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What's with demonizing people who go to emergency rooms for "routine" care?

vastleft's picture



It's a popular meme: poor (or not-so-poor) people are ruining everything with their emergency-room visits.

They're not playing by the rules! These scofflaws foolishly and recklessly visit large medical facilities that are open 24-hours a day. Emergency rooms are intrinsically expensive (if it doesn't say so in the Bible, that's an oversight), and they're regrettably not allowed to turn people away. Thus, creeps and lowlifes are gaming the system and getting health care for themselves and their children that the system has otherwise done a superb job of denying them.

Obviously, it would be technically impossible to provide lower-cost services side-by-side with ERs, or to allow people whose primary-care doctors are busy, closed, or inconveniently located to go, on occasion, to community health centers without getting hassled or screwed by health-insurance companies.

Note: 2008 campaign video via Caro, from this discussion. To me, what's interesting about it isn't that Obama is caught unprepared without access to his prepared remarks. To err is human (especially when a machine we rely on goes on the fritz).

But to visit the ER is human, too. And what strikes me about this video is that it shows yet another conventional-wisdom talking point making no sense. Obama's not stumbling because he's stupid. He's stumbling because our "uniquely American" ideas about health care are.

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Submitted by lambert on

"Funny" how uncritically recycling right wing snark concealed an important data point in the health care debate!

"Funny" also how uncritically recycling right wing snark made for a missed opportunity to catch Obama throwing another constituency -- the poor -- under the bus!

Well done! Right wing snark is designed to disempower and destroy the left. That's why we shouldn't ever use it.

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

DCblogger's picture
Submitted by DCblogger on

it is true, you cannot incorporate the talking points of the health neglect system without sounding incoherent.

Sarah's picture
Submitted by Sarah on

if you're not there as a result of, say, falling down foaming at the mouth for no apparent reason in a crowd or at your office (cf "Brothers and Sisters" and the 'heartthrob' Rob Lowe storyline recently) or of being slaughtered in a tangle of vehicular collision.

First, you or your child is what a doctor would call "uncomfortable." (Again I say, let me park my truck on your tongue, doc, and we'll talk about discomfort in a couple hours, okay?).

Second, you lack insurance, or the copay cash, or both, that would cover seeing your PCP or your child's pediatrician in a timely manner. (This is in defense of those folks who actually do have transportation of their own in their control and at their convenience 24/7/365, which is less likely among the impoverished, btw, as well as having an in-network PCP or pediatrician available if some insurance does apply, which is increasingly out of reach for what the media genteelly refer to as "lower middle income" families.)

Third, you hope it will go away if you don't go to a doctor immediately. (Human nature, I suspect, if not outright fear -- perhaps based on previous experience with physical therapy, injections, or other medicaments -- keeps people from going to the doctor at the drop of a hat even if they can afford it.)

Fourth, you try something OTC or passed down (old wives' tale or OWT) through your culture, which doesn't solve the problem.

Fifth, something goes spectacularly awry -- a major fever, a massive emesis, an accident that results in a sprain or break or other injury you simply cannot 'live with' until you can find affordable treatment -- and there you are:

Stuck in the ER waiting.

The ER is not allowed to turn away patients. The ER does do triage. Triage means that the sickest or most seriously injured patients are seen before patients appearing to triage personnel to be less seriously ill or injured. However, because the ER operates all the time, and because its personnel and equipment are very specialized, its costs are often more expensive than would be treatment for the same condition in a family clinic or a pediatrician's office IF a patient had that option.

Now, let me point out one thing, again. By law (federal law, actually) the ER is not allowed to turn away patients. This means that even if you have NO funding you can get an evaluation and treatment in the ER regardless.

The population of the US is about 250 million persons, IIRC. As of 2004, there were 47 million uninsured residents in the US. I would bet that as of today that number has increased to 50 million, or 1/5th of the population.

If one fifth of the nation's population has no recourse except the ER in dire circumstances, is it any wonder the ER is crowded all the time?

Wouldn't it make more sense to provide an option for patients who need care that could be done efficaciously by non-trauma-specialists? You'd think so.

Budget constraints affect every institution in this country. In the state of Texas we often have one school nurse in a small district who must divide work hours among multiple campus offices. This is not safe or sane, but it's how "no new taxes" forces districts to cope with the budget. Over the past 15 years public health clinics (not to mention private practice clinics, particularly in rural areas) have closed across Texas and New Mexico (I suspect this is also true in other states; cf Big Charity hospital in NOLa).

So the problem comes back to money. If there's no money to keep the doors open, the clinic closes. If the clinic closes that's one less option for folks who need treatment. If the only option left is the ER, how is that a patient's fault?

This uniquely American health care system traps the patients.


We can admit that we’re killers … but we’re not going to kill today. That’s all it takes! ~ Captain James T. Kirk, Stardate 3193.0

1 John 4:18

BDBlue's picture
Submitted by BDBlue on

they're poor. What more of a reason do you need to demonize people?

Seriously, having gone to an ER, I cannot imagine anyone thinking any one would choose to get healthcare that way. That's why people with insurance start with their own doctor - not because it's cheaper, but because it's generally less of a pain in the ass. For starters, I've never sat all night at my doctor's office waiting to be seen. And most Americans know that the people flooding the ERs are not doing so because they want to. I think this could really backfire as more Americans lose their jobs and health insurance or are worried about losing them. Because they know the people they're talking about could be them, poor or not.

"Do what you feel in your heart to be right -- for you'll be criticized anyway. You'll be damned if you do, and damned if you don't. " - Eleanor Roosevelt

vastleft's picture
Submitted by vastleft on

The "ERs are too expensive" thing really sticks in my craw. If they're too expensive, put a cheaper-to-run clinic next door, keep it open 24/7, and don't turn away anybody. Partner with community health centers, to extend your reach. Stop acting like people seeking to get/keep healthy is some sort of blight.

I recall a guy during the campaign saying that health care was a right. I guess I'm getting senile, because I convinced myself that he'd won, and not this other character who's going on about the cost of care.

Submitted by lambert on

... I think that guy said that health care "should be" a right, but I think it's excusable to imagine that guy would actually do something about what should be. Especially The Bestest President EVAH!

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

BDBlue's picture
Submitted by BDBlue on

"Should be a right" is in line with his actions in Illinois where he helped change a bill that would make universal healthcare state policy to one where it was simply a policy goal. Because it should be a right, but let's not actually make it one.

From the Boston Globe -

The Health Care Justice Act, which Obama sponsored in the state Senate, grew out of work done by the Campaign for Better Health Care, an Illinois coalition of healthcare advocates, labor unions, and nonprofit organizations. The ostensible goal was simple: make affordable healthcare available to all Illinoisans. But the politics were anything but simple.

On one side were healthcare advocates, eager to capitalize on the Democrats having won control of the General Assembly and the governor's office. On the other were most insurers, who worked vigorously to sink the bill. Obama was in the middle, trying to reconcile a range of agendas to get a viable plan signed into law.

The bill originally called for a "Bipartisan Health Care Reform Commission" to implement a program reaching all 12.4 million Illinois residents. The legislation would have made it official state policy to ensure that all residents could access "quality healthcare at costs that are reasonable." Insurers feared that language would result in a government takeover of healthcare, even though the bill did not explicitly say that.

By the time the legislation passed the Senate, in May 2004, Obama had written three successful amendments, at least one of which made key changes favorable to insurers.

Most significant, universal healthcare became merely a policy goal instead of state policy - the proposed commission, renamed the Adequate Health Care Task Force, was charged only with studying how to expand healthcare access. In the same amendment, Obama also sought to give insurers a voice in how the task force developed its plan.

Lobbyists praised Obama for taking the insurance industry's concerns into consideration.

"Barack is a very reasonable person who clearly recognized the various roles involved in the healthcare system," said Phil Lackman, a lobbyist for insurance agents and brokers. Obama "understood our concern that we didn't want a predetermined outcome."

"Do what you feel in your heart to be right -- for you'll be criticized anyway. You'll be damned if you do, and damned if you don't. " - Eleanor Roosevelt

DCblogger's picture
Submitted by DCblogger on

I only went to the emergency room once. that night there was a young man there who clearly was in the very late stages of tuberculousis. It was truly grim. I am really sick of a society that puts people in untenable situations and then proceeds to bleat about cost control. They don't have this problem in Canada. How many of those people in the ER voted for Obama? Maybe he should do something for them.

Submitted by jawbone on

HMO's had rather ill-defined valid reasons for paying for ER visits. It was suggested that patients ought to call the insurance company to get an OK to go to the ER.

Yeah, think about that.

I was giving a dinner party and running a tad late, as usual. I was getting some seldom used serving dishes out of a tall cupboard and the vibrations from moving things around apparently caused a heavy lead glass pitcher to fall from the uppermost shelf -- onto my face, hitting me just below my nose. Or on my nose. Anyway, it caused a cut inside my nose and down toward my upper lip, and I could not get the bleeding to stop.

The pitcher was unharmed. Very heavy.

I was shaking, as I don't do well with lots of blood, managed to dig out my insurance card, called the insurance company. Actually I tried to call the HMO -- my fingers were shaking so badly I kept hitting wrong buttons. After dialing correctly, after going through the recorded prompts, I got to a human. I was beginning to feel like I might faint, which I told the telephone rep. But I was told by the HMO I needed to call my doctor (Saturday night, gang), which I did. Got the recording which gave a number to call in emergencies. Managed to make that call; was told to go to the ER.

Worried about a big bill, I called the HMO back to see if there was anything I needed to tell the ER. Told that I now had HMO permission and OK to take my bleeding to the ER.

I called guests, explained problem, postponed dinner. Fortunately, two people were already on their way, thinking they could help with last minute prep. I was still bleeding profusely when they arrived and they drove me to the ER. Which was good for me, as I probably couldn't have driven well. But my friends had an entire night at the ER, except for the time they went out to go for dinner.

It took forever to get care, as it was a busy night and the bleeding had lessened, lowering my priority. Then the delays were made worse by the need for calling in a plastic surgeon to do the stitches on my face. Apparently, it was SOP at this ER to have facial wounds closed by plastic surgeons.

Well, the HMO would not give them permission to use a plastic surgeon. Not medically necessary. The docs and managers of the ER went round and round about this, saying they needed to have a plastic surgeon come in, gave their medical reasons, etc. (Probably gave their liability reasons as well.) Literally hours went by and it was approaching midnight. The docs said the wound needed to be closed soon, as the window for a good scar result was closing.

The plastic surgeon on call was now off call. However, in the change of personnel at the ER, a resident(?)who had recently spent time in plastic surgery came on duty, and we decided that she should go ahead with the suturing. She was caring, seemed sure of her technique, and I have only a little bump on the nostril, some bumps inside. So, all worked out well.

But...it was just awful to see how the HMO made docs and other personnel squander their very valuable time. It was awful sitting in an uncomforable ER waiting area, waiting on the whims (or directed actions?) of a telephone clerk at the HMO.

(BTW, my corporation had separate plans for execs and worker bees. Worker bees had HMO's limiting the geographical area where they could get treatment,among other limitations; execs were covered wherever they needed care. Also had more choices of doctors, etc. Cool, huh? This was not common knowledge; a friend who was an exec assistant learned about it from his boss.)

Sarah's picture
Submitted by Sarah on

mindset.

Public health clinics cost money. Privatizing them puts them at the mercy of profit.
Either way, the "no new taxes" and "no entitlements" rhetoric and the accompanying demand for reducing government spending brought us where we are today.

I am very disappointed to find this kind of talk coming from the President now.
I wish I were surprised.

We have not had a President who genuinely and unselfishly advocated for poor people in the United States since LBJ. Whatever you care to say about his escalation of the war in Viet Nam, it was President Lyndon Baines Johnson who brought us Medicare and Medicaid, advocated for Social Security, and tried hard to create a Great Society for the betterment of all Americans -- particularly those historically impoverished.

I reckon we ought to revisit LBJ in some depth.


We can admit that we’re killers … but we’re not going to kill today. That’s all it takes! ~ Captain James T. Kirk, Stardate 3193.0

1 John 4:18

Submitted by lambert on

And the anti-poverty efforts were successful, at least temporarily. Though I suppose today we might call them pro-justice.

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

Sarah's picture
Submitted by Sarah on

You ought to give Randall Woods' book a once-over. I'm going to see if I can get it at the library. Publisher's Weekly gave it a nice review, and an excerpt I saw elsewhere made me want to know more.

Woods finds Johnson's key motivation to be largely altruistic, emerging from righteous outrage over the poverty and racism he'd witnessed while growing up in Texas. Woods serves up a Johnson who is less cynical, less self-serving and more heroic and tragic than the man portrayed elsewhere. Woods's Johnson is a man who saw his greatest personal ambitions realized with the Civil Rights Acts of 1957 and 1964, and the Great Society programs. Not inappropriately, Woods concludes his eloquent and riveting account by quoting Ralph Ellison, who noted that Johnson, spurned at the end of his life by both liberals and conservatives, would "have to settle for being recognized as the greatest American President for the poor and for the Negroes, but that, as I see it, is a very great honor indeed."

This quote from the book reveals something about the soul of Texans, too, as well as about LBJ (and conversely, about our national discourse 40 years later):

"The Johnson family's patriotism was the patriotism of Woodrow Wilson and Theodore Roosevelt, not Warren Harding and Calvin Coolidge," writes Woods. "Their liberalism was the 'positive' liberalism of the Progressive Era presidents, who saw the federal government as an active agent dedicated to conserving natural resources, regulating big business to insure a modicum of social justice."

The last halfway decent governor Texas had was Ann Richards. Since then we've been immured in w and perry. I hate to think what'll happen if we can't shake this trend towards "conservative" government: it's devastated our public servants, our public service, our schools, our infrastructure, and our ability to recover from the damage. Molly Ivins was right when she called my home state the nation's bad-government laboratory.

It surprises people to learn President Eisenhower was born in Texas (and honestly, he makes me think more of the Missourian, Truman, than the other Texan, LBJ; and don't get me started on the Bushes, pere et fils but especially fils [SPIT] as Presidents, let alone human beings, in comparison to Truman, nevermind comparing him with Johnson) because he stands in such contrast, historically, to LBJ -- master poltitician, arm-twister extraordinaire, and a man who looked at war through the lenses McNamara held up for him, yet an advocate for the poor and disenfranchised, the impoverished and the Negro and in those days we used that word as a polite reference, please recall -- who saw that his work on behalf of his people (remember, Johnson grew up in a pre-electric rural Texas, where the chores rivaled Lincoln's for sheer back-breaking drudgery) was going to cost his party for generations, and did the right thing anyhow.

But back, momentarily, to Ike: For a Republican (and he was very pre-Nixon, so perhaps a different critter altogether than a post-1963 Republican, let alone a post-1980 or a post 9-11-01 Republican), President Eisenhower was a pretty sensible sort. Like most GOP presidents he presided over a recession; but the was the last of them to recognize the danger of giving the reins to corporations, I think. It may be that LBJ was the last to succeed in resisting such handovers, although I think his valiant efforts to avoid such capitulation played a large part in the anti-Carter sentiment ginned up by the media.

Hmm. I don't know, Lambert; I remember Johnson firsthand (and Kennedy a little). Do you?

This touches on another one of my obsessions with Texas. History here is always at hand, if not underfoot, in spades. Despite what the TV and movies and the popular stereotypes suggest, though, Texas is really NOT about the Bushes, or the Hunts, or the Bass family (now; back in the day we were concerned with Sam Bass, but he wasn't famous for his riches as much as his method of acquiring 'em) -- because those are such minor divergences from the bigger (and older, and otherwise-directed) whole that is Texas.

I'd give damn near anything to get people to see Texas instead of the stereotypes.
Think of it this way: Fred Phelps is NOT Kansas, but he's often used to stand for it.
In the same manner, w isn't Texas. But we get blamed anyhow.


We can admit that we’re killers … but we’re not going to kill today. That’s all it takes! ~ Captain James T. Kirk, Stardate 3193.0

1 John 4:18

Submitted by lambert on

I was a teenager when Vietnam heated up; I remember seeing the Chicago convention on TV.

If only we lived in an alternative history where war was not "the health of the state," and LBJ had enough of whatever it would have taken to face down the VietNam advocates (the legacy of the revered Kennedy). I'm convinced that -- unlike Bush in Iraq and, possibly, Obama in the new acronym, Af-Pak -- LBJ wasn't committed to his war for either personal or policy reasons -- brutal and tough politician that he was. Versailles boxed him in. Same as with Clinton, another great Democrat of outsized character with monumental flaws -- government was always there, ultimately, for human purposes, not corporate purposes, or ideological purposes, or inscrutably evil purposes (Bush and Nixon). I don't get that feeling with Obama at all; he's as chilly as a spreadsheet.

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

scoutt's picture
Submitted by scoutt on

I like that.
But I think the description we're supposed to prefer is "PRACTICAL as a spreadsheet".

Submitted by lambert on

If I may preen momentarily, we invent memes here at Corrente.

(Thinking back to our discussion on TOTUS. And, importantly, this one backed by solid evidence -- think about the focus on health care cost, for example. Then ask yourself, who owns the spreadsheet. How it's done.)

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

vastleft's picture
Submitted by vastleft on

It was why I was so put off by Obama's campaign, squandering a perfect storm of public outrage at the failures of "conservatism" and legendary oratorical gifts on this half-assed triangulation and praise for the "transformative" Reagan.

Julene's picture
Submitted by Julene on

wasn't it just conventional wisdom less than six months ago that everyone had the right to be treated at the emergency room - so there was no such thing as people without access to healthcare and therefore it was perfectly fine to fill up those EDs?

Ahh, now I see the difference between Republicans and Democrats...

Submitted by Anne on

in one of the our nearby private hospitals (I live in the Baltimore area and you can't swing a dead cat without hitting a medical facility - which is good, in that there is excellent care to be had - Hopkins, as well as Univ. of MD, the place where the "golden hour" of trauma medicine was born) which I think was three or four years ago, with my mother, I noticed that on the main wall near the triage desk was a big sign that more or less said, "We can't turn you away because you can't pay, but once we assess you, and stabilize any urgent/acute condition, we don't have to keep you and can ship your ass to the nearest public hospital, which will get stuck with the bill."

And then there's this, in a FactCheck.org analysis of an ad from Conservatives for Patients' Rights (hint: I think the title is akin to the Clear Skies Initiative or the Healthy Forests Act) which just made me want to throw something (emphasis is mine):

Conservatives for Patients’ Rights is, as its name indicates, a conservative group, and it’s also quite obviously not a proponent of government-run health care. Its minute-long ad was launched April 27 with what the group said was a month-long $1 million buy. (We've seen it on CNN several times this week.) CPR was launched this year and is led by Rick Scott, former head of Columbia/Hospital Corporation of America.

The ad states that government-run health care systems, in particular those in Britain and Canada, take control away from patients and ration health care. CPR is certainly entitled to state its own view. But the ad implies that the U.S. Congress wants to implement a health system like those in Britain and Canada. That's contrary to what President Obama and Democratic leaders in Congress have said.

Obama hasn’t called for such a government-run plan, also called a “single-payer" plan. In fact, he has flatly rejected it. The administration has said on the White House’s “Health Care” Web page (and previously on its transition site) that “President Obama and Vice President Biden believe” that government-run health care is “wrong.” And they also believe, the administration says, that the other extreme, “letting the insurance companies operate without rules,” is wrong. (The White House redesigned its health care page on April 30; a cached page with the quoted language is attached to this article.)

Obama has long said he would allow individuals or small businesses to buy insurance through a public plan – like the one now available to members of Congress. But nobody would be forced to drop his or her current insurance, and private plans would exist as they do now. This was the health care plan he promoted as a presidential candidate.

Obama has perfected the bamboozle: he tells people just enough to make them think he is on their side, and he does that primarily because he has no core beliefs to which he has any commitment.

He's going to completely fuck this up and, to use an Obama-ism, "a whole buncha" Democrats are going to help him.

scoutt's picture
Submitted by scoutt on

that comments over at talkleft?
i always nod my head when I read your comments.
(if those ARE your comments)

Submitted by Anne on

I have too many things to remember as it is without having to remember who I am on various blogs... :-)

I hope the nodding isn't because my comments are putting you to sleep, lol.

Valhalla's picture
Submitted by Valhalla on

I 'member your comments from TL as well, and am very glad to see you hanging around Corrente.

Because the problem is not that we have too little condescension from our tribe. -- okanogen

Submitted by Anne on

Great to see you - I've missed your comments at TL...

Glad to be part of the mix here.

deniseb's picture
Submitted by deniseb on

Why is it that money spent on health care is considered by everyone to be wasted? I don't understand. I know that we spend twice as much as anyone else already, but even if we spend more, why is that a problem, if we get good health and peace of mind in return? Doesn't the money contribute to the overall economy as much as, for example, if it were spent on Pet Rocks or Jimmy Choo shoes? Please enlighten me, someone.

Submitted by hipparchia on

this is one meme i'd like to destroy actually, that we spend lots of money on healthcare. the money we're wasting isn't going to healthcare, it's going to fatcat ceos and shareholders and layers and layers of bureaucracy. we actually get less care than most other wealthy, industrialized nations.

and yes, i agree -- why shouldn't we spend money on health and care, and provide jobs with social value?

Sarah's picture
Submitted by Sarah on

and yes, IMNVHO, 99.99 1/2 % of that money is wasted. What exactly does a health insurance company do, make, produce, or provide that actually assists, empowers, or improves conditions for either their direct customers (premium payers) or their so-called beneficiaries (docs, clinics, hospitals)?

(For that matter I could make the same argument about life insurance and several other flavors of the suit-and-tie confidence games, but I digress).


We can admit that we’re killers … but we’re not going to kill today. That’s all it takes! ~ Captain James T. Kirk, Stardate 3193.0

1 John 4:18