have a job, then you don't deserve the finer things in life like food, housing, or even health. Rush also insisted that Obamacare would lead to euthanising our elderly. Rush seems to think that paying $20k to have a baby is a good thing - it's moving cash around our economy. Once you realize that in reality, a normal birth uses $4k in health professionals and durables and $16k to pay for 4 unemployed/uninsured moms it becomes obvious that Rush needs to look at the issues a bit more and stop pandering to the crazies who accept his word as though there should be a book in the bible with his name on it.

[secondwind]

27. I had to go to an emergency room in Nova Scotia, while on vacation 3 years ago...... my

host called the hospital and told them I had serious pain in my left shoulder (turned out to be small tear in rotator cuff), and they said to come right on over.

We drove 8 minutes to the hospital, I was asked some general information, and seated for about 15 minutes. A lovely man from New Brunswick came over to me and led me to the examining room . He spent plenty of time with me, and told me he thought it was a torn rotator cuff and that I should have x-rays.

They took 3 x-rays of my shoulder area. Total cost : 110 Canadian.

Doctor bill: Ready? 55 Canadian

The doctor showed me some exercises I could do while on vacation, which nearly eliminated the pain and I was able to go on my way and enjoy the rest of the vacation trip.

This was a clean facility, with good posters on the walls with good advice, and it smelled clean, etc. no urine smell, the office was equipped with modern equipment, computers, etc., and my entire visit was not stressful and totally wonderful.

This was on a SUNDAY AFTERNOON.

[GObamaGO]

30. Your post does point out how broken our system is in.

The Affordable Health Care Act is a small start toward fixing the system. We have a long way to go, and if we continue to elect Republicans in Congress (and perish the thought - for President) we will never get there.

[oldernwiser]

31. I hate to say this

But, Romney is right - for the wrong reason.

First of all, people tend to forget that insurance isn't free money. It gets funded from a pool of contributors, and the healthier they are the more funding the pool gets. If people wait until they REALLY need medical attention before they subscribe to a plan then what you end up with is negative cash flow into the pool. It's unfortunate that the healthiest among us feel that since they're never sick and live a healthy lifestyle that there's no reason for them to "waste" their money on insurance.

The national healthcare act is, in my opinion, a time bomb. Essentially, it says that everyone gets accepted into a health plan regardless of ongoing issues. It will force private insurers to accept not just a risk but the CERTAINTY of paying out more money than they currently take in which will raise premiums across the board. Those unable to afford the private insurers rates will be able to get a government sponsored policy, so if the healthiest of us are enrolled privately then the government will take on the negative cash flow issue which will result in much higher taxes across the board - the working middle class being hardest hit without regard to where they're insured.

Our current hospital regulations say that public hospitals must accept patients regardless of their ability to pay. This is a good thing - it keeps poorer people from needlessly dying. But, if a hospital takes in 5 people who can't pay and 1 who can, it doesn't take a rocket scientist to figure out that the 1 who can pay, pays for the 5 who can't. This is why the cost of health care keeps spiraling upward, especially when the economy slows down and people are out of work: 5 people become 10 or 15 or 50. We all carry that economic burden whether we're insured or not. Insurance companies have to cap their payouts to keep hospitals from hitting them with inflated costs, but since the amount they pay is negotiated annually, even THAT figure goes up over time.

The point of the OP was to say that we need to do something about the uninsured problem, but the real issue is how to keep medical costs from skyrocketing until we have to be one of the 1% to get our injuries fixed. If we are going to accept having to pay for those who can't pay for themselves, then maybe we really ought to scrap insurance altogether and fully nationalize our healthcare industry - that would mean contributing to a medical pool in the form of direct taxation. Since we're paying for it already every time we see a doctor or visit a hospital, the costs might as well be fairly distributed.

The GOP position on this issue is just plain wrong as well. They figure that it's unfair to expect those who work to have to pay for those who don't in the form of taxes. The thing is, if we only pay when we need treatment then we can expect to have to pay $5000 for a single nebulizer treatment and a prescription at our local hospitals. And the more people who can't pay will most certainly make $5000 a bargain in a few years. The GOP's staunch refusal to even consider nationalization guarantees that more public hospitals will close - further increasing wait times, driving the most qualified doctors into private hospitals and killing our healthcare as we know it.

Obama was on the right track, but his legislation doesn't go far enough - it treats insurance as the problem instead of taking on the way we apportion healthcare and it's costs.

[aint_no_life_nowhere]

35. Great post

I've experienced similar things. I was billed $10,000 by the ER for a prescription and some anti-biotics to treat a urinary tract infection. The sharp pain came on suddenly and I couldn't find a urologist who would see me unless I waited at least 2 weeks for an appointment. My cousin accidentally shot himself through his belly fat and spent three hours in the ER getting stitches and was billed $20,000 along with $2,000 for the ambulance (which lost its way on the way to the hospital). My mother broke her wrist about 6 years ago and spent 4 hours in the ER waiting room in pain because they were so understaffed.

When I went to negotiate my own $10,000 bill, I was shocked to see that the billing department alone took up a vast wing of the hospital and had about 5 times the employees as the ER. The lady who spoke to me said that the process for billing has become so complicated, with different sets of forms for each insurance company and so byzantine to administrate that just billing activities alone drain major resources from the hospital. We don't have a healthcare system. Something that chaotic, that broken, and unreliable doesn't merit being called a "system".

[Liberal_in_LA]

37. she's a doctor. why didn't she just stitch it up herself?