The key elements of today’s debate on health care converge in the ER, from the cutting-edge quality of the U.S. system to the millions of uninsured people who show up for care. The debate reaches a critical moment this week, as Congress returns to Washington to take up proposals to revamp the system. President Obama will address a joint session of Congress on Wednesday to press for action.
To explore the issue, USA TODAY chronicled 24 hours in the emergency room at the UVA Medical Center, a teaching hospital and trauma center that serves patients across a swath of central Virginia. From dawn Monday to dawn Tuesday, Aug. 24-25, reporters talked with patients and their families, doctors and nurses, helicopter pilots and ER housekeepers about their experiences with health care and their views on changing the system.
Their experiences and observations underscore why changing the health care system has proved so hard for presidents and policymakers: the complexity of the system, the pressure from chronic diseases, the shortfall in preventive care, the high costs, the competing demands ”” and the life-or-death stakes.
The shortfall in preventive care is, IMO, one of the chief issues. That, in itself, is hugely complex, but has to do with our “I want it all and I want it now” culture, our medical-legal system and our payment system where primary/preventive care is poorly paid or not paid at all – which drives medical students laden with debt into specialties and subspecialties (“partialist doctors”, as a friend once called them!). The solution isn’t just universal healthcare, it is payment reform, legal reform and – most unlikely of all – culture reform. Just my two bits, discounted 50% for “usual and customary” and/or “allowable” by Medicare and private insurers. 🙂
montanan is correct. Nothing is free, including ER visits. Someone is paying for them, and part of the pay is the long wait. The government mandates that everyone must be treated that comes to the ER and not required to pay. So why should anyone buy insurance? As for preventive care, the public does not want it. We know how to do it but rarely will anyone agree to it. If we are to have socialized medicine, then let’s take the areas that are already socialized—Medicare, Medicaid, VA and fully fund them and get them running well before we streatch them over the entire nation! Obama says he can do that and not pay anymore out, by savings in mandated electronic medical records (Joke) and stopping fraud. HAHA, he can’t even get his appoiintees and the Congressmen to pay their taxes. Hope everyone enjoys what the majority voted for last November.
I would differ with my esteemed colleague on this one: “The government mandates that everyone must be treated that comes to the ER and not required to pay.”
What EMTALA requires is that everyone is entitled to an emergency triage exam. This may be done be a nurse. “Let’s see. You have had back pain for four years. You say that your primary gives you Percocet, but it is 5:30 on a Friday and your primary is now off for the weekend, but you just ran out of your narcotics. Sorry, but the sign on the door says [b]EMERGENCY[/b], and back pain for four years ain’t an emergency.” Ditto for sniffles for three days, “temperatures” of 99.5F, etc.
If ER’s would not cave in to those using the ERs as health clinics, the ER volume would decrease dramatically. The triage nurse just needs to refer them to the local health clinic in the morning. But what needs to happen is 1) the government (for Medicare and Medicaid patients) and private insurance needs to stop paying the ERs for these cases, and 2) it needs to back up the ER by supporting local health clinics that provide care for much less and coming up with screening algorithms for the most common ER visits (headache, GI upset, etc.) that would allow the triage nurse to not fear lawsuits.
And of course robroy is correct. HOWEVER in the ER’s I have worked in and with, the hospital is often heavy handed about not turning away anyone. They are scared to death by the federal EMTALA laws and also some one who has been triaged and then goes out the door and dies in 72 hours or strokes out. Our ER docs say that to really triage someone takes about as much work up as just going on to see them. The only limit is that these patient may sit for a long time. Lawsuits are always lurking over our shoulder and most just do the full court press and max workup and not worry about the costs. Our corrupt courts and shyster lawyers salivate over getting patients to be unhappy. Also, our local politicians have told our city/county hospital board that this is “the peoples’ hospital” and should be free. So bills are not pursued and money at time of visit is off limits to even mention. Many federal health clinics close at 5-7 PM and even the hospital clinics charge, so I see patients who say up front that they don’t want to pay the clinic even reduced pay since they can go to the ER on their own schedule. Still, our ER docs are the best and give great work.