Topic of the Week: The Health Reform Bill

For those of us working in the ED, you can't NOT SEE the impact of the broken health care system. About 80% of what we do in the ED is treat problems that really could have been treated in a typical doctor's office, out-patient clinic or urgent care center more quickly and less expensively. Some of these patients's are insured. Some of these are looking for something their doctor's office didn't give them, but many are there because they have no other access into the
health care system. Short and simple, it's next to impossible to gain access to a primary care provider unless you have decent insurance. While the ED is there, it is not even mediocre as a substitute for primary care. I can't manage your diabetes, high blood pressure, cholesterol, etc. in the ER. I also can't follow you up to make sure that you are getting better. Lots of folks fall through the cracks and these are often catastrophic. This was former President George W Bush's idea of a health care system...and it's failing miserably.

Without insurance it can be an uphill battle getting admitted to the hospital for inpatient care. Unless you have a problem that's obviously life or limb threatening. Even if you do get admitted, you're likely to be discharged as soon as possible. Your follow-up care will likely be less than stellar. In short, as a non-payor you're the equivalent of a medical "hot potato," and no one wants to be the one left responsible for your care. Sometimes my role in the ER includes "guilting" physicians into do the right thing for patients. Nobody wants to sign up for a job they know they're not going to get paid to do. Many doctor's attitudes are no different from the average laborer on this point. Hippocrates should be rolling over in his tomb.

A former girlfriend's uninsured mother was admitted with pneumonia. She had a large effusion on chest xray. She did not receive thoracentesis or CT despite a long smoking history. While visiting her cousin in another town several weeks later, she got sicker and was hospitalized again. Then she was transferred to another major medical center. She underwent bronchoscopy and was in the hospital for a week or so. A physician told my girlfriend that her mother would be in the hospital for weeks, but she was discharged within 24 hours of the discussion. The patient again got sicker and was hospitalized again. Finally, after now months of symptoms and five hospitalizations, she was diagnosed with lung cancer beyond any hope of surgical cure or
chemotherapy. She died shortly thereafter.

A major NC medical center recently refused an established patient's liver transplant after his employer changed insurance companies. The patient was there in the hospital. The liver was there. The hospital refused the transplant because they thought there was a chance that they wouldn't get paid. Because of this fear, they essentially condemned the patient to certain death. The insurance issue later straightened out, but the patient died before getting another liver. The wrongful death payout for this will be huge, but because it involves one of the largest urban healthcare systems in the state, you'll never about it in the news. Reimbursement drives US health care and the insurance companies drive reimbursement. In essence, the insurance industry drives health care and despite an ever-increasing number of uninsured, the industry produces record profits year after year.

The Health Reform Law is an attempt to reform the health insurance industry. This not only provides an avenue for over 30 million uninsured to gain private health insurance, but also benefits Medicare recipients and State Medicaid programs over the next decade. For those with insurance, it provides protections that guarantee you won't be dropped if you get sick and that there will be no benefit limits to keep you out of bankruptcy from medical costs. The law does NOT create socialized medicine in the US. Hospitals and Providers will not work for the government and there is no single-payor system for health care costs. Despite the rhetoric from conservatives and the Fox Lie Network, there are no government panels that decide who gets care and who doesn't. What the law does is place health care decisions back into the hands of providers and patients. The law isn't perfect to be sure, but it is a step in the right direction. A step that has long been overdue. Every journey begins with a small step. I guess we'll see where this journey takes us. Regardless, it is better than where we are now.