How bad is it in America? - Breaking an arm among the 30M without health care (VDH on Health Care)

VictorHanson.com ^ | March 13, 2004 | Victor Davis Hanson

[Remember_Salamis]

How bad is it in America?

I broke my arm last week and went into the emergency room at our local hospital about 24 hours after a Sunday morning accident. My family doctor told me to go to the ER first to get an x-ray and then take it over to his office later that Monday afternoon.

[valkyrieanne]

I hear you. What do you think we need to do, in terms of national policy?

[usadave]

Cell-phones and new pick-ups—whether they are products of cheap Chinese labor or easy American credit—are nevertheless optional expenditures.

Or, as many of the illegal alien families do, it is the result of the father working off the books for cash while the mother and their six children make the rounds at the welfare/food stamp/WIC offices to scoop up all the freebies that they can. And because of the fact that many Latino illegal aliens have multiple IDs that they've purchased on the black market under different names, they can receive welfare/food stamp/WIC benefits under several different names.

[usadave]

The federal government requires that anyone who shows up at an ER be treated, regardless of their ability to pay.

Actually, federal law simply requires that anyone who shows up at an ER must be seen by somebody on the ER medical staff, usually the triage nurse. Federal law does not require that anyone who shows up at an ER must receive actual treatment for their medical condition.

[Tinman]

National policy? I can't answer that. I don't believe "socialized" medicine is the answer. Nor is it what we should seek.

Health care is a business. However, for folks who have lost or been denied insurance coverage, the bills should be realistic. I have a friend who works in medical billing, she estimates most medical costs are multiplied by a factor of 10, possibly more. Why in the world should anyone be paying $15-$35 for one pill?! $800-$3500 per day for their bed?! (Yes, I have the itemized bills.) I have no idea what certain tests and procedures actually cost but over $1000 per day for "general supplies" seems a bit steep.

Furthermore, I've been told bills, for the uninsured, are actually "marked up" above insured rates so, when the facility writes them off, as a business loss, there is a greater tax break.

I cannot say enough to praise the health care professionals we have dealt with, in the last few years. The people on the "business" end of things, (insurers, office managers, lawyers, collection agencies, and other "bean counters") are another matter.

Regards

[speekinout]

The insurance system, particularly Medicaid and Medicare, is what is "broken". They have negotiated prices for some health care services to the level where the providers get less for the service than it costs to provide it. The providers have no choice except to make up the costs by overcharging the uninsured or overcharging for things that are not regulated (like the cost of a bandage or an aspirin).
We also need to rein in the lawsuits. They add enormously to the cost of health services.

Our health care system is still the best in the world, but if we don't get insurance reform and tort reform, that won't last.

I think we have to start having Medical Savings Accounts and Catastrophic Care policies available for everyone.

[snopercod]

Emergency Room Services Reduced

From the New York Times: Emergency Rooms Get Eased Rules on Patient Care

The Bush administration is relaxing rules that say hospitals have to examine and treat people who require emergency medical care, regardless of their ability to pay.

Under the new rule, which takes effect on Nov. 10, patients might find it more difficult to obtain certain types of emergency care at some hospitals or clinics that hospitals own and operate.

The new rule makes clear that hospitals need not have specialists "on call" around the clock. Some patients might have more difficulty winning damages in court for injuries caused by violations of the federal standards.

"The overall effect of this final rule will be to reduce the compliance burden for hospitals and physicians," the administration says in a preamble to the regulation, to be published next Tuesday in The Federal Register.

The administration drafted the new rule after hearing complaints from scores of hospitals and doctors who said the old standards were onerous and confusing, exposed them to suits and fines and encouraged people to seek free care in emergency rooms. Courts have often ruled for patients, and against hospitals.

In an interview, Thomas A. Scully, administrator of the federal Centers for Medicare and Medicaid Services, said tonight that the new standards would reduce the costs of compliance for hospitals and doctors without weakening patients' protection.

The new rule limits the scope of a law from 1986 that defines hospital obligations. It expands the situations in which hospitals are exempt from the federal requirements.

Mr. Scully said the 1986 law did "a lot of wonderful things, but also does some perverse things that cause a lot of heartburn for doctors and hospitals."

For example, Mr. Scully said, if a hospital has a cancer center or a dialysis center three blocks from its main building, the employees of the center have to be trained to deal with emergency cases, duplicating the work of the emergency room.

But Dr. Robert A. Bitterman, an emergency physician at the Carolinas Medical Center in Charlotte, N.C., said: "The new rule could aggravate an existing problem. Specialists are not accepting on-call duties as frequently as we would like. As a result, hospital emergency departments lack coverage for various specialties like neurosurgery, orthopedics and ophthalmology. The new rule could make it more difficult for patients to get timely access to those specialists."

Mr. Scully's deputy, Leslie V. Norwalk, said: "The old rules contributed to the overcrowding of emergency rooms. Hospitals were afraid to move patients out of the emergency department for fear of violating the rules."

The new rule, while not a wholesale return to the situation before 1986, scales back regulations that specify when and where hospitals have to provide emergency services. Patients turned away or refused emergency care can still sue, but hospitals will, in many cases, have stronger defenses.

Dr. Douglas L. Wood, a cardiologist at the Mayo Clinic in Rochester, Minn., said hospital duties under the 1986 law had grown because of court decisions and the "layering of regulation on regulation."

In the last five years, the government has collected more than $4 million from 164 hospitals and doctors accused of violating the law.

The new rule narrows the definition of "hospital property" where patients are entitled to emergency care. In addition, it says the 1986 law does not apply to emergency patients after a hospital has admitted them.

The 1986 law, the Emergency Medical Treatment and Labor Act, or Emtala, applies to all hospitals that participate in Medicare and offer emergency services.

Under the law, if any person -- not just a Medicare beneficiary -- goes to the emergency department of a hospital for treatment, the hospital has to provide a "medical screening examination."

If the examination shows an emergency medical condition, the hospital has to provide treatment to stabilize the patient's condition. Alternatively, the hospital can have the patient transferred to another institution if the expected benefits outweigh the risks.

Under the new rule, the administration says, "Emtala no longer applies to any individual who is admitted as an inpatient."

Hospitals and doctors who violate a requirement of the 1986 law can be fined $50,000 for each violation and can be excluded from Medicare. In addition, patients have a right to sue hospitals that violate the law. Some patients have recovered hundreds of thousands of dollars.

The American Hospital Association and other industry groups have long sought changes in the emergency room standards. In 1999, when Mr. Scully was president of the Federation of American Hospitals, he complained that the government was using the 1986 law in ways never intended by Congress.

Maureen D. Mudron, Washington counsel for the American Hospital Association, welcomed the new rule today, saying that it provided "clear and practical guidance."

Under federal law, each hospital participating in Medicare also has to keep a list of doctors who are available, on call, to treat emergency room patients.

The new rule gives hospitals greater discretion in arranging such coverage. A hospital can legally exempt senior members of the medical staff from on-call duty, it says. Moreover, the new rule says federal law does not require all hospitals to have doctors on call 24 hours a day seven days a week.

In addition, the rule says, doctors can have simultaneous on-call duties at two or more hospitals and can schedule elective surgery or other medical procedures when they are on call.

The old rules applied to all hospital departments, even those not at the main hospital site. The new rule applies to an "off-campus" site only if it is specifically licensed as an emergency room, if the site is held out to the public as a place that provides emergency care or if emergency cases accounted for at least one-third of all outpatient visits in the prior year.

The old rules provided protection to anyone seeking care on hospital property, meaning "the entire main hospital campus."

The new rule makes clear that the law does not apply to doctors' offices, rural health clinics, nursing homes or other "nonhospital entities," even if they are adjacent to the main hospital building and are owned or operated by the hospital.

--written By ROBERT PEAR

[snopercod]

Looks like you're correct, Dave. Only an examination is required by the 1986 law. OTOH, this may be one of those cases where our out-of-control judiciary has "changed the law".

The above article was printed in September, 2003?

[gracie1]

I know the hospital that VDH went to, my second son was born there. I go there for my care even though I work at a large hospital in Fresno, and my Dr's office is down the street. The scene he is describing fits the same scene I see whenever I go there for care.

Furthermore, we have an extensive network of rural health clinics in region that sees all patients who come in. I used to work at one a few years age. We saw everyone who came in for care, regardless of ability to pay. We had a sliding scale for cash paying patients.

The main problem we had was arranging for specialty care, especially neurosurgery. Those usually got referred to Fresno, or to Stanford.

[Mr. Silverback]

I have an 11-year old reliable Honda and no health insurance. Now, where do I fit in your 'scheme' ?

Don't get your panties in a wad, and that's coming from a guy with no cell phone, no health insurance and an 11 year old Buick sold to me by my sister-in-law for well under blue book.

Hanson is dead on here. America is full of people with no health insurance who nevertheless receive health care that would be the envy of 99% of humans who ever walked the Earth, and at least 5 billion of the ones who walk it now. Meanwhile, Dem politicians paint a false picture of the situation in order to convince the electorate to give up more of their freedoms. Meanwhile, our coddling of illegals leaves Mexico in continuous corruption mode (why change when the unsatisfied will simply go North?) and swells our country with people who don't belong in our job market or on our welfare rolls. Hanson is objecting to those things, not to you getting medical care.

In a a total free market health care system, you could afford catastrophic insurance and pay for your own minor care, but as long as the Dems keep people like you convinced that criticism of this stupid system is a scheme to shaft the poor, we'll never get there, will we?

[Mr. Silverback]

VDH article over here!

[philetus]

"If you broke your arm, would you be refused care? If you were bleeding to death, would hospitals turn you away?"

Quebec Man Dies After He Forgets Health Card


http://www.freerepublic.com/focus/f-news/1123927/posts

[usadave]

Looks like you're correct, Dave. Only an examination is required by the 1986 law. OTOH, this may be one of those cases where our out-of-control judiciary has "changed the law".

Quite possibly. I believe the main reason that most hospital Emergency Rooms rarely refuse to provide medical treatment to anybody that walks in is because of the fear of a lawsuit. I think many ERs have adopted, if not formally at least informally, the policy of just treating everybody that walks in the door, and by doing so, reduce the ER's potential liability should somebody's medical condition, which wasn't treated by the ER staff because it wasn't deemed serious enough at the time, gets progressively worse.

[janetgreen]

Meanwhile, Dem politicians paint a false picture of the situation in order to convince the electorate to give up more of their freedoms.

It's not only the Dems that are doing this, Mr. S. Lots of RINOs must be included in that group.

[snopercod]

That's what I love about FR. I learn things all the time.

My wife works at a small hospital (medical records). She tells me that less than half of the patients actually pay or have insurance. I really don't know how these rural hospitals stay in business.

And ours doesn't offer a discount for cash, either. You can pay off a $10,000 bill at $25 per month if you want, but they won't cut you any kind of a deal if you pay it all up front. I haven't figured that one out yet.

[Tolik]

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[Tolik]

Thanks for the ping.

BUMP

[TopQuark]

VDH.

[Tinman]

I agree with all your points.

In disputing our denial of coverage, with Blue Cross/Blue Shield TX, we were finally offered coverage, at $1500. per month!

I have no sympathy for those who qualify and can obtain "affordable" health insurance but choose to go without and spend their money on "other things".

We always had insurance, prior to being "dumped". It's now my belief that what the insurance companies really want are customers who will pay the premiums but never get sick.

It's also incredibly frustrating to be told that you "don't qualify" for assistance when you've spent your entire life paying into and supporting the "system".

Regards

[AZLiberty]

The community health centers are a well-kept secret, but one that provides the healthcare safety net that everybody talks about. The Democrats don't publicize it because they want you to think there's a crisis in health care for the poor. The government doesn't publicize it because they don't want any more customers than they already have.

CHCs charge on a sliding scale. If you're indigent, you pay nothing. Anybody else is welcome, but they have to pay something.

Naturally, the CHCs are underfunded, but this is resulting in a high level of innovation. For example, the CHCs are leading the way in chronic disease management. While chronic disease accounts for 70-75% of healthcare costs in this country, most people are still treated according to the acute care model. The chronic disease is allowed to simmer, and when things get really bad the patient shows up at the ER -- at huge expense and at huge risk to the patient. The CHCs are beginning to employ a chronic care model, where at-risk patients are identified and "managed" aggressively using an approach that involves a large degree of self-management and strong coordination between members of the healthcare team. The goal is to keep the patient healthy, so as to prevent acute incidents, emergency visits, emergency surgery, and serious consequences to the patient.

The CHCs have found that it is in their economic interest to take a long-term view of their patients rather than a short-term view. Health insurers are more likely to focus on the short term because there's a high turnover in membership, due to job mobility and employers frequently switching carriers.

The health system is broken, but this little piece of socialism seems to be working -- as long as everybody doesn't find out about it, and as long as the rest of us are willing to pay for it.

[Capt.YankeeMike]

as a health insurance agent for the past 24 yrs i can assure you he is not talking about you, but the point i have been arguing (forever)is that the democrats scream that we dont treat people without health coverage, when in fact, we do....
The Capt.