Observations from the Emergency Room

[mattkime]

[quote Lux Interior]One of the strangest things about medical care is they charge the uninsured a hell of a lot more than they charge the insured (meaning the insurance companies). Yes, I know the reasons behind it, still doesn't make sense.
It makes sense this way - people with little or no power in society are charged the most whether they can pay it or not. this is true for a lot of things.

[mspace]

Since insurance companies don't pay full fees, the fees get inflated to make up for it.

That's one reason why it's so much more if you don't have insurance. After all, they have to charge the inflated rate to all, or it would be "deceptive" practice.

[Racer X]

I was at a store a few months ago, and saw a young mother with 4 kids under maybe 6 years old. Running around the store unattended. Two of the kids were using something with handles as swords, and were sword fighting. One slipped, and gashed his scalp on an endcao, below his hairline. Mom, who spoke almost no english, had a hard tiime explaining to the manager what she needed. They ended up calling an ambulance, and taking the kid to an ER, for what was about a 1/4" cut, needing a stitch. Probably a butterfly bandage would have done it.

I wonder how much the taxpayers ended up paying for mom's innability to watch her kids in public.

[wowzer]

Well, since we're on my turf, I better chime in. I am a residency director for Emergency Medicine...which means that I train Emergency Medicine doctors.


I agree with most of what was said here. The health care 'system' is really a misnomer...there is no system...just small fiefdoms of hospital networks (and sometimes bad ones at that) and private physician ggroups. I wish there was a uniform system where medical records are interchangable and available to me when a patient arrives in my ED.

Most city based Emergency Departments are filled to capacity (I know mine is for the most part). Crowding has become a national agenda, as Americans are needing emergency services more often. It's going to get a lot worse in the near future.

The costs are definitely shifted--that is if you have no insurance, then you will be charged the standard hospital bill---which is outrageously high. Why? This way the hospital can tell an insurance plan that their costs are sky-high...the discounted price that insurance groups like GHI, BCBS, etc will then be significantly lower. But if the hospital were to tell the 'real' cost of a visit, they'd actually lose money. It's completely idiotic---when whole institutions act like an infomercial (buy now and you'll get a second one free!) you can tell there is no system.

Medicine is truly broken because of the fragmented nature of the practice. Monetary issues, local fiefdoms, and politics (i.e. supporting your local congressman) will protect the industry indefinitely.

What we need is a true population base referendum...but that will never happen as this becomes no one is strong enough to demand it.

As for the 'lowest' members of society in the ED's, that is also studied, and IIRC, the average IQ for Emergency Department patients is lower than the standard population. It does make some sense, those who are least able (intellectually) will wind up in the ED's more often. We do a ton of primary care in the ED...some of my residents object, but when I tell these doctors that many of these patients will not be able to see a doctor in any other setting (i.e. clinics which want money up front), so they really are helping their fellow man, most understand and no longer object.

I'm following the Massachusets health coverage plan very closely, as it may be a stepping stone for the rest of the country. We'll see. I think it'll be a very bumpy ride.

[Grumpyguy]

[quote markmedic]Your characterization of all ER patients as tattooed and overweight shows a distinct air of cultural and ethnic snobbishness. Evaluating everyone on the basis of their presence in the ER and their loud behaviors shows a lack of compassion. Did you listen to anyone's story for the day. Many people are there because of their family members, lack of health insurance, mental illness and addictions. Calling these people the underside of humanity reveals a very biased opinion of humanity. Has no one in your family ever suffered before from an addiction, a mental illness or a stomach virus? Withdrawing patients are actually very sick, they have tendencies to seize, airway compromise and electrolyte imbalances.
Really, complaining about dirty, drug addicted people makes me snobbish? You can call a pig a horse, but at the end of a day, it is still a pig.

Yes, these were the low end of our society. Do I want to associate with them. No. Do I want to emulate their behavior. No.

Do I want to have to endure their low class behavior? No.

Does that make me a snob or an ass? Do not really care.