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(CBS News)   One reason for the high cost of emergency hospitalization in the America? "Superusers" that are clogging the nation's emergency rooms by treating them like party rooms for any little thing that ails them   (cbsnews.com) divider line 259
    More: Interesting, Villareal, emergency rooms, San Francisco General Hospital, emergency physician, primary care physicians, MedStar Washington Hospital Center, rubber bands, American College of Emergency Physicians  
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9775 clicks; posted to Main » on 15 Oct 2013 at 10:22 PM (38 weeks ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



259 Comments   (+0 »)
   
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2013-10-15 07:44:00 PM
But I've been assured by very serious people that our health care system is perfect as it is?
 
2013-10-15 07:47:52 PM
The actual one is paying for all the people between you and your doctor.  Yea free market!
 
2013-10-15 07:53:57 PM
I wants mah oxybamacotton an skrimps!
 
2013-10-15 07:58:38 PM
Nice article - good job mentioned the key reason there are "superusers" - lack of health insurance.  For many people, the only way to see a doctor is to go to the ER.

And no, no one gets "free" treatment at the ER.  They send a bill and the patient is responsible for his care.  Of course hospitals have a hard time collecting since lack of health insurance is generally accompanied by a lack of monetary resources.  So who pays for a good chunk of ER visits?  Everyone else.

Also, you cannot get just any kind of treatment at the ER.  Sure, if you are having a heart attack they will stabilize you, and if you have a primary care physician you might (as TFA suggests) get some needed tests.  But it's not like you can walk in and say "I have a family history of colon cancer, I'm 50 and I'd like a colonoscopy."  Well, you can say that but you ain't getting no colonoscopy.  So you don't get the preventative treatment.  Who pays for your frequent visits during your bout with colon cancer?  You know who.
 
2013-10-15 07:59:34 PM
*mentioning
 
2013-10-15 08:04:08 PM
I blame Fartbong0

Why won't he pass some sort of health care improvement act?
 
2013-10-15 08:37:41 PM
AKA "The uninsured".
 
2013-10-15 08:39:14 PM

sno man: The actual one is paying for all the people between you and your doctor.  Yea free market!


All civilized nations provide basic health care for free to everyone.
 
2013-10-15 08:44:07 PM
Free treatment in the ER?

That's the joke, right?

/EMTALA is not free.
 
2013-10-15 08:46:32 PM

hardinparamedic: Free treatment in the ER?

That's the joke, right?

/EMTALA is not free.


Don't even get me started on the ambulance ride.
 
2013-10-15 08:51:50 PM
One reason for the high cost of emergency hospitalization in the America? "Superusers" that are clogging the nations emergency rooms by treating them like party rooms for any little thing that ails them

Superusers are clogging the nation's restrooms too. Yes, I'm talking about you Derek. What you do in there after lunch is criminal.
 
2013-10-15 08:53:43 PM

Marcus Aurelius: hardinparamedic: Free treatment in the ER?

That's the joke, right?

/EMTALA is not free.

Don't even get me started on the ambulance ride.


Which in an ideal world of taxpayer funded third service EMS agencies would be free too.

Thanks Obama.
 
2013-10-15 09:01:11 PM
"Superusers are a small but expensive group: One large study conducted from 2009-2012 at a Los Angeles hospital noted that 99 percent of ER visitors come in fewer than 10 times a year, with nearly 67 percent coming in just once. But, the remaining 1 percent of visitors accounted for thousands of visits in one year."

This paragraph is completely devoid of meaning.

Most "superusers" are like me, people with chronic conditions that put them in crisis at least a couple of times a year. I have excellent insurance (thank goodness) but I have 4 neurological conditions that have me dialing 911 not infrequently. Some people are certainly using ERs when they could use a PCP but that's not really that common. Ers suck. Hospitals suck. I've discharged myself against advice from both because I knew they were only keeping me because they didn't know what to do or because I would be an interesting case for the students the next morning. No one spends six hours in an ER for something minor. (Six if you're lucky. I've spent that long just waiting to be seen and then another six for tests before being admitted.) 

I don't understand why we keep vilifying patients and championing the assholes who profit off the ones they can and try to bankrupt the ones they can't exploit.
 
2013-10-15 09:07:39 PM

Marcus Aurelius: sno man: The actual one is paying for all the people between you and your doctor.  Yea free market!

All civilized nations provide basic health care for free to everyone.


yup, I'm in one... sticking my tongue out and giving a raspberry.
 
2013-10-15 09:09:19 PM

AliceBToklasLives: Nice article - good job mention[ing] the key reason there are "superusers" - lack of health insurance.  For many people, the only way to see a doctor is to go to the ER.


I wish the author had nutted-up and said that, but I didn't see it mentioned in the article. I'm willing to be that most of those "superusers" should be going to urgent care, not ER, and would be if they had insurance. Why they don't have insurance is a different question, but if we had single-payer, SOCIALIZED health care, it wouldn't matter.
 
2013-10-15 09:12:12 PM

ginandbacon: "Superusers are a small but expensive group: One large study conducted from 2009-2012 at a Los Angeles hospital noted that 99 percent of ER visitors come in fewer than 10 times a year, with nearly 67 percent coming in just once. But, the remaining 1 percent of visitors accounted for thousands of visits in one year."

This paragraph is completely devoid of meaning.

Most "superusers" are like me, people with chronic conditions that put them in crisis at least a couple of times a year. I have excellent insurance (thank goodness) but I have 4 neurological conditions that have me dialing 911 not infrequently. Some people are certainly using ERs when they could use a PCP but that's not really that common. Ers suck. Hospitals suck. I've discharged myself against advice from both because I knew they were only keeping me because they didn't know what to do or because I would be an interesting case for the students the next morning. No one spends six hours in an ER for something minor. (Six if you're lucky. I've spent that long just waiting to be seen and then another six for tests before being admitted.) 

I don't understand why we keep vilifying patients and championing the assholes who profit off the ones they can and try to bankrupt the ones they can't exploit.


You must've missed this key sentence:

"There are patients who have serious medical conditions who see the ER as the point of access," Dorner said.
 
2013-10-15 09:14:38 PM
And yea, not free.  But not bloated full of for profit middle men that only add cost to the system.  We can do it for "free" for a tickle over half the US cost per capita, with a tenth of the per capita that should by volume, reduce cost...
 
2013-10-15 09:16:02 PM

Mitch Taylor's Bro: ginandbacon: "Superusers are a small but expensive group: One large study conducted from 2009-2012 at a Los Angeles hospital noted that 99 percent of ER visitors come in fewer than 10 times a year, with nearly 67 percent coming in just once. But, the remaining 1 percent of visitors accounted for thousands of visits in one year."

This paragraph is completely devoid of meaning.

Most "superusers" are like me, people with chronic conditions that put them in crisis at least a couple of times a year. I have excellent insurance (thank goodness) but I have 4 neurological conditions that have me dialing 911 not infrequently. Some people are certainly using ERs when they could use a PCP but that's not really that common. Ers suck. Hospitals suck. I've discharged myself against advice from both because I knew they were only keeping me because they didn't know what to do or because I would be an interesting case for the students the next morning. No one spends six hours in an ER for something minor. (Six if you're lucky. I've spent that long just waiting to be seen and then another six for tests before being admitted.) 

I don't understand why we keep vilifying patients and championing the assholes who profit off the ones they can and try to bankrupt the ones they can't exploit.

You must've missed this key sentence:

"There are patients who have serious medical conditions who see the ER as the point of access," Dorner said.


It is the point of access for those of us who have major crises. That's sort of the point of them.
 
2013-10-15 09:16:26 PM

Marcus Aurelius: sno man: The actual one is paying for all the people between you and your doctor.  Yea free market!

All civilized nations provide basic health care for free to everyone.


Americans are an uncivilized lot.
 
2013-10-15 09:22:09 PM

ginandbacon: Mitch Taylor's Bro: ginandbacon: "Superusers are a small but expensive group: One large study conducted from 2009-2012 at a Los Angeles hospital noted that 99 percent of ER visitors come in fewer than 10 times a year, with nearly 67 percent coming in just once. But, the remaining 1 percent of visitors accounted for thousands of visits in one year."

This paragraph is completely devoid of meaning.

Most "superusers" are like me, people with chronic conditions that put them in crisis at least a couple of times a year. I have excellent insurance (thank goodness) but I have 4 neurological conditions that have me dialing 911 not infrequently. Some people are certainly using ERs when they could use a PCP but that's not really that common. Ers suck. Hospitals suck. I've discharged myself against advice from both because I knew they were only keeping me because they didn't know what to do or because I would be an interesting case for the students the next morning. No one spends six hours in an ER for something minor. (Six if you're lucky. I've spent that long just waiting to be seen and then another six for tests before being admitted.) 

I don't understand why we keep vilifying patients and championing the assholes who profit off the ones they can and try to bankrupt the ones they can't exploit.

You must've missed this key sentence:

"There are patients who have serious medical conditions who see the ER as the point of access," Dorner said.

It is the point of access for those of us who have major crises. That's sort of the point of them.


You lack reading comprehension. Got it.
 
2013-10-15 09:29:35 PM
Can't we just disable root access at the admin level?
 
2013-10-15 09:30:27 PM

Mitch Taylor's Bro: ginandbacon: Mitch Taylor's Bro: ginandbacon: "Superusers are a small but expensive group: One large study conducted from 2009-2012 at a Los Angeles hospital noted that 99 percent of ER visitors come in fewer than 10 times a year, with nearly 67 percent coming in just once. But, the remaining 1 percent of visitors accounted for thousands of visits in one year."

This paragraph is completely devoid of meaning.

Most "superusers" are like me, people with chronic conditions that put them in crisis at least a couple of times a year. I have excellent insurance (thank goodness) but I have 4 neurological conditions that have me dialing 911 not infrequently. Some people are certainly using ERs when they could use a PCP but that's not really that common. Ers suck. Hospitals suck. I've discharged myself against advice from both because I knew they were only keeping me because they didn't know what to do or because I would be an interesting case for the students the next morning. No one spends six hours in an ER for something minor. (Six if you're lucky. I've spent that long just waiting to be seen and then another six for tests before being admitted.) 

I don't understand why we keep vilifying patients and championing the assholes who profit off the ones they can and try to bankrupt the ones they can't exploit.

You must've missed this key sentence:

"There are patients who have serious medical conditions who see the ER as the point of access," Dorner said.

It is the point of access for those of us who have major crises. That's sort of the point of them.

You lack reading comprehension. Got it.


How is that? Ers are absolutely a point of access if you are seriously ill. Even PCPs will tell you to go to the ER is you have symptoms they find alarming. ER doctors themselves have told me in no uncertain terms to skip calling my PCP's office and just call for an ambulance if I have serious symptoms. 

How do you think ERs should be used? If you think you are really sick, you should go to the ER. You will have ACCESS to tests and ACCESS to specialists. It's kind of why we have them.
 
2013-10-15 09:31:15 PM

GreenAdder: Can't we just disable root access at the admin level?


LOL
 
2013-10-15 09:31:44 PM

sno man: Marcus Aurelius: sno man: The actual one is paying for all the people between you and your doctor.  Yea free market!

All civilized nations provide basic health care for free to everyone.

yup, I'm in one... sticking my tongue out and giving a raspberry.


You irascible bastarge!
 
2013-10-15 09:33:32 PM

fusillade762: Marcus Aurelius: sno man: The actual one is paying for all the people between you and your doctor.  Yea free market!

All civilized nations provide basic health care for free to everyone.

Americans are an uncivilized lot.


For the most part, I cannot disagree.
 
2013-10-15 10:02:37 PM
Well, if there's one thing we know it's that the United States put a man on the moon, but healthcare can just never be fixed.

Never ever ever.
 
2013-10-15 10:12:36 PM

sno man: And yea, not free.  But not bloated full of for profit middle men that only add cost to the system.  We can do it for "free" for a tickle over half the US cost per capita, with a tenth of the per capita that should by volume, reduce cost...


Mote in my eye says what?
 
2013-10-15 10:13:57 PM

hardinparamedic: Which in an ideal world of taxpayer funded third service EMS agencies would be free too.

Thanks Obama.


God damn it, you got a free bambulance ride with the 'Bammy too?

When's my turn?
 
2013-10-15 10:19:19 PM

ginandbacon: Most "superusers" are like me, people with chronic conditions that put them in crisis at least a couple of times a year. I have excellent insurance (thank goodness) but I have 4 neurological conditions that have me dialing 911 not infrequently. Some people are certainly using ERs when they could use a PCP but that's not really that common. Ers suck. Hospitals suck. I've discharged myself against advice from both because I knew they were only keeping me because they didn't know what to do or because I would be an interesting case for the students the next morning. No one spends six hours in an ER for something minor. (Six if you're lucky. I've spent that long just waiting to be seen and then another six for tests before being admitted.)

I don't understand why we keep vilifying patients and championing the assholes who profit off the ones they can and try to bankrupt the ones they can't exploit.

You must've missed this key sentence:

"There are patients who have serious medical conditions who see the ER as the point of access," Dorner said.

It is the point of access for those of us who have major crises. That's sort of the point of them.

You lack reading comprehension. Got it.

How is that?


You start off with "most superusers are like you..." then talk about how your chronic conditions force you to go to ER a lot. Then you move into talking about how some people go to ER when they should be going to a primary care physician, but it's not that common, then say that no one goes to ER for minor stuff.

Is that accurate so far?

So I highlight the least ranty part of that paragraph, "No one spends six hours in an ER for something minor," and copypasta-ed that sentence FTFA that describes you to a "T" to point out that the article agrees with your original statement that "most superusers are like you." Maybe I should've copypasta-ed the three paragraphs that preceded it? Maybe you could go back and re-read TFA and let me know if that would've helped. Or maybe not. Christ, I remember getting into it with you on an abortion article and thinking, "geez, I guess I'm not agreeing with this person hard enough?"

For the record, my opinion on the matter is:

1. The high cost of ER care is driven by people who use them and can't pay. You claim to have "excellent" health insurance, so this does not apply you.
2. The ER cost issue is exacerbated by the fact that there are fewer ERs (and a lot fewer trauma centers) because a lot of hospitals can't justify the costs. It's a self-perpetuating cycle of fail that's impacted ER wait times AND increasing ER costs.
3. Providing a minimum amount of health care coverage for anyone who needs it (socialized medicine) would get a few people out of ER because maybe they'd see a doctor before their conditions turned chronic. Again, since you have 4 neurological conditions, I highly doubt this applies to you, either.
4. But more importantly, if we had socialized medicine, maybe we'd have more ERs and both the cost and wait times would come down.

It's not about vilifying patients; it's about fixing a broken system. TFA only talks about the patient-oriented causes...probably because that's all the studies mentioned were studying. I wish the author had mentioned the insurance aspect, but "wishing" ain't "having."
 
2013-10-15 10:25:08 PM
Jeez the 1% is at it again. Occupy Hospitals!
 
2013-10-15 10:25:18 PM
I believe the correct nomenclature is frequent flyers
 
2013-10-15 10:26:53 PM

Peter von Nostrand: I believe the correct nomenclature is frequent flyers


That's in the article, too. But using generally accepted terms doesn't generate web site traffic and ad impressions.
 
2013-10-15 10:26:57 PM
Ice water IV's for all frequent fliers.
 
2013-10-15 10:27:58 PM
Came in here to make some linux but people are just too serious right now. Mid week late night farkers need more beer.
 
2013-10-15 10:30:53 PM

AliceBToklasLives: Nice article - good job mentioned the key reason there are "superusers" - lack of health insurance.  For many people, the only way to see a doctor is to go to the ER.

And no, no one gets "free" treatment at the ER.  They send a bill and the patient is responsible for his care.  Of course hospitals have a hard time collecting since lack of health insurance is generally accompanied by a lack of monetary resources.  So who pays for a good chunk of ER visits?  Everyone else.

Also, you cannot get just any kind of treatment at the ER.  Sure, if you are having a heart attack they will stabilize you, and if you have a primary care physician you might (as TFA suggests) get some needed tests.  But it's not like you can walk in and say "I have a family history of colon cancer, I'm 50 and I'd like a colonoscopy."  Well, you can say that but you ain't getting no colonoscopy.  So you don't get the preventative treatment.  Who pays for your frequent visits during your bout with colon cancer?  You know who.


why do you hate America?
 
2013-10-15 10:32:15 PM

runescorpio: Came in here to make some linux but people are just too serious right now. Mid week late night farkers need more beer.


and less bullshiat, and more beer, and what were we talking about?
 
2013-10-15 10:34:16 PM

AliceBToklasLives: Nice article - good job mentioned the key reason there are "superusers" - lack of health insurance.  For many people, the only way to see a doctor is to go to the ER.

And no, no one gets "free" treatment at the ER.  They send a bill and the patient is responsible for his care.  Of course hospitals have a hard time collecting since lack of health insurance is generally accompanied by a lack of monetary resources.  So who pays for a good chunk of ER visits?  Everyone else.

Also, you cannot get just any kind of treatment at the ER.  Sure, if you are having a heart attack they will stabilize you, and if you have a primary care physician you might (as TFA suggests) get some needed tests.  But it's not like you can walk in and say "I have a family history of colon cancer, I'm 50 and I'd like a colonoscopy."  Well, you can say that but you ain't getting no colonoscopy.  So you don't get the preventative treatment.  Who pays for your frequent visits during your bout with colon cancer?  You know who.


If they charged less overall, everyone else would pay less. Hospitals gouge you on prices n the US.

I've gone hospitals in China that cost less than fifteen dollars for consultation and medicine. Doctors there don't drive BMWs. They don't have a hundred thou in student loan debt that their patents have to pay for. Etc.

Are the hospitals as modern? No. For example, you get X-rays instead of cat scans. But you can afford to go!

So, yeah, free riders suck, and drive up prices. But the heatlhcare bus costs way too much already in the US. Bunch of thieves.
 
2013-10-15 10:36:36 PM

Mitch Taylor's Bro: ginandbacon: Mitch Taylor's Bro: ginandbacon: "Superusers are a small but expensive group: One large study conducted from 2009-2012 at a Los Angeles hospital noted that 99 percent of ER visitors come in fewer than 10 times a year, with nearly 67 percent coming in just once. But, the remaining 1 percent of visitors accounted for thousands of visits in one year."

This paragraph is completely devoid of meaning.

Most "superusers" are like me, people with chronic conditions that put them in crisis at least a couple of times a year. I have excellent insurance (thank goodness) but I have 4 neurological conditions that have me dialing 911 not infrequently. Some people are certainly using ERs when they could use a PCP but that's not really that common. Ers suck. Hospitals suck. I've discharged myself against advice from both because I knew they were only keeping me because they didn't know what to do or because I would be an interesting case for the students the next morning. No one spends six hours in an ER for something minor. (Six if you're lucky. I've spent that long just waiting to be seen and then another six for tests before being admitted.) 

I don't understand why we keep vilifying patients and championing the assholes who profit off the ones they can and try to bankrupt the ones they can't exploit.

You must've missed this key sentence:

"There are patients who have serious medical conditions who see the ER as the point of access," Dorner said.

It is the point of access for those of us who have major crises. That's sort of the point of them.

You lack reading comprehension. Got it.


Maybe they can go to the ER to get that fixed.
 
2013-10-15 10:36:47 PM
So Subby the uninsured?

images.wikia.com

It's also not the high cost of emergency rooms, but all of healthcare.  Those uninsured drive up your health insurance costs, because someone has to pay for them.  you do via government footing the bill, or insurers passing on the costs from hospitals.

Luckily the ACA is forcing them to pay for at least some of their care if they're able, while also funneling them to much cheaper primary care instead of costly emergency care.
 
2013-10-15 10:37:36 PM

sno man: Marcus Aurelius: sno man: The actual one is paying for all the people between you and your doctor.  Yea free market!

All civilized nations provide basic health care for free to everyone.

yup, I'm in one... sticking my tongue out and giving a raspberry.


i230.photobucket.com

There's only one man who would dare give me the raspberry....
 
2013-10-15 10:37:54 PM

GreenAdder: Can't we just disable root access at the admin level?


Bad programming. The healthcare.exe requires root access.
 
2013-10-15 10:38:46 PM
Welfare/low income people are coached the following: "Go only to the ER, walk up to the desk person and say 'I cannot pay, I require Pro-Bono health care' ". This is the source for tons of spurious ER visit. From a few years in the ER, I would say probably 1/2 the traffic is pro-bono/welfare/medicare/medicaid related work.
 
2013-10-15 10:41:16 PM
worked for a major medical x ray film company based in Japan. we were the first customer, their USA division. they marked up what they sold/shipped to our warehouses.

the USA salesmen would pursue major accounts. they would give away huge dollars worth of hi tech equipment with free install and maintenance to help land a film contract. since they were stepping on the toes of a local dealer (who carried multiple brands of film & equipment) that dealer would get a cut right off the bat. if the local dealer was trained & under contract to service that equipment they would get fat dollars annually regardless if they went on site 1 time or 10 times.

the USA division marked up film and equipment sold to x-ray film & equipment dealers.

the x-ray film & equipment dealers marked up the film, equipment & service contracts they sold to every doc-in-the-box, vet, dentist, hospital, clinic, you name it.

it costs a bundle to cover the overhead of any doc-in-the-box, vet, dentist, hospital, clinic, you name it. so they mark up every x-ray sky high to cover expenses and make a profit at the end of the day.

whole lot of people making a whole lot of money.
 
2013-10-15 10:41:40 PM
Don't people already know this? I know at least one specific mother who uses the ER as her kid's clinic (ear aches, etc.) Sadly, she's Conservative last time I checked.
 
2013-10-15 10:42:36 PM

Mitch Taylor's Bro: ginandbacon: Most "superusers" are like me, people with chronic conditions that put them in crisis at least a couple of times a year. I have excellent insurance (thank goodness) but I have 4 neurological conditions that have me dialing 911 not infrequently. Some people are certainly using ERs when they could use a PCP but that's not really that common. Ers suck. Hospitals suck. I've discharged myself against advice from both because I knew they were only keeping me because they didn't know what to do or because I would be an interesting case for the students the next morning. No one spends six hours in an ER for something minor. (Six if you're lucky. I've spent that long just waiting to be seen and then another six for tests before being admitted.)

I don't understand why we keep vilifying patients and championing the assholes who profit off the ones they can and try to bankrupt the ones they can't exploit.

You must've missed this key sentence:

"There are patients who have serious medical conditions who see the ER as the point of access," Dorner said.

It is the point of access for those of us who have major crises. That's sort of the point of them.

You lack reading comprehension. Got it.

How is that?

You start off with "most superusers are like you..." then talk about how your chronic conditions force you to go to ER a lot. Then you move into talking about how some people go to ER when they should be going to a primary care physician, but it's not that common, then say that no one goes to ER for minor stuff.

Is that accurate so far?

So I highlight the least ranty part of that paragraph, "No one spends six hours in an ER for something minor," and copypasta-ed that sentence FTFA that describes you to a "T" to point out that the article agrees with your original statement that "most superusers are like you." Maybe I should've copypasta-ed the three paragraphs that preceded it? Maybe you could go back and re-read TFA and let me know if that would've helped. Or m ...


I get the feeling you and I probably have very similar goals for health care for our fellow citizens. 

I think this article sheds a slightly better light on the issue as evidenced by this quote "While they represented just .2 percent of all patients, they accounted for 4.5 percent of all emergency department visits in the region.
The new studies found that frequent users typically have serious medical issues."

http://www.healthpolicysolutions.org/2012/10/10/er-frequent-flyers-n ee d-more-care-not-less/

"Superusers" aren't really a big burden on ERs and most of them are there for a very good reason.

As I mentioned, I am really lucky. I have conditions that I have learned how to manage for the most part to keep me out of the ER and fantastic health insurance, BUT there are times when I need that critical care. I don't think anyone should think twice about seeking out that care when they need it just because the media has coined a nasty term to describe them. (Or me.) The next time I wake up on a sidewalk from low blood pressure or end up in acute renal failure after vomiting for 5 days, I will end up in the ER. And that's exactly where I should be. I could get even more graphic but it seems unnecessary. 

And I need to stress again that I am one of the lucky ones. Except for the renal failure and the pulmonary embolisms last spring, I really don't have anything to worry about. And I, unlike millions of very ill Americans, I don't have to worry about how to pay for my many trips to the ER.

And just to wind this up, I really do think you and I are probably on the same side on this issue if we just had a chance to sit down over a drink and hash it out.
 
2013-10-15 10:42:40 PM

TyrantII: Those uninsured drive up your health insurance costs


More than the healthcare lobby and their shareholders in government? America's health care industry even drives up costs in neighboring countries. The provision of health care should be a regulated, compassionate and efficient venture, not the loot-and-pillage for profits situation in the US.
 
2013-10-15 10:44:40 PM

TelJanin: Welfare/low income people are coached the following: "Go only to the ER, walk up to the desk person and say 'I cannot pay, I require Pro-Bono health care' ". This is the source for tons of spurious ER visit. From a few years in the ER, I would say probably 1/2 the traffic is pro-bono/welfare/medicare/medicaid related work.


"okay, we'll put you on our pro-bono prayer list, no charge. Hope the Lord blesses you!"

/faith-based healthcare
 
2013-10-15 10:44:43 PM
I actually read something that had contrary conclusions.  It said that while superusers clogged the system their problems were often easy and cheap to treat and were profit makers that subsidized the high cost of expensive equipment.  If emergency rooms only treated true emergencies there would be too few to offset the cost of operating the emergency room and would result in either higher costs or the closure of ERs.  The problem comes from the fact that many superusers are uninsured and thus the hospitals cannot charge as much as they would like.
 
2013-10-15 10:45:53 PM
I wish that primary doctors were in hospitals.

I don't see my primary care doctor too often because it takes a long time to get into see him, once you're there you have to wait longer than at urgent care places (not ERs), and he always has to send you to a specialist. The specialist never does anything on the first visit, or they send you somewhere else for lab work.

It would be nice if you could see your primary care doctor in a hospital, get any lab work you need at the same time, and if you're referred to a specialist, have that specialist at the same hospital and not start from square one again.

Even for more chronic things, I tend to go to my urgent care because they have a lab there and it's much faster to be seen (usually less than 15 minutes) compared to waiting up to 4 hours for a scheduled appointment with your primary care doctor. I then usually e-mail those lab results to my primary care doctor and communicate that way. I do have a great primary care doctor; he's just way overworked (especially compared to the specialists) and he has no equipment to do any testing in his office.
 
2013-10-15 10:47:17 PM

TelJanin: Welfare/low income people are coached the following: "Go only to the ER, walk up to the desk person and say 'I cannot pay, I require Pro-Bono health care' ". This is the source for tons of spurious ER visit. From a few years in the ER, I would say probably 1/2 the traffic is pro-bono/welfare/medicare/medicaid related work.


citationneeded.jpg
 
2013-10-15 10:47:39 PM

InternetSecurityGuard: Ice water IV's for all frequent fliers.


Honestly IVs feel like ice water already. It's not a lot of fun when your core temp is lowered really fast like that. At least they give you heated blankets now.
 
2013-10-15 10:49:01 PM
Maybe if everyone had basic preventative care covered by their tax dollars and public funds, like in EVERY OTHER CIVILIZED COUNTRY IN THE ENTIRE FARKING WORLD, then people wouldn't abuse emergency rooms by treating them like doctor's offices.

But no, we need to keep the insurance companies fat and rich. The people who buy into the whole idea that universal health care is "other people going to the doctor on MY dime" are farking assholes and complete idiots. By keeping our neighbors free from illness and disease, we ensure our community has productive workers, safe roads (sick people driving = more accidents), safe schools and neighborhoods (mental illness, if caught early, could prevent some random acts of violence), and slower spread of communicable diseases.

Simply put: If my tax dollars can keep someone from making ME sick by allowing them to visit a doctor and receive treatment, then my tax dollars are aiding ME and my family. Indeed, my entire community. If my tax dollars can protect ME from some sick person passing out and crossing the median while driving, then my tax dollars are aiding ME and my family. If my tax dollars can ensure that the roads get plowed, the cops show up for work, and the grocery store isn't staffed with contagious workers, then my tax dollars are aiding ME and my family. It's simple math. I pay taxes, they see doctors, I'm less likely to be killed, injured, or inconvenienced by their untreated illness.

But short-sighted assholes believe what insurance companies pay politicians and pundits to spew, and we're stuck with a health care system that works GREAT for people who make a large sum of money, but totally abandons everyone else.

When America dies, it won't be because of terrorism, war, or some natural disaster. It will be because we let sick folks spread a virus that could have been easily contained if only we'd created a system that made it easy and affordable for EVERYONE to visit a doctor when they feel ill. America will die when a disease kills us all, and other nations will survive because they had the wisdom to realize that the health of the individual affects us ALL.
 
2013-10-15 10:49:45 PM

hardinparamedic: Marcus Aurelius: hardinparamedic: Free treatment in the ER?

That's the joke, right?

/EMTALA is not free.

Don't even get me started on the ambulance ride.

Which in an ideal world of taxpayer funded third service EMS agencies would be free too.

Thanks Obama.


Unfortunately you and I know that this isn't an ideal world. Sometimes the Evil Empire is a good thing.
 
2013-10-15 10:49:46 PM

ginandbacon: And just to wind this up, I really do think you and I are probably on the same side on this issue if we just had a chance to sit down over a drink and hash it out.


"To Alcohol! The cause of... and solution to... all of life's problems."

:-)
 
2013-10-15 10:50:16 PM
If only we had a way to ensure that everyone has access to low cost health insurance.


If only...


\DNRTFA
\\really sick of the fact this is even under debate
\\\some weirdos insist on three.
 
2013-10-15 10:50:33 PM
Mitt Romney, On 60 Minutes, Cites Emergency Room As Health Care Option For Uninsured


http://www.huffingtonpost.com/2012/09/23/mitt-romney-60-minutes-heal th -care_n_1908129.html

I'll just leave this here.. where no Republican can see it..
 
2013-10-15 10:51:43 PM

Mitch Taylor's Bro: ginandbacon: And just to wind this up, I really do think you and I are probably on the same side on this issue if we just had a chance to sit down over a drink and hash it out.

"To Alcohol! The cause of... and solution to... all of life's problems."

:-)


GIN UP!
 
2013-10-15 10:52:43 PM

KrispyKritter: whole lot of people making a whole lot of money.


Why is it that so many problems in the USA that I hear about can be boiled down to "A whole lot of people are making a whole lot of money and nobody wants to/is able to do anything about it"?
 
2013-10-15 10:52:49 PM

ginandbacon: And just to wind this up, I really do think you and I are probably on the same side on this issue if we just had a chance to sit down over a drink and hash it out.


as a complete aside, how is it that someone with very serious, chronic health issues goes out drinking and has a fark username like "ginandbacon?"

just askin'
 
2013-10-15 10:52:56 PM

swingerofbirches: I wish that primary doctors were in hospitals.

I don't see my primary care doctor too often because it takes a long time to get into see him, once you're there you have to wait longer than at urgent care places (not ERs), and he always has to send you to a specialist. The specialist never does anything on the first visit, or they send you somewhere else for lab work.

It would be nice if you could see your primary care doctor in a hospital, get any lab work you need at the same time, and if you're referred to a specialist, have that specialist at the same hospital and not start from square one again.

Even for more chronic things, I tend to go to my urgent care because they have a lab there and it's much faster to be seen (usually less than 15 minutes) compared to waiting up to 4 hours for a scheduled appointment with your primary care doctor. I then usually e-mail those lab results to my primary care doctor and communicate that way. I do have a great primary care doctor; he's just way overworked (especially compared to the specialists) and he has no equipment to do any testing in his office.


As someone who spent 20 years in the medical field you do not have a great primary care doctor.

You should never have to wait more than 20 minutes outside of your appointment time.  If he is too busy, he should not take on new patients.

He should have a lab in house.  Lab equipment is expensive, but that is where the majority of the money is made in a medical practice, and it allows him to be a better doctor.

Why does he always have to send you to specialist?  Because he gets a referral fee.  So he bills you and gets the payola.

You need a new doctor and not a greedy cheapskate.
 
2013-10-15 10:53:36 PM
What my girlfriend who is an ER doc has to deal with on a regular basis.

http://www.youtube.com/watch?v=Q6sRyrB_UMA
 
2013-10-15 10:54:09 PM
  "Superusers are a small but expensive group: One large study conducted from 2009-2012 at a Los Angeles hospital noted that 99 percent of ER visitors come in fewer than 10 times a year."

I would bet it is less than 2 times per year.


with nearly 67 percent coming in just once.

I hope so, but what percent of the population goes 0 times per year ?

But, the remaining 1 percent of visitors accounted for thousands of visits in one year.

I don't get how this works,   So these "superusers" go to one ER fail to get drugs, get discharged.  Go to another ER, get discharged don't get drugs, go to yet another ER, get drugs get discharged,  every single day?   except it seems for those few days that they get drugs on their first or 2nd ER visit, perhaps those are weekends?

sounds like a full time job to me
 
2013-10-15 10:55:05 PM
The only reason for the high cost of hospitalization in America: the insurance industry.
 
2013-10-15 10:58:48 PM
sudo give me some oxycontin
 
2013-10-15 11:01:27 PM
This is new?  We've had friends over the last 25 years tells us of their experiences in the trenches.  Paramedics called out to the same locations time and time again for losers using them as a shuttle service for doctor's appointments.  ER nurses seeing the same people come in for "emergency level" pain for ingrown toenails (no, I'm not making that up) and illegal aliens bringing in their kids for colds or bouts of the flu.

Society will always have leeches--the issue is personal responsibility and the growing trend of accepting more and more people to shirk it.

And where do some of you live--six hours in the ER?  The longest I've ever waited, start to finish, is maybe 90 minutes, and I'm out the door or watching my kid go into appendectomy surgery.
 
2013-10-15 11:02:18 PM

whatshisname: TyrantII: Those uninsured drive up your health insurance costs

More than the healthcare lobby and their shareholders in government? America's health care industry even drives up costs in neighboring countries. The provision of health care should be a regulated, compassionate and efficient venture, not the loot-and-pillage for profits situation in the US.


Never said they don't.  That's primarily a factor of highly inelastic demand (need healthcare, have to have it) and a lack of information (mainly prices).  Both economic imbalances screaming for Government to step in and level the playing field.  ACA is also trying to address that.

But the article is mainly ER visits and treatment.
 
2013-10-15 11:03:05 PM

pete1729: What my girlfriend who is an ER doc has to deal with on a regular basis.

http://www.youtube.com/watch?v=Q6sRyrB_UMA


I see stuff like this all the time. Most frequent fliers are on Medicaid. And unfortunately in this state there is a (small) copay for the primary care doctor but not for the ER and everything is paid for. So they have no incentive to go see their primary care doctor. They come in for any reason at all and mostly they are desperate for attention. There is a collective groan among every employee in the ED when frequent flier's name appears on the tracker and the person is there for insomnia at 3PM. Yes it has happened. This is why we need to stigmatize people like this
 
2013-10-15 11:04:00 PM
*CTL-F "sudo"  1 found*
Good.
*leaves whistling*
 
2013-10-15 11:04:51 PM
My brother teaches in St. Louis. He told his students one day he would not be there the next day because he had a doctor's appointment. The students didn't know what that was. When they were sick, they went to the emergency room.
 
2013-10-15 11:05:18 PM

fickenchucker: T
Society will always have leeches--the issue is personal responsibility and the growing trend of accepting more and more people to shirk it.



You contradict yourself in one run on sentance.  Well done.

There's far fewer leeches and much less crime now than in the past.
 
2013-10-15 11:05:44 PM

swingerofbirches: I wish that primary doctors were in hospitals.

I don't see my primary care doctor too often because it takes a long time to get into see him, once you're there you have to wait longer than at urgent care places (not ERs), and he always has to send you to a specialist. The specialist never does anything on the first visit, or they send you somewhere else for lab work.

It would be nice if you could see your primary care doctor in a hospital, get any lab work you need at the same time, and if you're referred to a specialist, have that specialist at the same hospital and not start from square one again.

Even for more chronic things, I tend to go to my urgent care because they have a lab there and it's much faster to be seen (usually less than 15 minutes) compared to waiting up to 4 hours for a scheduled appointment with your primary care doctor. I then usually e-mail those lab results to my primary care doctor and communicate that way. I do have a great primary care doctor; he's just way overworked (especially compared to the specialists) and he has no equipment to do any testing in his office.


My primary care doctor is quick and convenient. She can diagnose most problems, sees patients within about ten minutes of the scheduled time, and sends all lab work out to the local university hospital (turnaround on most lab work is a day, two at the most). She's willing to listen to any complaint, and I've walked in with seasonal allergies and walked out with a bag full of free samples for high-grade Benadryl and Allegra. (I don't know that it helped my allergies, but I woke up two days later feeling amazing.)

Oh, wait. My primary care was at a university infirmary. Explains a lot.

Klonopin is a hell of a drug, kids.
 
2013-10-15 11:07:45 PM

Marcus Aurelius: AKA "The uninsured".


As in my ex-wife.  She could have insurance if she's just go back to work but noooo, blaming me for her lack of employment nearly 6 years after the divorce fulfills her need to be a victim.
 
2013-10-15 11:07:53 PM

InternetSecurityGuard: Ice water IV's for all frequent fliers.




Ice water enemas!
 
2013-10-15 11:07:53 PM

sendtodave: AliceBToklasLives: Nice article - good job mentioned the key reason there are "superusers" - lack of health insurance.  For many people, the only way to see a doctor is to go to the ER.

And no, no one gets "free" treatment at the ER.  They send a bill and the patient is responsible for his care.  Of course hospitals have a hard time collecting since lack of health insurance is generally accompanied by a lack of monetary resources.  So who pays for a good chunk of ER visits?  Everyone else.

Also, you cannot get just any kind of treatment at the ER.  Sure, if you are having a heart attack they will stabilize you, and if you have a primary care physician you might (as TFA suggests) get some needed tests.  But it's not like you can walk in and say "I have a family history of colon cancer, I'm 50 and I'd like a colonoscopy."  Well, you can say that but you ain't getting no colonoscopy.  So you don't get the preventative treatment.  Who pays for your frequent visits during your bout with colon cancer?  You know who.

If they charged less overall, everyone else would pay less. Hospitals gouge you on prices n the US.

I've gone hospitals in China that cost less than fifteen dollars for consultation and medicine. Doctors there don't drive BMWs. They don't have a hundred thou in student loan debt that their patents have to pay for. Etc.

Are the hospitals as modern? No. For example, you get X-rays instead of cat scans. But you can afford to go!

So, yeah, free riders suck, and drive up prices. But the heatlhcare bus costs way too much already in the US. Bunch of thieves.


Free riders, lawsuits, educational costs, malpractice insurance, technology and contracted maintenance of that technology, staffing numbers per patient, building upgrades and upkeep (patients expect hospitals to function as hotels and offer the same amenities such as private rooms w/ baths, well appointed guest spaces, etc), retention bonuses and continuing education, specialists and licensing expenses really don't leave much left over for the thieves.
 
2013-10-15 11:08:06 PM
AA and NA should treat their own.  Start mini-clinics!  Get sponsored by P&G and some coffee brand...
 
2013-10-15 11:08:55 PM

Hagbardr: sudo give me some oxycontin


Screw oxycontin.

sudo give me klonopin and vicodin
 
2013-10-15 11:09:07 PM

TelJanin: Welfare/low income people are coached the following: "Go only to the ER, walk up to the desk person and say 'I cannot pay, I require Pro-Bono health care' ". This is the source for tons of spurious ER visit. From a few years in the ER, I would say probably 1/2 the traffic is pro-bono/welfare/medicare/medicaid related work.


userserve-ak.last.fm
 
2013-10-15 11:10:01 PM
Eddie Adams from Torrance [TotalFark]
2013-10-15 08:04:08 PM


I blame Fartbong0

Why won't he pass some sort of health care improvement act?

Being the big supporter of zero care, you must be one of the 2 dozen people who signed up since sign-ups began.
 
2013-10-15 11:10:32 PM

ricochet4: ginandbacon: And just to wind this up, I really do think you and I are probably on the same side on this issue if we just had a chance to sit down over a drink and hash it out.

as a complete aside, how is it that someone with very serious, chronic health issues goes out drinking and has a fark username like "ginandbacon?"

just askin'


Heh. I have a mess of shiat that isn't dangerous just disabling. Drinking doesn't really affect any of it (thank the gods and goddesses.) I can't actually go out much anymore but I can still drink :)

My friends come to my house and I give them good cheer which seems to make up for me not running around to their things. 

I do get out sometimes and even went to NY for my birthday last weekend but whooooooweeee am I paying for that trip now! I have learned to budget (well I am trying to learn to budget) my energy. 

I haven't been to the ER since last February which is not bad for me. But I have definitely been a frequent flier for the last few years.
 
2013-10-15 11:11:04 PM

pete1729: What my girlfriend who is an ER doc has to deal with on a regular basis.

http://www.youtube.com/watch?v=Q6sRyrB_UMA


My x in college was exatly like her, I can't remember how many times I spent the night in an effect waiting room becouse he had a seizure after we were together for 2 years I found out that he had been fakeing them to get disability. I don't know how I missed it for so long and it messed me up for a long time not able to trust anyone.
 
2013-10-15 11:11:46 PM
when people dont care what shiat costs, because they arent paying the bill.
then they overindulge in a service and waste it.
 
2013-10-15 11:14:11 PM

AliceBToklasLives: Nice article - good job mentioned the key reason there are "superusers" - lack of health insurance.  For many people, the only way to see a doctor is to go to the ER.

And no, no one gets "free" treatment at the ER.  They send a bill and the patient is responsible for his care.  Of course hospitals have a hard time collecting since lack of health insurance is generally accompanied by a lack of monetary resources.  So who pays for a good chunk of ER visits?  Everyone else.

Also, you cannot get just any kind of treatment at the ER.  Sure, if you are having a heart attack they will stabilize you, and if you have a primary care physician you might (as TFA suggests) get some needed tests.  But it's not like you can walk in and say "I have a family history of colon cancer, I'm 50 and I'd like a colonoscopy."  Well, you can say that but you ain't getting no colonoscopy.  So you don't get the preventative treatment.  Who pays for your frequent visits during your bout with colon cancer?  You know who.


The dude can pay for it.  It goes like this.  I have a couple of green bills in my pocket.  How much for a colonoscopy to check for X is I pay cash.. up front right now.  Oh, its 20% of the normal bill?  OK then. lets go.
 
2013-10-15 11:16:23 PM
Here's an idea: how about everyone take care of their own bills?  Get the state out of it completely. If you want to pool resources with some like minded folks and spend money for insurance, go for it. Or if you want to just pay as you go, or save up and pay, or save nothing and then bleed out when something happens-- go for it.  Similarily, if you want to start a charity to fix clef lips or teach retarded kids to skateboard-- go for it.

That's the American way. You succeed or fail based on your own ability.  Should be no different for health care than it is for education, quarterbacking, or meeting chicks. Unfortunately, under today's quasi-socialist system, everybody gets an A, everyone gets a chance to play quarterback, and if you can't find a date to the prom it's because you "suffer" from Asperger's and are a "victim" of bullying.

More person responsibility, less collectivism.

However, IF you insist on turning us into the USSA, at least go full throttle. The current system is NOT free market and Obamacare is NOT true socialism. Health care (including Obamacare) is driven by corporations that are so in bed with the federal government that they have corrupted any sense of altruism, yet at the same time they are not true market actors.  We're getting the worst of both worlds.

Who's with me?
 
2013-10-15 11:18:10 PM
There will always be people who abuse the system.  But, doesn't it seem logical that if you put people in a corner, they're going to go for the only way out?

I know people who have had to make the decision to go to the emergency room knowing they couldn't pay.  It wasn't something they took joy in and they weren't proud about it.  In fact, they all put off seeking medical attention longer than they should have or would have if they could afford urgent care or a doctor's visit.  And in the end, it ends up costing even more than if they'd been able to get care early or through another avenue.

I think it's obvious.  Some issues require medical attention and some people simply cannot afford it, because it's expensive.  So, no matter what, another party is going to foot that bill.  It just doesn't make sense to have a system in place that forces people, who can't pay, to use the most expensive option for care.  If I'm paying, I'd rather pay the bill for the preventative care or the doctor's office / urgent care visit, than the ambulance and emergency room costs.
 
2013-10-15 11:20:07 PM
www.screeninsults.com
Thanks for the free healthcare estupido gringos. Send the bill to general delivery TJ and a check will be in the mail sooooon. I'm sure glad I voted for Hobama!
 
2013-10-15 11:21:41 PM

Marcus Aurelius: All civilized nations provide basic health care for free to everyone.


Is that the same "civilized" nations that spent the better part of the last millennium blowing each other to shiat, or the one that still has hundreds of thousands of people who can remember when it was one country's policy to murder an entire race? Incidentally, that same "civilized" country is the most powerful one among the "civilized" world.

The United States changes very slowly. It always has, it always will. Europe is more advanced in being "civilized" because when all was said and done there was nothing left, hence nothing left to lose. Change is easy when you start from scratch. The same cannot be said here.

We'll get there. In the meantime, this whole "US is uncivilized" meme grinds my gears. I NEVER want to hear anybody ever accuse an American of arrogance again. Uncivilized, my ass.
 
2013-10-15 11:22:30 PM

nickdaisy: Here's an idea: how about everyone take care of their own bills?  Get the state out of it completely. If you want to pool resources with some like minded folks and spend money for insurance, go for it. Or if you want to just pay as you go, or save up and pay, or save nothing and then bleed out when something happens-- go for it.  Similarily, if you want to start a charity to fix clef lips or teach retarded kids to skateboard-- go for it.

That's the American way. You succeed or fail based on your own ability.  Should be no different for health care than it is for education, quarterbacking, or meeting chicks. Unfortunately, under today's quasi-socialist system, everybody gets an A, everyone gets a chance to play quarterback, and if you can't find a date to the prom it's because you "suffer" from Asperger's and are a "victim" of bullying.

More person responsibility, less collectivism.

However, IF you insist on turning us into the USSA, at least go full throttle. The current system is NOT free market and Obamacare is NOT true socialism. Health care (including Obamacare) is driven by corporations that are so in bed with the federal government that they have corrupted any sense of altruism, yet at the same time they are not true market actors.  We're getting the worst of both worlds.

Who's with me?


Why do you need someone to back your play?  Go it alone, Grizzly Adams.
 
2013-10-15 11:22:58 PM
de gibs!
 
2013-10-15 11:24:41 PM
I recall hearing of some community health approach (Brooklyn?) where they made a point of identifying the "superusers" and giving them extra preemptive care. They found it much cheaper to do things like train the patients on how to take their medicine or even send out a nurse for occasional supervision than to treat some patients every couple of weeks in the emergency room.
 
2013-10-15 11:25:55 PM

swingerofbirches: It would be nice if you could see your primary care doctor in a hospital, get any lab work you need at the same time, and if you're referred to a specialist, have that specialist at the same hospital and not start from square one again.


This is pretty much what Kaiser is. A lot of people are down on HMOs, but you can't deny the convenience of having primary doctors, specialists, labs (x-ray, blood tests, etc.), and pharmacy all under one roof.
 
2013-10-15 11:27:59 PM

OscarTamerz: [www.screeninsults.com image 500x368]
Thanks for the free healthcare estupido gringos. Send the bill to general delivery TJ and a check will be in the mail sooooon. I'm sure glad I voted for Hobama!


The Mexicans I know work pretty damned hard and are under- paid for what they produce: I'm more likely to begrudge medical attention to one of our own that has made public assistance a way of life.
 
2013-10-15 11:30:34 PM
Did not read thread, but no sh*t subby.

/just in case it hadn't been said.
 
2013-10-15 11:31:14 PM

Hagbardr: sudo give me some oxycontin


Heh...
 
2013-10-15 11:31:54 PM
My wife and I know someone who does this. Granted, she is a single mom of 3, no education, and makes minimum wage. The ER bills Medicaid.

I explained this to a Teaderper co-worker, and told him, that under Fartbongo care, she probably still can't afford insurance, but her tax for not having any, is more than she currently contributes. So, in reality, our cold/current healthcare system is actually more socialistic than Obamacare, and why is he arguing for Socialism... I'm pretty sure his hair went full grey in under 5 seconds. His lack of both Herp and Derp or any reply was soo gratifying.
 
2013-10-15 11:32:34 PM

ginandbacon: "Superusers are a small but expensive group: One large study conducted from 2009-2012 at a Los Angeles hospital noted that 99 percent of ER visitors come in fewer than 10 times a year, with nearly 67 percent coming in just once. But, the remaining 1 percent of visitors accounted for thousands of visits in one year."

This paragraph is completely devoid of meaning.

Most "superusers" are like me, people with chronic conditions that put them in crisis at least a couple of times a year. I have excellent insurance (thank goodness) but I have 4 neurological conditions that have me dialing 911 not infrequently. Some people are certainly using ERs when they could use a PCP but that's not really that common. Ers suck. Hospitals suck. I've discharged myself against advice from both because I knew they were only keeping me because they didn't know what to do or because I would be an interesting case for the students the next morning. No one spends six hours in an ER for something minor. (Six if you're lucky. I've spent that long just waiting to be seen and then another six for tests before being admitted.) 

I don't understand why we keep vilifying patients and championing the assholes who profit off the ones they can and try to bankrupt the ones they can't exploit.


Well, FTFA it sounds like there's also people who just can't afford any other type of care and so end up in crisis more often, too, but I sympathize with you. That would absolutely suck.
 
2013-10-15 11:32:50 PM

UsikFark: TelJanin: Welfare/low income people are coached the following: "Go only to the ER, walk up to the desk person and say 'I cannot pay, I require Pro-Bono health care' ". This is the source for tons of spurious ER visit. From a few years in the ER, I would say probably 1/2 the traffic is pro-bono/welfare/medicare/medicaid related work.

"okay, we'll put you on our pro-bono prayer list, no charge. Hope the Lord blesses you!"

/faith-based healthcare


RON PAUL
 
2013-10-15 11:33:12 PM

Adolf Oliver Nipples: Uncivilized, my ass.


cdn.overclock.net
 
2013-10-15 11:34:05 PM
Good thing Obamacare does nothing to address this crippling issue, I wrote, knowing that it had been addressed a dozen times before in the thread.
 
2013-10-15 11:35:39 PM

ZeroCorpse: Maybe if everyone had basic preventative care covered by their tax dollars and public funds, like in EVERY OTHER CIVILIZED COUNTRY IN THE ENTIRE FARKING WORLD, then people wouldn't abuse emergency rooms by treating them like doctor's offices.

But no, we need to keep the insurance companies fat and rich. The people who buy into the whole idea that universal health care is "other people going to the doctor on MY dime" are farking assholes and complete idiots. By keeping our neighbors free from illness and disease, we ensure our community has productive workers, safe roads (sick people driving = more accidents), safe schools and neighborhoods (mental illness, if caught early, could prevent some random acts of violence), and slower spread of communicable diseases.

Simply put: If my tax dollars can keep someone from making ME sick by allowing them to visit a doctor and receive treatment, then my tax dollars are aiding ME and my family. Indeed, my entire community. If my tax dollars can protect ME from some sick person passing out and crossing the median while driving, then my tax dollars are aiding ME and my family. If my tax dollars can ensure that the roads get plowed, the cops show up for work, and the grocery store isn't staffed with contagious workers, then my tax dollars are aiding ME and my family. It's simple math. I pay taxes, they see doctors, I'm less likely to be killed, injured, or inconvenienced by their untreated illness.

But short-sighted assholes believe what insurance companies pay politicians and pundits to spew, and we're stuck with a health care system that works GREAT for people who make a large sum of money, but totally abandons everyone else.

When America dies, it won't be because of terrorism, war, or some natural disaster. It will be because we let sick folks spread a virus that could have been easily contained if only we'd created a system that made it easy and affordable for EVERYONE to visit a doctor when they feel ill. America will die w ...


Your utopian countries are also abused. They also restrict available care to deal with it. That includes the richest of EU countries, such as England and Germany.

Second, the for-profit U.S. system you decry so vociferously is, in fact, responsible for over half of the WORLD's medical research and advancement. Now, do you know why that is? Can you possibly contemplate the *fact* that the capitalist system produces so much incentive for progress it manages to almost single-handedly advance medicine for the globe? You god damned myopic collectivist?
 
2013-10-15 11:40:19 PM

Shryke: Can you possibly contemplate the *fact* that the capitalist system produces so much incentive for progress it manages to almost single-handedly advance medicine for the globe?


The US would continue R&D with a completely socialist healthcare system. Bankrupting citizens doesn't help the nation's health.
 
2013-10-15 11:43:35 PM

Shryke: ZeroCorpse: Maybe if everyone had basic preventative care covered by their tax dollars and public funds, like in EVERY OTHER CIVILIZED COUNTRY IN THE ENTIRE FARKING WORLD, then people wouldn't abuse emergency rooms by treating them like doctor's offices.

But no, we need to keep the insurance companies fat and rich. The people who buy into the whole idea that universal health care is "other people going to the doctor on MY dime" are farking assholes and complete idiots. By keeping our neighbors free from illness and disease, we ensure our community has productive workers, safe roads (sick people driving = more accidents), safe schools and neighborhoods (mental illness, if caught early, could prevent some random acts of violence), and slower spread of communicable diseases.

Simply put: If my tax dollars can keep someone from making ME sick by allowing them to visit a doctor and receive treatment, then my tax dollars are aiding ME and my family. Indeed, my entire community. If my tax dollars can protect ME from some sick person passing out and crossing the median while driving, then my tax dollars are aiding ME and my family. If my tax dollars can ensure that the roads get plowed, the cops show up for work, and the grocery store isn't staffed with contagious workers, then my tax dollars are aiding ME and my family. It's simple math. I pay taxes, they see doctors, I'm less likely to be killed, injured, or inconvenienced by their untreated illness.

But short-sighted assholes believe what insurance companies pay politicians and pundits to spew, and we're stuck with a health care system that works GREAT for people who make a large sum of money, but totally abandons everyone else.

When America dies, it won't be because of terrorism, war, or some natural disaster. It will be because we let sick folks spread a virus that could have been easily contained if only we'd created a system that made it easy and affordable for EVERYONE to visit a doctor when they feel ill. Americ ...



Why can't we have a hybrid system where those who want to keep their private insurance can, but everyone, regardless of income, can sign up for Medicaid?
 
2013-10-15 11:44:27 PM

Shryke: Second, the for-profit U.S. system you decry so vociferously is, in fact, responsible for over half of the WORLD's medical research and advancement.


No, that would be the university systems via government funded grants, performing basic/ground level, but unprofitable research. That often times gets scooped up and refined by medical companies, but without the unprofitable research (shouldered by the government), we'd be getting jack squat in terms of medical advancements.
 
2013-10-15 11:44:35 PM
This is how poor people get health care.  They call 911.  For a cold.  Because they don't own a car.  Because they've never been employed.  And this is normal for them.
 
2013-10-15 11:46:44 PM
Use urgent care centers!
 
2013-10-15 11:46:55 PM

Lsherm: This is how poor people get health care.  They call 911.  For a cold.  Because they don't own a car.  Because they've never been employed.  And this is normal for them.


thanks obama
 
2013-10-15 11:47:31 PM

PsiChick: ginandbacon: "Superusers are a small but expensive group: One large study conducted from 2009-2012 at a Los Angeles hospital noted that 99 percent of ER visitors come in fewer than 10 times a year, with nearly 67 percent coming in just once. But, the remaining 1 percent of visitors accounted for thousands of visits in one year."

This paragraph is completely devoid of meaning.

Most "superusers" are like me, people with chronic conditions that put them in crisis at least a couple of times a year. I have excellent insurance (thank goodness) but I have 4 neurological conditions that have me dialing 911 not infrequently. Some people are certainly using ERs when they could use a PCP but that's not really that common. Ers suck. Hospitals suck. I've discharged myself against advice from both because I knew they were only keeping me because they didn't know what to do or because I would be an interesting case for the students the next morning. No one spends six hours in an ER for something minor. (Six if you're lucky. I've spent that long just waiting to be seen and then another six for tests before being admitted.) 

I don't understand why we keep vilifying patients and championing the assholes who profit off the ones they can and try to bankrupt the ones they can't exploit.

Well, FTFA it sounds like there's also people who just can't afford any other type of care and so end up in crisis more often, too, but I sympathize with you. That would absolutely suck.


That article was weak to say the least. The one I posted above gave a better account of who "superusers" actually are. Most of us actually have serious health issues.

And thank you but I'm lucky as I mentioned since I'm not likely to die from any of this crap and I do have insurance. I just think it's pure BS to demonize .2% of patients for no good reason.
 
2013-10-15 11:49:04 PM
As someone who sat with his wife while his underage children sat home waiting for her kidney infection and 105 degree fever, waiting for the girl that drank too much the night before to finish puking and the baby with a runny nose to get seen  by a doctor, this is pretty much dead on.  Lots of people look at the emergency room as a regular clinic, and a guy that needed to be seen waited 6 hours (leg pain, dizzyness, known cardiovascular patient at least 75 years old in a wheelchair) waits first come first served.
 
2013-10-15 11:49:27 PM

Shryke: Second, the for-profit U.S. system you decry so vociferously is, in fact, responsible for over half of the WORLD's medical research and advancement


lol, is it?

I'm pretty doubtful.
 
2013-10-15 11:49:46 PM
Stop blaming the victim.
 
2013-10-15 11:51:35 PM

Ablejack: The US would continue R&D with a completely socialist healthcare system.


And this is why all other socialist medical systems do squat? Stunning observation.
 
2013-10-15 11:51:37 PM

Lsherm: This is how poor people get health care.  They call 911.  For a cold.  Because they don't own a car.  Because they've never been employed.  And this is normal for them.


What percentage of American adults have never had a job?  Please provide citation.
 
2013-10-15 11:53:08 PM

Felgraf: No, that would be the university systems via government funded grants,


That is a good deal of it, but your idea that no profit occurs is quite false. Patents and funds pour in to said universities OUTSIDE of tax dollars en masse. From guess where?
 
2013-10-15 11:53:11 PM
My girlfriend's been to the ER multiple times this year because her PCP is an incompetent twit. It took six months to get a specialist to answer the freaking phone and I had to resort to lawyering up just to file a greviance.

Health insurance in this country is maintained only because something must feed the Shoggoth, lest they multiply and run amok.
 
2013-10-15 11:53:29 PM

Nutsac_Jim: The dude can pay for it.  It goes like this.  I have a couple of green bills in my pocket.  How much for a colonoscopy to check for X is I pay cash.. up front right now.  Oh, its 20% of the normal bill?  OK then. lets go.


In many cases it doesn't matter if you can pay for it.  If you don't have insurance, they will not do the procedure.  You could wave a bunch of hundreds in their face and the answer is still no.

Ok, so you say "then you can pay for insurance."  Nope.  Even if you can afford insurance, pre-existing condition clause (which can include "you need x procedure") means no insurance for you.
 
2013-10-15 11:53:46 PM

spamdog: I'm pretty doubtful.


Great paper published by the EU recently concerning this subject. Google it.
 
2013-10-15 11:54:31 PM
I had one of these frequent fliers two doors down from me, back when I lived in the ghetto. This fat biatch (between 350-400lb) called on average about twice a week, and every time an ambulance would come and usually one or two fire trucks. I felt really bad for the guys that had to haul her fat ass down the stairs, because of course she was on the second floor. I'm pretty sure she was the mother of the seven kids that lived there, but there were plenty of 'em running all over the place so it was hard to tell. I'm guessing she was just a noncompliant Type 2 diabetic abusing the shiat out of the system.

Speaking of the system, now that I know much more about it, I'm confident in saying that a big chunk of that 1% is eligible for Medicaid, they just choose not to fill out the paperwork and continue to abuse the ER. The ones who aren't are usually illegals. Both these groups together are a big chunk of why aspirins are $50, and other stupid-high hospital costs. It's also been covered in a variety of places lately - you can call and negotiate your bill down, and a large part of what they're stripping off is from other people's bills that don't pay.
 
2013-10-15 11:54:43 PM

solitary: Stop blaming the victim.


Thank you.
 
2013-10-15 11:55:29 PM
Also, the reason I hated fat biatch so much was because of her herd of annoying sprogs, and the fact that when she called and a fire truck showed up, they'd block off the whole damn road. /csb
 
2013-10-15 11:58:31 PM

AliceBToklasLives: Nice article - good job mentioned the key reason there are "superusers" - lack of health insurance.  For many people, the only way to see a doctor is to go to the ER.


Most Urgent Care and Minute Clinic facilities will see you for a small fee without insurance.  Minute Clinics are ~$80 cash for a visit.  The Urgent Care facility I use is run by Memorial, which charges about $75 and if they have the generic onsite they will give it to you as part of your cost. 

Actually, most doctors will see you rather cheaply without insurance if you just ask them.  I had a growth removed and checked for cancer for under $200 because I told them I wanted to pay cash.  That is a reasonable price to see a specialist for a common job that includes local sedation, surgery, and a prescription
 
2013-10-15 11:59:13 PM

solitary: Stop blaming the victim.


Who is the victim in all of this? I'm having trouble figuring it out. The sick person with no means to pay who gets care is a victim? How can that be? How about the hospital that has to eat the costs, are they victims in this? How about the doctors that take Medicare patients when Medicare doesn't pay the cost of care? Are they victims?
 
2013-10-15 11:59:26 PM

GreenAdder: Can't we just disable root access at the admin level?


Not really. That would allow r/w problems at the blood access level.
 
2013-10-16 12:00:52 AM

Adolf Oliver Nipples: solitary: Stop blaming the victim.

Who is the victim in all of this? I'm having trouble figuring it out. The sick person with no means to pay who gets care is a victim? How can that be? How about the hospital that has to eat the costs, are they victims in this? How about the doctors that take Medicare patients when Medicare doesn't pay the cost of care? Are they victims?


No.
 
2013-10-16 12:02:02 AM

Infernalist: Adolf Oliver Nipples: solitary: Stop blaming the victim.

Who is the victim in all of this? I'm having trouble figuring it out. The sick person with no means to pay who gets care is a victim? How can that be? How about the hospital that has to eat the costs, are they victims in this? How about the doctors that take Medicare patients when Medicare doesn't pay the cost of care? Are they victims?

No.


Why not? Didn't they incur costs that have to be paid for? Would you do things job-related for me for free? Why would you ask them to?
 
2013-10-16 12:04:14 AM

Adolf Oliver Nipples: Infernalist: Adolf Oliver Nipples: solitary: Stop blaming the victim.

Who is the victim in all of this? I'm having trouble figuring it out. The sick person with no means to pay who gets care is a victim? How can that be? How about the hospital that has to eat the costs, are they victims in this? How about the doctors that take Medicare patients when Medicare doesn't pay the cost of care? Are they victims?

No.

Why not? Didn't they incur costs that have to be paid for? Would you do things job-related for me for free? Why would you ask them to?


Because they can afford it.
 
2013-10-16 12:06:27 AM

ginandbacon: "Superusers are a small but expensive group: One large study conducted from 2009-2012 at a Los Angeles hospital noted that 99 percent of ER visitors come in fewer than 10 times a year, with nearly 67 percent coming in just once. But, the remaining 1 percent of visitors accounted for thousands of visits in one year."

This paragraph is completely devoid of meaning.

Most "superusers" are like me, people with chronic conditions that put them in crisis at least a couple of times a year. I have excellent insurance (thank goodness) but I have 4 neurological conditions that have me dialing 911 not infrequently. Some people are certainly using ERs when they could use a PCP but that's not really that common. Ers suck. Hospitals suck. I've discharged myself against advice from both because I knew they were only keeping me because they didn't know what to do or because I would be an interesting case for the students the next morning. No one spends six hours in an ER for something minor. (Six if you're lucky. I've spent that long just waiting to be seen and then another six for tests before being admitted.) 

I don't understand why we keep vilifying patients and championing the assholes who profit off the ones they can and try to bankrupt the ones they can't exploit.


First of all, you are not a superuser. One of my tenants is a 71 yr old woman who has an itch and goes to the ER. Nothing came from it. She went in January for a rash and nothing came from it, she scrubbed herself to hard in the shower and it made a red mark. February is when her husband died, she had an emergency trip for "woman problems" but they sent her home with no prescriptions.

She has absolutely no reason to goto the ER except for the attention she gets - only once was a valid reason, her skin doesn't allow her to stay in the sun to long or it gets harden - she heads to the ER When she's out of cream  for it........
I think In August she had a massive headache and went to the ER.

Was she in dire pain in any of these situations? Nope - I was once a superbug when I went to the ER 7 times in less than 40 days. I had massive pains behind my eye for about an hour - the worst pain you could ever feel, and it would disappear.
Finally I got the right doctor who remembered reading about it in his college books - I had clustered headaches. Turns out my overwork habits caught up with me and my sleeping habits went to hell so my headaches came out. He printed me a sheet of paper of what to eat, how to control my sleep habits and asked me to book a date with the best nerosurgeon as soon as I can.

It took 7 trips because I had no clue what it was, I suspect not all people are lonely or having imaginary pains - mine I simply couldn't Identify it even with the internet's help. However people have no clue what other people medical conditions are, you can't point to me and say I am healthy when clearly I have one of the most harshest diseases known to man.
 
2013-10-16 12:06:53 AM
Sadly, part of the problem is also that people who don't necessarily need health care also abuse the system because it gets them something they want, attention.

I know it's awful to say but I've seen people in my neighborhood do this.  They go to the emergency room for the smallest of things because all of a sudden people care at least a little about them vs. being on the street where they're consistently ignored and disparaged.  It pisses me off that it's seen as a better thing to pay for emergency care rather than some simple social services.
 
2013-10-16 12:08:31 AM

sendtodave: So, yeah, free riders suck, and drive up prices. But the heatlhcare bus costs way too much already in the US. Bunch of thieves.


To be clear, I don't consider all poor people "free riders."  Just a very small percentage that take advantage of the system, as well as a small percentage of healthy middle class people who don't have insurance (hence mandatory coverage in ACA).  Most poor people do in fact work, and they work for insufficient wages - they are not "free riders."

I'm happy to be taxed so that everyone has access to health care, just like I'm happy to be taxed so that everyone has access to food.   The funny thing is, if we had such a health care tax (or some kind of universal single-payer system) we would probably pay less than we do now.  Setting aside the waste of going to the ER for minor issues, all the (costly) bureaucratic bullshiat, etc., preventative care for poor people means more people are working (not dying of preventable or treatable illnesses) which means a high GDP, more tax revenue, and generally win for everyone.

But that will never happen because IT'S NOT FAIR:(
 
2013-10-16 12:08:51 AM
have more walk-in clinics open in evenings.

problem solved.
 
2013-10-16 12:10:46 AM

Shryke: Ablejack: The US would continue R&D with a completely socialist healthcare system.

And this is why all other socialist medical systems do squat? Stunning observation.


No. It is because the US government already funds medical research.
 
2013-10-16 12:10:50 AM

Infernalist: Adolf Oliver Nipples: Infernalist: Adolf Oliver Nipples: solitary: Stop blaming the victim.

Who is the victim in all of this? I'm having trouble figuring it out. The sick person with no means to pay who gets care is a victim? How can that be? How about the hospital that has to eat the costs, are they victims in this? How about the doctors that take Medicare patients when Medicare doesn't pay the cost of care? Are they victims?

No.

Why not? Didn't they incur costs that have to be paid for? Would you do things job-related for me for free? Why would you ask them to?

Because they can afford it.


Well, we can now dismiss your opinion. Someone go to school for 8+ years, learns a highly demanding discipline where failure means somebody dies or is crippled for life, incurs a six-figure debt, and then puts themselves out there so that people can use them because "they can afford it"? No wonder we have a doctor shortage, who would put themselves through that just so people like you can hose them. There's absolutely no justice in that.
 
2013-10-16 12:11:20 AM
Anecdote: I have Tricare. Good insurance but in the last 6 months I had to find a new PCP. I guess Tricare is not profitable enough because a doc (under the auspices of a large corporate group) can no longer take my insurance. I went to the ER a couple of weeks ago. I am no hypochondriac, but 2 days of a tight chest and difficulty in breathing scared me. Turns out it may be pleurisy. Meds - i am fine 2 days later. What bugged me was the slack jawed chick in the ER who had a very, very newborn, dressed in a cute outfit, sprawled on her lap. She brought her baby in because the baby was not "acting right". I suggested she wrap the baby in a snug blankie and she said "She hates that and kicks them off." Newborns need that. She bundled her baby and voila she quit acting fussy - baby girl was bundled up and silent. Stupid young mother with no mothering skills. That is in our ERs.
 
2013-10-16 12:13:02 AM

cardex: pete1729: What my girlfriend who is an ER doc has to deal with on a regular basis.

http://www.youtube.com/watch?v=Q6sRyrB_UMA

My x in college was exatly like her, I can't remember how many times I spent the night in an effect waiting room becouse he had a seizure after we were together for 2 years I found out that he had been fakeing them to get disability. I don't know how I missed it for so long and it messed me up for a long time not able to trust anyone.


My ex-wife was faking seizures for a few years too. Some people...
 
2013-10-16 12:13:46 AM

Shadowtag: My girlfriend's been to the ER multiple times this year because her PCP is an incompetent twit. It took six months to get a specialist to answer the freaking phone and I had to resort to lawyering up just to file a greviance.

Health insurance in this country is maintained only because something must feed the Shoggoth, lest they multiply and run amok.


So... I read that as her being on PCP and thought she must be a crazy lay.
 
2013-10-16 12:14:52 AM

theflatline: swingerofbirches: I wish that primary doctors were in hospitals.

I don't see my primary care doctor too often because it takes a long time to get into see him, once you're there you have to wait longer than at urgent care places (not ERs), and he always has to send you to a specialist. The specialist never does anything on the first visit, or they send you somewhere else for lab work.

It would be nice if you could see your primary care doctor in a hospital, get any lab work you need at the same time, and if you're referred to a specialist, have that specialist at the same hospital and not start from square one again.

Even for more chronic things, I tend to go to my urgent care because they have a lab there and it's much faster to be seen (usually less than 15 minutes) compared to waiting up to 4 hours for a scheduled appointment with your primary care doctor. I then usually e-mail those lab results to my primary care doctor and communicate that way. I do have a great primary care doctor; he's just way overworked (especially compared to the specialists) and he has no equipment to do any testing in his office.

As someone who spent 20 years in the medical field you do not have a great primary care doctor.

You should never have to wait more than 20 minutes outside of your appointment time.  If he is too busy, he should not take on new patients.

He should have a lab in house.  Lab equipment is expensive, but that is where the majority of the money is made in a medical practice, and it allows him to be a better doctor.

Why does he always have to send you to specialist?  Because he gets a referral fee.  So he bills you and gets the payola.

You need a new doctor and not a greedy cheapskate.


OMG....I am gut-laughing like I haven't done in years! So funny.....

For those who don't know, this guy is an imbecile, and clearly doesn't have 20 minutes experience in the field, much less 20 years. Making money on in-office labs? Ha!!!! Try $4 for any lab draw, which barely pays for the needle you use. "Referral fees?" What world do you live in? This has NEVER been legal in the US, and the only "payola" any PCP gets is a basket of cheese doodles and a nice thank you card. Christ, specialists would give their left nut to be able to pay for referrals, but is so unbelievably unethical that no one would dare risk their own license, much less the license of the PCP. No license, no money, work at McDonald's. Shear stupidity.

I'm assuming I'm the only jackass biting on your troll, but for the ignorant, thought I'd shine a light on your silly, silly post. Grats on your super-fail.
 
2013-10-16 12:15:13 AM
ER nurse here (RN at a level 2 trauma center with ten years experience, charge nurse, triage nurse, trauma lead, pediatrics, blah blah blah.) A few thoughts:

- In medicine, you can have it be cheap, modern, or fast. For every system out there, you can only pick two of those attributes. We in the US pick modern and fast, most other first world countries pick modern and cheap, the third world goes cheap and fast. But you can't have all three, or at least we as humans haven't figure out how to do that yet. There are pros and come to each. It isn't ALL bad here in the US. Pretty bad, but there is a sunny side.
- There are ways to deal with frequent fliers (those who abuse the system for attention or drugs or a free warm place to sleep or because they are too stupid to know better). Sit them in triage for a thousand years until they leave, send social workers at them to give them resources to help themselves, arrest them for malingering and trespassing, education about the difference between their chronically perceived "emergencies" and actual emergencies, treat and street in fastback ASAP, and a few other tricks. And rarely are illegal immigrants those who abuse our resources.
- Obamacare is, depending on who you talk to, the end of American healthcare or a toothless half-measure without any lasting impact.
- I see no big changes in sight. You can't fix stupid and you can't refuse care to troglodytes without opening yourself to massive litigation.
 
2013-10-16 12:15:21 AM

solitary: Stop blaming the victim.

 
2013-10-16 12:16:31 AM

Adolf Oliver Nipples: Infernalist: Adolf Oliver Nipples: Infernalist: Adolf Oliver Nipples: solitary: Stop blaming the victim.

Who is the victim in all of this? I'm having trouble figuring it out. The sick person with no means to pay who gets care is a victim? How can that be? How about the hospital that has to eat the costs, are they victims in this? How about the doctors that take Medicare patients when Medicare doesn't pay the cost of care? Are they victims?

No.

Why not? Didn't they incur costs that have to be paid for? Would you do things job-related for me for free? Why would you ask them to?

Because they can afford it.

Well, we can now dismiss your opinion. Someone go to school for 8+ years, learns a highly demanding discipline where failure means somebody dies or is crippled for life, incurs a six-figure debt, and then puts themselves out there so that people can use them because "they can afford it"? No wonder we have a doctor shortage, who would put themselves through that just so people like you can hose them. There's absolutely no justice in that.


Yeah, pretty much.

Also, I don't give a single fark.  The lives of American citizens are more important that a rich fark getting richer.

Stick that in your pipe and smoke it.
 
2013-10-16 12:17:14 AM

spamdog: Shryke: Second, the for-profit U.S. system you decry so vociferously is, in fact, responsible for over half of the WORLD's medical research and advancement

lol, is it?

I'm pretty doubtful.


No doubt on the research. I take issue with calling it advancement.
 
2013-10-16 12:18:45 AM

AliceBToklasLives: Nice article - good job mentioned the key reason there are "superusers" - lack of health insurance.  For many people, the only way to see a doctor is to go to the ER.

And no, no one gets "free" treatment at the ER.  They send a bill and the patient is responsible for his care.  Of course hospitals have a hard time collecting since lack of health insurance is generally accompanied by a lack of monetary resources.  So who pays for a good chunk of ER visits?  Everyone else.

Also, you cannot get just any kind of treatment at the ER.  Sure, if you are having a heart attack they will stabilize you, and if you have a primary care physician you might (as TFA suggests) get some needed tests.  But it's not like you can walk in and say "I have a family history of colon cancer, I'm 50 and I'd like a colonoscopy."  Well, you can say that but you ain't getting no colonoscopy.  So you don't get the preventative treatment.  Who pays for your frequent visits during your bout with colon cancer?  You know who.


I think you miss the point that the 1% of retards who think the ER is the place to go when they have the sniffles waste time and money. And yes, idiots think the ER is the place to go for minor medical problems - Lord knows there are tons of rediclinics and other places for simple problems, they just can't be bothered with that.
 
2013-10-16 12:19:17 AM
It is very,very intimidating being in a thread with so many health care experts.
 
2013-10-16 12:19:45 AM

Adolf Oliver Nipples: Well, we can now dismiss your opinion. Someone go to school for 8+ years, learns a highly demanding discipline where failure means somebody dies or is crippled for life, incurs a six-figure debt, and then puts themselves out there so that people can use them because "they can afford it"? No wonder we have a doctor shortage, who would put themselves through that just so people like you can hose them. There's absolutely no justice in that.


Actually Adolf, it's people like you that get hosed. The doctors and hospitals get paid; by you, others with insurance, and the government (you again). The US government pays more for healthcare per capita than the French government does.
/if only our healthcare were as good.
 
2013-10-16 12:19:51 AM
Yeah, before I had insurance, I had to hit the ER for a genuine emergency (pancreatitis), and I noticed on my bill that my three-minute visit to the triage nurse cost $300.00. I tried adding up her salary for her time spent with me, institutional power and resources used, and it came nowhere near that; I would have pegged it at $40.00, generously. I was left wondering how much of that was due to overhead, insurance and such, and how much was due to people like me.

My debt was eventually forgiven, due to my poor financial standing, but that really made me boggle.
 
2013-10-16 12:21:16 AM

ginandbacon: "Superusers are a small but expensive group: One large study conducted from 2009-2012 at a Los Angeles hospital noted that 99 percent of ER visitors come in fewer than 10 times a year, with nearly 67 percent coming in just once. But, the remaining 1 percent of visitors accounted for thousands of visits in one year."

This paragraph is completely devoid of meaning.

Most "superusers" are like me, people with chronic conditions that put them in crisis at least a couple of times a year. I have excellent insurance (thank goodness) but I have 4 neurological conditions that have me dialing 911 not infrequently. Some people are certainly using ERs when they could use a PCP but that's not really that common. Ers suck. Hospitals suck. I've discharged myself against advice from both because I knew they were only keeping me because they didn't know what to do or because I would be an interesting case for the students the next morning. No one spends six hours in an ER for something minor. (Six if you're lucky. I've spent that long just waiting to be seen and then another six for tests before being admitted.) 

I don't understand why we keep vilifying patients and championing the assholes who profit off the ones they can and try to bankrupt the ones they can't exploit.


Not one statement in your post is correct, regarding anyone other than you.
 
2013-10-16 12:22:12 AM

OscarTamerz: [www.screeninsults.com image 500x368]
Thanks for the free healthcare estupido gringos. Send the bill to general delivery TJ and a check will be in the mail sooooon. I'm sure glad I voted for Hobama!


Hit the nail right on the head.

Most if not all illegal aliens are taught to use the emergency room for all their medical care.
 
2013-10-16 12:23:50 AM

fusillade762: But I've been assured by very serious people that our health care system is perfect as it is?


Few people think our health care system is great, let alone perfect.  Many people believe that Obamacare will make things much worse.  That's not the same thing as saying the system is perfect, great, or anything else including "in dire need of major changes".
 
2013-10-16 12:24:50 AM

phunkey_monkey: OscarTamerz: [www.screeninsults.com image 500x368]
Thanks for the free healthcare estupido gringos. Send the bill to general delivery TJ and a check will be in the mail sooooon. I'm sure glad I voted for Hobama!

Hit the nail right on the head.

Most if not all illegal aliens are taught to use the emergency room for all their medical care.


There's just something about the Main page that drags out the retards.
 
2013-10-16 12:27:44 AM

Ablejack: Actually Adolf, it's people like you that get hosed. The doctors and hospitals get paid; by you, others with insurance, and the government (you again). The US government pays more for healthcare per capita than the French government does.
/if only our healthcare were as good.


Infernalist: Also, I don't give a single fark. The lives of American citizens are more important that a rich fark getting richer.


Yep, rich. That's it.

For every doctor you see driving a Beemer and jet-setting there are 10 struggling the same as you. The arrogance of the position you guys are taking is astounding. A doctor owes you nothing. NOTHING. As much as any other person in the workforce, he earns his living. Yet you demand his charity, or, more to the point, his blood, out of some absurd sort of social justice which doesn't exist and isn't anything of the sort under any circumstances.
 
2013-10-16 12:28:44 AM

YouFarkingIdiot: fusillade762: But I've been assured by very serious people that our health care system is perfect as it is?

Few people think our health care system is great, let alone perfect.  Many people believe that Obamacare will make things much worse.  That's not the same thing as saying the system is perfect, great, or anything else including "in dire need of major changes".


Obamacare is the only hope for the insurance based system. Without ACA, the US would socialize medicine much more quickly; out of necessity.
 
2013-10-16 12:30:24 AM

AliceBToklasLives: Nice article - good job mentioned the key reason there are "superusers" - lack of health insurance.  For many people, the only way to see a doctor is to go to the ER.

And no, no one gets "free" treatment at the ER.  They send a bill and the patient is responsible for his care.  Of course hospitals have a hard time collecting since lack of health insurance is generally accompanied by a lack of monetary resources.  So who pays for a good chunk of ER visits?  Everyone else.

Also, you cannot get just any kind of treatment at the ER.  Sure, if you are having a heart attack they will stabilize you, and if you have a primary care physician you might (as TFA suggests) get some needed tests.  But it's not like you can walk in and say "I have a family history of colon cancer, I'm 50 and I'd like a colonoscopy."  Well, you can say that but you ain't getting no colonoscopy.  So you don't get the preventative treatment.  Who pays for your frequent visits during your bout with colon cancer?  You know who.


After ~ 7 years working at an island ER in a community with absolutely no outreach or poverty intervention programs, I've witnessed that this is the norm.  Irony: most of the 'working poor' I knew (motel housekeepers, service industry folks) might be able to get medicaid for the kids, but no adult coverage existed if you did not have a legally defined physical disability.

You have the ER Visit abusers, always. Then you have sincerely needy people who put off something small that could have been treated simply with a brief office visit that they had no way to afford. But with no coverage, the person waits it out, hoping over the counter measures will work. When it doesn't, and increasing pain or threat of work-loss happens, the ER becomes the only recourse because we couldn't refuse treatment over ability to pay.
 
2013-10-16 12:30:56 AM

Mitch Taylor's Bro: Peter von Nostrand: I believe the correct nomenclature is frequent flyers

That's in the article, too. But using generally accepted terms doesn't generate web site traffic and ad impressions.


Or generate sympathy.

Let's see how to make this look REALLY BAD.

Water is a natural right, everyone needs it to live. The government should take over so that farmers and ranchers never need to spend a penny of their own for it, and the rest of us should pay for it. (note:I'm pretty sure this actually happens and I hate it)
 
2013-10-16 12:31:07 AM

Ablejack: YouFarkingIdiot: fusillade762: But I've been assured by very serious people that our health care system is perfect as it is?

Few people think our health care system is great, let alone perfect.  Many people believe that Obamacare will make things much worse.  That's not the same thing as saying the system is perfect, great, or anything else including "in dire need of major changes".

Obamacare is the only hope for the insurance based system. Without ACA, the US would socialize medicine much more quickly; out of necessity.


Obamacare is the ONLY hope, are you just trolling?
 
2013-10-16 12:32:40 AM
The average lay person is so ill informed regarding healthcare.

Most 'superusers' usually have some form of insurance...the most common offender is medicaid patients. They often pay nothing for their ER visits and thus have not a single disincentive to wait to see their primary doctor. If you ask them why they are in the ER for a minor ailment, they are usually very up front that their doctor cant see them for a few day and they didnt feel like waiting. Its a matter of convenience and there is no cost to them.

Other forms of 'Superusers' come in the form of privately insured or medicare patients with some variety of personality disorder which drives their need for repeated er visits. Typical examples are the chronic pain patient who is never given enough pain medication or the borderline personality patients that fabricate a variety or nonsepific symptos in order to get attention and create a disturbance.

The fear of legal consequences permits the continuation of this behavior at the detriment of care to others. Even without all of these people abusing the system, emergency services are already struggling to meet demand.

And if I can give one piece of advice, it is for lay people to please stay out of healthcare decision-making. The reality is that most people are ignorant of the actual problems and their good intentions often only make things worse.
 
2013-10-16 12:33:39 AM

Adolf Oliver Nipples: Ablejack: Actually Adolf, it's people like you that get hosed. The doctors and hospitals get paid; by you, others with insurance, and the government (you again). The US government pays more for healthcare per capita than the French government does.
/if only our healthcare were as good.

Infernalist: Also, I don't give a single fark. The lives of American citizens are more important that a rich fark getting richer.

Yep, rich. That's it.

For every doctor you see driving a Beemer and jet-setting there are 10 struggling the same as you. The arrogance of the position you guys are taking is astounding. A doctor owes you nothing. NOTHING. As much as any other person in the workforce, he earns his living. Yet you demand his charity, or, more to the point, his blood, out of some absurd sort of social justice which doesn't exist and isn't anything of the sort under any circumstances.


Now you are just rambling on about things you've made up. I have healthcare insurance. It's just that I understand the system is failing.
 
2013-10-16 12:34:48 AM
When a super user comes in, stick their ass in the bathroom and forget about them..... they'll leave sooner or later.  Or, die - either way, problem solved and cheaper healthcare for everyone.
 
2013-10-16 12:37:22 AM

mikeray: Ablejack: Obamacare is the only hope for the insurance based system. Without ACA, the US would socialize medicine much more quickly; out of necessity.

Obamacare is the ONLY hope, are you just trolling?


Well, the healthcare industry was toppling the economy. Something had to give. Obamacare makes the system more efficient rather than scrapping it and going public.
 
2013-10-16 12:39:28 AM
It's the Pareto principle in another dimension. 99% of the population uses 1% of ER resources. The other 1% of hypochondriacs, homeless drunks and addicts, and maybe a smidgeon of new mothers prone to panic burden the system.

The hypochondriacs need to be treated elsewhere (or given a course on how they'll get MRSA in the ER), programs have experimented with giving the most expensive homeless subsidized apartments, and new mothers need access to educational programs.
 
2013-10-16 12:40:11 AM

Ablejack: mikeray: Ablejack: Obamacare is the only hope for the insurance based system. Without ACA, the US would socialize medicine much more quickly; out of necessity.

Obamacare is the ONLY hope, are you just trolling?

Well, the healthcare industry was toppling the economy. Something had to give. Obamacare makes the system more efficient rather than scrapping it and going public.


Now that's just crazy talk. Good day sir, good day.
 
2013-10-16 12:41:39 AM

mikeray: Ablejack: mikeray: Ablejack: Obamacare is the only hope for the insurance based system. Without ACA, the US would socialize medicine much more quickly; out of necessity.

Obamacare is the ONLY hope, are you just trolling?

Well, the healthcare industry was toppling the economy. Something had to give. Obamacare makes the system more efficient rather than scrapping it and going public.

Now that's just crazy talk. Good day sir, good day.


How so?
 
2013-10-16 12:42:37 AM

mikeray: Ablejack: YouFarkingIdiot: fusillade762: But I've been assured by very serious people that our health care system is perfect as it is?

Few people think our health care system is great, let alone perfect.  Many people believe that Obamacare will make things much worse.  That's not the same thing as saying the system is perfect, great, or anything else including "in dire need of major changes".

Obamacare is the only hope for the insurance based system. Without ACA, the US would socialize medicine much more quickly; out of necessity.

Obamacare is the ONLY hope, are you just trolling?


Did you stop reading before the "insurance based system" part?
 
2013-10-16 12:45:46 AM

Ablejack: Now you are just rambling on about things you've made up. I have healthcare insurance. It's just that I understand the system is failing.


I also understand the system is failing, and for years I fought against the idea that we should socialize medicine because I didn't want MY money to go to the freeloaders. I had this great big highfallutin' idea that I was earning it and I owed nobody anything. I don't believe that anymore. More to the point, I don't see how I ever did believe that. Now I am completely 180 degrees from where I was before, so much so that I don't think Obamacare goes far enough. In that you and I are in complete agreement.

That does not mitigate the fact that doctors, even the ones that do drive Beemers and live in mansions, do a job that I am both incapable and unwilling to do. It is not right to assert a claim on their labor because they are "rich". You want to be "rich"? Go to school and earn it. I think you'll find that it doesn't pay off quite as well for everybody as you've been led to believe.

This isn't so much about you or your comment as much as it is the idea that we have some sort of right to lay claim on someone's work. The other guy I quoted said exactly that. Your comment about high cos per capita merely implied it. While you're right about the high costs, how much of that trickles down? Healthcare is like any other industry, the people at the bottom always suck hind tit.
 
2013-10-16 12:46:03 AM

Rev.K: Well, if there's one thing we know it's that the United States put a man on the moon, but healthcare can just never be fixed.

Never ever ever.


Well sure, that would be soshulizm and we can't be having that.
 
2013-10-16 12:53:52 AM

Fano: ginandbacon: "Superusers are a small but expensive group: One large study conducted from 2009-2012 at a Los Angeles hospital noted that 99 percent of ER visitors come in fewer than 10 times a year, with nearly 67 percent coming in just once. But, the remaining 1 percent of visitors accounted for thousands of visits in one year."

This paragraph is completely devoid of meaning.

Most "superusers" are like me, people with chronic conditions that put them in crisis at least a couple of times a year. I have excellent insurance (thank goodness) but I have 4 neurological conditions that have me dialing 911 not infrequently. Some people are certainly using ERs when they could use a PCP but that's not really that common. Ers suck. Hospitals suck. I've discharged myself against advice from both because I knew they were only keeping me because they didn't know what to do or because I would be an interesting case for the students the next morning. No one spends six hours in an ER for something minor. (Six if you're lucky. I've spent that long just waiting to be seen and then another six for tests before being admitted.) 

I don't understand why we keep vilifying patients and championing the assholes who profit off the ones they can and try to bankrupt the ones they can't exploit.

Not one statement in your post is correct, regarding anyone other than you.


No?

"Despite the widespread belief that these patients can be directed elsewhere, these patients for the most part need to be treated when they come in,"
 
2013-10-16 12:54:32 AM

nickdaisy: Here's an idea: how about everyone take care of their own bills?  Get the state out of it completely. If you want to pool resources with some like minded folks and spend money for insurance, go for it. Or if you want to just pay as you go, or save up and pay, or save nothing and then bleed out when something happens-- go for it.  Similarily, if you want to start a charity to fix clef lips or teach retarded kids to skateboard-- go for it.

That's the American way. You succeed or fail based on your own ability.  Should be no different for health care than it is for education, quarterbacking, or meeting chicks. Unfortunately, under today's quasi-socialist system, everybody gets an A, everyone gets a chance to play quarterback, and if you can't find a date to the prom it's because you "suffer" from Asperger's and are a "victim" of bullying.

More person responsibility, less collectivism.

However, IF you insist on turning us into the USSA, at least go full throttle. The current system is NOT free market and Obamacare is NOT true socialism. Health care (including Obamacare) is driven by corporations that are so in bed with the federal government that they have corrupted any sense of altruism, yet at the same time they are not true market actors.  We're getting the worst of both worlds.

Who's with me?


Your rationalism has no place in America.
 
2013-10-16 12:54:53 AM

OscarTamerz: [www.screeninsults.com image 500x368]
Thanks for the free healthcare estupido gringos. Send the bill to general delivery TJ and a check will be in the mail sooooon. I'm sure glad I voted for Hobama!


So original...
2/10
 
2013-10-16 12:55:39 AM

Infernalist: phunkey_monkey: OscarTamerz: [www.screeninsults.com image 500x368]
Thanks for the free healthcare estupido gringos. Send the bill to general delivery TJ and a check will be in the mail sooooon. I'm sure glad I voted for Hobama!

Hit the nail right on the head.

Most if not all illegal aliens are taught to use the emergency room for all their medical care.

There's just something about the Main page that drags out the retards.


He's not that wrong. When I got bitten by a raccoon in D.C., I was in the process of traveling, and headed to Florida to get my exam in the ER. When I asked how much it would cost (I didn't have insurance at the time) the doctor asked me if I could pay. I said "of course, I'm not a deadbeat." He laughed and then said, "then you'll be paying a lot." He explained to me that they had tons of illegals who didn't pay squat, therefore, everyone else had to pay MUCH more.
 
2013-10-16 12:58:16 AM

HotWingAgenda: nickdaisy: Here's an idea: how about everyone take care of their own bills?  Get the state out of it completely. If you want to pool resources with some like minded folks and spend money for insurance, go for it. Or if you want to just pay as you go, or save up and pay, or save nothing and then bleed out when something happens-- go for it.  Similarily, if you want to start a charity to fix clef lips or teach retarded kids to skateboard-- go for it.

That's the American way. You succeed or fail based on your own ability.  Should be no different for health care than it is for education, quarterbacking, or meeting chicks. Unfortunately, under today's quasi-socialist system, everybody gets an A, everyone gets a chance to play quarterback, and if you can't find a date to the prom it's because you "suffer" from Asperger's and are a "victim" of bullying.

More person responsibility, less collectivism.

However, IF you insist on turning us into the USSA, at least go full throttle. The current system is NOT free market and Obamacare is NOT true socialism. Health care (including Obamacare) is driven by corporations that are so in bed with the federal government that they have corrupted any sense of altruism, yet at the same time they are not true market actors.  We're getting the worst of both worlds.

Who's with me?

Your rationalism has no place in America.


I'm sorry but you are in the wrong thread to be talking about personal responsibility . What is that and who is going to pay for it for me?
 
2013-10-16 12:58:28 AM

TheMega: When a super user comes in, stick their ass in the bathroom and forget about them..... they'll leave sooner or later.  Or, die - either way, problem solved and cheaper healthcare for everyone.


Asshole.
 
2013-10-16 01:02:26 AM

ginandbacon: Fano: ginandbacon: "Superusers are a small but expensive group: One large study conducted from 2009-2012 at a Los Angeles hospital noted that 99 percent of ER visitors come in fewer than 10 times a year, with nearly 67 percent coming in just once. But, the remaining 1 percent of visitors accounted for thousands of visits in one year."

This paragraph is completely devoid of meaning.

Most "superusers" are like me, people with chronic conditions that put them in crisis at least a couple of times a year. I have excellent insurance (thank goodness) but I have 4 neurological conditions that have me dialing 911 not infrequently. Some people are certainly using ERs when they could use a PCP but that's not really that common. Ers suck. Hospitals suck. I've discharged myself against advice from both because I knew they were only keeping me because they didn't know what to do or because I would be an interesting case for the students the next morning. No one spends six hours in an ER for something minor. (Six if you're lucky. I've spent that long just waiting to be seen and then another six for tests before being admitted.) 

I don't understand why we keep vilifying patients and championing the assholes who profit off the ones they can and try to bankrupt the ones they can't exploit.

Not one statement in your post is correct, regarding anyone other than you.

No?

"Despite the widespread belief that these patients can be directed elsewhere, these patients for the most part need to be treated when they come in,"


The article stated for the most part they were drunks and mental patients. Can we do it cheaper by having a place for drug abusers and nuts to go to, that ISN'T the ER?
 
2013-10-16 01:05:37 AM

HotWingAgenda: nickdaisy: Here's an idea: how about everyone take care of their own bills?  Get the state out of it completely. If you want to pool resources with some like minded folks and spend money for insurance, go for it. Or if you want to just pay as you go, or save up and pay, or save nothing and then bleed out when something happens-- go for it.  Similarily, if you want to start a charity to fix clef lips or teach retarded kids to skateboard-- go for it.

That's the American way. You succeed or fail based on your own ability.  Should be no different for health care than it is for education, quarterbacking, or meeting chicks. Unfortunately, under today's quasi-socialist system, everybody gets an A, everyone gets a chance to play quarterback, and if you can't find a date to the prom it's because you "suffer" from Asperger's and are a "victim" of bullying.

More person responsibility, less collectivism.

However, IF you insist on turning us into the USSA, at least go full throttle. The current system is NOT free market and Obamacare is NOT true socialism. Health care (including Obamacare) is driven by corporations that are so in bed with the federal government that they have corrupted any sense of altruism, yet at the same time they are not true market actors.  We're getting the worst of both worlds.

Who's with me?

Your rationalism has no place in America.


Cool!  Poor people dying in the streets!
 
2013-10-16 01:07:56 AM

Reverend Monkeypants: HotWingAgenda: nickdaisy: Here's an idea: how about everyone take care of their own bills?  Get the state out of it completely. If you want to pool resources with some like minded folks and spend money for insurance, go for it. Or if you want to just pay as you go, or save up and pay, or save nothing and then bleed out when something happens-- go for it.  Similarily, if you want to start a charity to fix clef lips or teach retarded kids to skateboard-- go for it.

That's the American way. You succeed or fail based on your own ability.  Should be no different for health care than it is for education, quarterbacking, or meeting chicks. Unfortunately, under today's quasi-socialist system, everybody gets an A, everyone gets a chance to play quarterback, and if you can't find a date to the prom it's because you "suffer" from Asperger's and are a "victim" of bullying.

More person responsibility, less collectivism.

However, IF you insist on turning us into the USSA, at least go full throttle. The current system is NOT free market and Obamacare is NOT true socialism. Health care (including Obamacare) is driven by corporations that are so in bed with the federal government that they have corrupted any sense of altruism, yet at the same time they are not true market actors.  We're getting the worst of both worlds.

Who's with me?

Your rationalism has no place in America.

Cool!  Poor people dying in the streets!


As opposed to what?
'
 
2013-10-16 01:09:26 AM
So taking full advantage of the Bush national health care plan?
 
2013-10-16 01:27:45 AM
it would also help if ER doctors would grow a farking spine and kick out the patients who are well known to use the ER for food and shelter. Most of my on call conversations go something like this:

ER Attending:  Hey, this guy say's he suicidal
Psych Consultant: Yeah, he's a well-known malingerer who uses psych wards as shelter.  He's full of shiat.  You can send him on his way.
ER: But he says he's SUICIDAL!?
Psych:  yeah, he says that every time he comes into an ER.  He gets himself admitted, gets a few days of sandwiches, gets bored, and moves on to a new hospital
ER:  So can we admit him to your psych floor?
Psych:  Umm, no.  we're not a homeless shelter.
ER:  So what happens if he kills himself?
Psych:  He won't. Our whole department knows this guy.  He's been coming in with the same feigned psych complaints for the last 10 years. He says in psych wards because they're more cozy than the city's homeless shelters. Not once has he had anything close to a suicide attempt
ER:  But he says he has "Schizoaffective Bipolar Disorder"
Psych:  (gives look of "are you a farking moron?)
ER:  Look, I'm really concerned about my liability, can you just admit him?
Psych: Look, it's Friday night, and we only have two beds on our unit.  We're not wasting one on a guy who is well known in the entire city of ____ to be faking his symptoms as a means to get sandwiches. If we run out of beds and one of our established patients shows up between now and Monday morning, we're putting that patient's life at risk if we transfer them to another hospital.  We've had enough problems with community hospitals abruptly stopping clozapine on our patients this year, and I'm not about to let that happen because you're too much of a pants-pisser to make a god damn necessary clinical decision.
ER:  Fine, I'll admit him to telemetry.


...and that's how your healthcare dollars are spent.
 
2013-10-16 01:53:02 AM
uhh, obvious tag missing?  Hospitals are already legally required to treat everyone who comes to the ER.  Sharing the cost for a privilege everyone has is not that crazy.
 
2013-10-16 02:03:18 AM

GreenAdder: Can't we just disable root access at the admin level?


Surprised it took so long for a su comment
 
2013-10-16 02:23:20 AM

Fano: The article stated for the most part they were drunks and mental patients. Can we do it cheaper by having a place for drug abusers and nuts to go to, that ISN'T the ER?


The Tea Party caucus?
 
2013-10-16 02:29:50 AM

ShawnDoc: Fano: The article stated for the most part they were drunks and mental patients. Can we do it cheaper by having a place for drug abusers and nuts to go to, that ISN'T the ER?

The Tea Party caucus?


Yes California, they will just be normal folks there.
 
2013-10-16 02:52:10 AM

ransack.: GreenAdder: Can't we just disable root access at the admin level?

Surprised it took so long for a su comment


This incident will be reported.
 
2013-10-16 03:08:35 AM

fickenchucker: And where do some of you live--six hours in the ER? The longest I've ever waited, start to finish, is maybe 90 minutes, and I'm out the door or watching my kid go into appendectomy surgery.


5 hours, last week, University of Michigan, medium sized city, 8 PM, weekday, damn good hospital and thankfully my insurance doesn't discriminate and covers all ERs (pathetic I had to call and check).  Went to urgent care first and they gave me a do not pass Go go directly to the ER directive.


I did get periodic progress throughout though (triage nurse at 30 minutes, in a room an hour after, registration person, nurse, etc., treatment proper between hours 3 1/2 and 5.  The periodic progress + Walking Dead marathon + in a room = I was cool.

Longest I've waited just to get a room and an exam beyond "pain 1-10" and temperature (while in the waiting room) was in a different hospital, 6 hours, and that was with urgent care (again, my first choice is not the ER if I can help it) ready to call an ambulance if my SO didn't drive me there.

Congrats.
 
2013-10-16 03:10:44 AM

Longtime Lurker: Look, I'm really concerned about my liability,


Yup, there it is.

/facepalm
 
2013-10-16 03:24:35 AM
Last year, drove into town to pick up my after after some cancer tests,pulled into the ER, and it looked like it was standing room only when I walked in. What a mess! I asked the attendant, and she said it always gets like that after normal business hours. I'm of the impression "there's nothing on TV tonight, let's hang out at the ER".
/Scum.
//Uninsured.
 
2013-10-16 03:32:12 AM

Fano: ginandbacon: Fano: ginandbacon: "Superusers are a small but expensive group: One large study conducted from 2009-2012 at a Los Angeles hospital noted that 99 percent of ER visitors come in fewer than 10 times a year, with nearly 67 percent coming in just once. But, the remaining 1 percent of visitors accounted for thousands of visits in one year."

This paragraph is completely devoid of meaning.

Most "superusers" are like me, people with chronic conditions that put them in crisis at least a couple of times a year. I have excellent insurance (thank goodness) but I have 4 neurological conditions that have me dialing 911 not infrequently. Some people are certainly using ERs when they could use a PCP but that's not really that common. Ers suck. Hospitals suck. I've discharged myself against advice from both because I knew they were only keeping me because they didn't know what to do or because I would be an interesting case for the students the next morning. No one spends six hours in an ER for something minor. (Six if you're lucky. I've spent that long just waiting to be seen and then another six for tests before being admitted.) 

I don't understand why we keep vilifying patients and championing the assholes who profit off the ones they can and try to bankrupt the ones they can't exploit.

Not one statement in your post is correct, regarding anyone other than you.

No?

"Despite the widespread belief that these patients can be directed elsewhere, these patients for the most part need to be treated when they come in,"

The article stated for the most part they were drunks and mental patients. Can we do it cheaper by having a place for drug abusers and nuts to go to, that ISN'T the ER?


Wow, it did? Where? Because I read it again, and I nowhere saw the words "drunks and mental patients" and the only thing even close to what you said was in reference to ONE program in ONE hospital which said, quote:

According to Villar, many patients are using the ER to access other services, such as substance abuse treatment.

Now, also according to the article, quote: He says although his program had success, it came to a stop once the research finished. Villar said the problem was an issue of resources, including money and personnel.

So a) for the most part, the chronic ER users are not, according to the article "drunks and mental patients," they are chronically ill with a variety of illnesses, including mental illness and substance abuse, and b) yes, we could in fact make services available cheaper and free up ER space; unfortunately kindly people like yourself don't seem to want to fund people like Dr. Villar; instead they would rather criminalize drug use and stigmatize the mentally ill so they have nowhere to go BUT the County ER.

Do you begin to see the problem here, or do I need to use smaller words for you?
 
2013-10-16 04:00:23 AM
If only there were some program ... maybe funded and run by the government ... that assured that Americans got affordable access to basic healthcare, regardless of their employment status.
 
2013-10-16 04:12:34 AM

Mitch Taylor's Bro: I'm willing to be that most of those "superusers" should be going to urgent care, not ER


This reminded me of something - if you don't have insurance but DO have a reasonable amount of assets 'urgent care' at the proper clinic* can be far cheaper than an ER visit.

I have to make the disclaimer because there's still not enough 'competition' between health care providers, nor enough disclosure of billing practices and reasoning.  It's quite possible to have a urgent care visit that's under the cost of most copays/deductibles as is.

runwiz: I actually read something that had contrary conclusions.  It said that while superusers clogged the system their problems were often easy and cheap to treat and were profit makers that subsidized the high cost of expensive equipment.  If emergency rooms only treated true emergencies there would be too few to offset the cost of operating the emergency room and would result in either higher costs or the closure of ERs.  The problem comes from the fact that many superusers are uninsured and thus the hospitals cannot charge as much as they would like.


Well, a 'superuser' in the form of somebody with a chronic condition will indeed likely be fairly cheap to treat in the sense that you won't need a huge amount of diagnostics/doctor time, as they'll likely already know what's wrong with them and the necessary course of treatment.

However, on the equipment - there's a reason that all ER's I know about are attachments to a hospital.  The equipment within an ER for the most part is necessary for the hospital anyways, and I think that the marginal cost for setting up another exam room or even operating theator is quite reasonable if you look at it from a business angle vs a personal one($100k is often nothing to the large businesses that most hospitals are, $100k is a lot to most individuals).

Of course, my personal preference is that we don't involve healthcare plans masquerading as 'insurance' from dollar 1 anyways.  If most people paid for most of their own healthcare I think costs would drop substantially - the insurance companies impose an extreme amount of overhead, and not just in their policies.  As a result of them healthcare providers have to both set up extremely expensive billing departments to get money out of them, but are also insulated from standard competitive pressures that result in better services at lower costs.

Shop around a bit in medical realms where people still normally pay themselves, such as for plastic surgery, laser vision correction, and such and you find that costs tend to be quite reasonable.  Whether that's because they wouldn't exist if they weren't reasonable could be argued, but I remember the price drops these procedures have undergone as they went 'commercial'.
 
2013-10-16 06:06:10 AM

OtherBrotherDarryl: Use urgent care centers!


Serious question--do urgent care centers have to take people irregardless of ability to pay the way emergency rooms do?
 
2013-10-16 06:25:45 AM

Firethorn: Of course, my personal preference is that we don't involve healthcare plans masquerading as 'insurance' from dollar 1 anyways.  If most people paid for most of their own healthcare I think costs would drop substantially - the insurance companies impose an extreme amount of overhead, and not just in their policies.  As a result of them healthcare providers have to both set up extremely expensive billing departments to get money out of them, but are also insulated from standard competitive pressures that result in better services at lower costs.

Shop around a bit in medical realms where people still normally pay themselves, such as for plastic surgery, laser vision correction, and such and you find that costs tend to be quite reasonable.  Whether that's because they wouldn't exist if they weren't reasonable could be argued, but I remember the price drops these procedures have undergone as they went 'commercial'.


One thing health care plans provide is discounting. If you have insurance and even if you are paying out-of-pocket with a high deductible, hospitals will bill you at a much lower rate for care (saw a hospital stay of $30k get billed to Blue Cross for $9k). With no insurance you pay full retail. Also you can set up an HSA with high-deductible insurance so your health care is tax-free. Without an HSA you pay after-tax dollars and you can't even start to write it off until it's around 7% of your income.
 
2013-10-16 06:50:26 AM

ginandbacon: Mitch Taylor's Bro: ginandbacon: Most "superusers" are like me, people with chronic conditions that put them in crisis at least a couple of times a year. I have excellent insurance (thank goodness) but I have 4 neurological conditions that have me dialing 911 not infrequently. Some people are certainly using ERs when they could use a PCP but that's not really that common. Ers suck. Hospitals suck. I've discharged myself against advice from both because I knew they were only keeping me because they didn't know what to do or because I would be an interesting case for the students the next morning. No one spends six hours in an ER for something minor. (Six if you're lucky. I've spent that long just waiting to be seen and then another six for tests before being admitted.)

I don't understand why we keep vilifying patients and championing the assholes who profit off the ones they can and try to bankrupt the ones they can't exploit.

You must've missed this key sentence:

"There are patients who have serious medical conditions who see the ER as the point of access," Dorner said.

It is the point of access for those of us who have major crises. That's sort of the point of them.

You lack reading comprehension. Got it.

How is that?

You start off with "most superusers are like you..." then talk about how your chronic conditions force you to go to ER a lot. Then you move into talking about how some people go to ER when they should be going to a primary care physician, but it's not that common, then say that no one goes to ER for minor stuff.

Is that accurate so far?

So I highlight the least ranty part of that paragraph, "No one spends six hours in an ER for something minor," and copypasta-ed that sentence FTFA that describes you to a "T" to point out that the article agrees with your original statement that "most superusers are like you." Maybe I should've copypasta-ed the three paragraphs that preceded it? Maybe you could go back and re-read TFA and let me know if that would've helped. Or m ...

I get the feeling you and I probably have very similar goals for health care for our fellow citizens. 

I think this article sheds a slightly better light on the issue as evidenced by this quote "While they represented just .2 percent of all patients, they accounted for 4.5 percent of all emergency department visits in the region.
The new studies found that frequent users typically have serious medical issues."

http://www.healthpolicysolutions.org/2012/10/10/er-frequent-flyers-n ee d-more-care-not-less/

"Superusers" aren't really a big burden on ERs and most of them are there for a very good reason.

As I mentioned, I am really lucky. I have conditions that I have learned how to manage for the most part to keep me out of the ER and fantastic health insurance, BUT there are times when I need that critical care. I don't think anyone should think twice about seeking out that care when they need it just because the media has coined a nasty term to describe them. (Or me.) The next time I wake up on a sidewalk from low blood pressure or end up in acute renal failure after vomiting for 5 days, I will end up in the ER. And that's exactly where I should be. I could get even more graphic but it seems unnecessary. 

And I need to stress again that I am one of the lucky ones. Except for the renal failure and the pulmonary embolisms last spring, I really don't have anything to worry about. And I, unlike millions of very ill Americans, I don't have to worry about how to pay for my many trips to the ER.

And just to wind this up, I really do think you and I are probably on the same side on this issue if we just had a chance to sit down over a drink and hash it out.


If I remember right, you're a teacher. Of course you have no worries. Most people in the private sector have worries.
 
2013-10-16 06:52:02 AM

hardinparamedic: Marcus Aurelius: hardinparamedic: Free treatment in the ER?

That's the joke, right?

/EMTALA is not free.

Don't even get me started on the ambulance ride.

Which in an ideal world of taxpayer funded third service EMS agencies would be free too.

Thanks Obama.


It still wouldn't matter. 30million illegal aliens would still be using emergency rooms as first line medical because they work for cash and don't pay into the standard taxing systems.

You'd have to try to push a VAT tax to cover it, which wouldn't be a bad idea if you could get some cost controls in place.
 
2013-10-16 07:12:46 AM

Ablejack: Adolf Oliver Nipples: Well, we can now dismiss your opinion. Someone go to school for 8+ years, learns a highly demanding discipline where failure means somebody dies or is crippled for life, incurs a six-figure debt, and then puts themselves out there so that people can use them because "they can afford it"? No wonder we have a doctor shortage, who would put themselves through that just so people like you can hose them. There's absolutely no justice in that.

Actually Adolf, it's people like you that get hosed. The doctors and hospitals get paid; by you, others with insurance, and the government (you again). The US government pays more for healthcare per capita than the French government does.
/if only our healthcare were as good.


Look up when the French got air condictioning in their hospitals.
 
2013-10-16 07:26:29 AM

Gyrfalcon: Do you begin to see the problem here, or do I need to use smaller words for you?


Heh. I've had you favorited for a very long while and posts like this are exactly why.

Firethorn: Well, a 'superuser' in the form of somebody with a chronic condition will indeed likely be fairly cheap to treat in the sense that you won't need a huge amount of diagnostics/doctor time, as they'll likely already know what's wrong with them and the necessary course of treatment.


This is actually really true--unless something funky is going on like the time I got the blood clots in both lungs (I knew something was very wrong, I just didn't know what) I can pretty much show up and tell the attending what they need to do to treat and release me. My first few visits were ridiculously costly because no one in the room knew what was going on so they would order every test on the books and admit me.

These days I pretty much show up with a treatment plan and most of the time, depending on which ER I end up in, I can get in and out fairly quickly. And most EMTs will take me to the hospital I prefer which is in the same network as my PCP so they have my records which also helps speed things up a lot. I'm also incredibly compliant and basically pretty pleasant to deal with so I tend to get seen right away. Most of the staff in ERs are usually really happy to treat me since I'm not hard to work with. I've even become close friends with a nurse I had during one of my admissions.

Again, I should point out that most of what I'm dealing with is not life-threatening unless I manage it badly and I am learning how to not do that so I am a patient who is fairly easy to deal with. Most of us frequent flyers come in knowing exactly what needs doing and we do it with good cheer which makes us kind of the darlings of the ERs.

And I infinitely prefer not to be there but it's a whole heck of a lot better than being admitted and having to deal with hospital food for a few days. I'd rather go to the ER sooner and avoid that. Which is also cheaper in the long run.
 
2013-10-16 07:39:47 AM

AlwaysRightBoy: If I remember right, you're a teacher. Of course you have no worries. Most people in the private sector have worries.


Ah no! I have tutored kids in reading but it is a volunteer gig. It's insanely gratifying and something I would recommend to anyone. I have had insurance through the private sector and the public though. Both were wonderful. My private sector insurance was top notch. I think it was $10 to see my PCP, $40 for ambulance or ER visits, and $5 for meds. Admissions and diagnostic tests were free. I pay less with my gubmint one but it is a little more restrictive and I can't just do whatever my PCP wants whenever we want to. I have no real complaints though. Everything I have needed on it has been covered. The private insurance I had when all of this first started really needing insurance was through a very well known university and was one of the things that made up for the thin-as-air paycheck. That and the time off were hard to beat.
 
2013-10-16 07:45:55 AM

Mitch Taylor's Bro: ginandbacon: "Superusers are a small but expensive group: One large study conducted from 2009-2012 at a Los Angeles hospital noted that 99 percent of ER visitors come in fewer than 10 times a year, with nearly 67 percent coming in just once. But, the remaining 1 percent of visitors accounted for thousands of visits in one year."

This paragraph is completely devoid of meaning.

Most "superusers" are like me, people with chronic conditions that put them in crisis at least a couple of times a year. I have excellent insurance (thank goodness) but I have 4 neurological conditions that have me dialing 911 not infrequently. Some people are certainly using ERs when they could use a PCP but that's not really that common. Ers suck. Hospitals suck. I've discharged myself against advice from both because I knew they were only keeping me because they didn't know what to do or because I would be an interesting case for the students the next morning. No one spends six hours in an ER for something minor. (Six if you're lucky. I've spent that long just waiting to be seen and then another six for tests before being admitted.) 

I don't understand why we keep vilifying patients and championing the assholes who profit off the ones they can and try to bankrupt the ones they can't exploit.

You must've missed this key sentence:

"There are patients who have serious medical conditions who see the ER as the point of access," Dorner said.


In the state where I live, people on Medicaid are limited to those doctors who choose to accept the small, normally late payments from the State. This can make it very difficult to get an appointment, so very often they're waiting until that little ailment gets bad enough that they can't put off a visit any longer, then heading to the ER.

Sure, ER visits are much higher than regular office visits, but hey, the state's paying the bill so who cares?
 
2013-10-16 07:54:35 AM

flondrix: OtherBrotherDarryl: Use urgent care centers!

Serious question--do urgent care centers have to take people irregardless of ability to pay the way emergency rooms do?


Urgent care centers still cost more than a family doctor will typically charge up front per visit for the uninsured, and unless they are within 100 yards of an ER, or meet certain requirements outlined under EMTALA, they are under no obligation to see you or treat you if you cannot meet the up-front fee. (Typically 75 to 200 dollars)

jaybeezey: It still wouldn't matter. 30million illegal aliens would still be using emergency rooms as first line medical because they work for cash and don't pay into the standard taxing systems.


Uh, you might want to re-think that position statement.
 
2013-10-16 07:56:36 AM

ricochet4: TelJanin: Welfare/low income people are coached the following: "Go only to the ER, walk up to the desk person and say 'I cannot pay, I require Pro-Bono health care' ". This is the source for tons of spurious ER visit. From a few years in the ER, I would say probably 1/2 the traffic is pro-bono/welfare/medicare/medicaid related work.

citationneeded.jpg


No citation needed.  This has been going  on for a LONG time.  Honestly, the ER should just turn away "patients" who do not have a life-threatening emergency.  Let them go to the local welfare clinic the next day.
 
2013-10-16 08:08:23 AM

jestme: In the state where I live, people on Medicaid are limited to those doctors who choose to accept the small, normally late payments from the State. This can make it very difficult to get an appointment, so very often they're waiting until that little ailment gets bad enough that they can't put off a visit any longer, then heading to the ER.

Sure, ER visits are much higher than regular office visits, but hey, the state's paying the bill so who cares?


That's interesting. My BF has worked in social services here in MD for almost a decade and Medicaid is one of the favorite insurances of healthcare providers here. It pays for pretty much everything and pays fairly quickly. There is another program run by the state (PAC--I forget what it stands for, something adult care?) that is notoriously bad to work with, but most of those patients will be upgraded to better plans with ACA. In fact, he's applying for a grant position to do outreach in the homeless community to get them enrolled in Obamacare. They are very hard to get through to because of how much personal information they have to give out to take advantage of any kind of public assistance. I gather most of them are really reluctant to participate in any way even if it benefits them to do so. Not to mention the fact that many of them don't even have possession of their birth certificate and social security cards which they need in order to get into a benefit program. I'm not sure how many even have ID cards.

But he is very excited by the expansion this program offers to a very underserved client base.
 
2013-10-16 08:08:53 AM

sno man: And yea, not free.  But not bloated full of for profit middle men that only add cost to the system.  We can do it for "free" for a tickle over half the US cost per capita, with a tenth of the per capita that should by volume, reduce cost...


Nothing is ever free, especially when the government does it. If there was a single-payer system (government bureaucracy), as soon as the $$$ started rolling in they would spend it on something else - just like how they are bankrupting SS, Medicare, etc.
 
2013-10-16 08:09:59 AM
Don't biatch about them. These are the people you're trying so hard to help
 
2013-10-16 08:10:54 AM
Patient: Get me some primary care

ER: What? Get it yourself.

Patient: sudo get me some emergency care

ER: Okay.
 
2013-10-16 08:12:28 AM
Fark professional health care, I keep my own emergency kit handy:

www.colourbox.com

www.thedrunkgnome.com
 
2013-10-16 08:12:53 AM

thegreatmurgatroid: The average lay person is so ill informed regarding healthcare.

Most 'superusers' usually have some form of insurance...the most common offender is medicaid patients. They often pay nothing for their ER visits and thus have not a single disincentive to wait to see their primary doctor. If you ask them why they are in the ER for a minor ailment, they are usually very up front that their doctor cant see them for a few day and they didnt feel like waiting. Its a matter of convenience and there is no cost to them.

Other forms of 'Superusers' come in the form of privately insured or medicare patients with some variety of personality disorder which drives their need for repeated er visits. Typical examples are the chronic pain patient who is never given enough pain medication or the borderline personality patients that fabricate a variety or nonsepific symptos in order to get attention and create a disturbance.

The fear of legal consequences permits the continuation of this behavior at the detriment of care to others. Even without all of these people abusing the system, emergency services are already struggling to meet demand.

And if I can give one piece of advice, it is for lay people to please stay out of healthcare decision-making. The reality is that most people are ignorant of the actual problems and their good intentions often only make things worse.


You're mostly right except...
1) Medicaid is not insurance. It's an indigent healthcare program.
2) Your point about chronic pain patients wrongly puts the blame on anyone other than the patient for running out of meds.
3) It sounds like wherever you are doesn't have a large population of illegal immigrants. Here, they're the majority of ER patients.
 
2013-10-16 08:18:19 AM
What a Superuser may look like.
 
2013-10-16 08:21:27 AM
Of course, I want people to have health care," Vinson said. "I just didn't realize I would be the one who was going to pay for it personally."

Link
 
2013-10-16 08:24:06 AM

ginandbacon: AlwaysRightBoy: If I remember right, you're a teacher. Of course you have no worries. Most people in the private sector have worries.

Ah no! I have tutored kids in reading but it is a volunteer gig. It's insanely gratifying and something I would recommend to anyone. I have had insurance through the private sector and the public though. Both were wonderful. My private sector insurance was top notch. I think it was $10 to see my PCP, $40 for ambulance or ER visits, and $5 for meds. Admissions and diagnostic tests were free. I pay less with my gubmint one but it is a little more restrictive and I can't just do whatever my PCP wants whenever we want to. I have no real complaints though. Everything I have needed on it has been covered. The private insurance I had when all of this first started really needing insurance was through a very well known university and was one of the things that made up for the thin-as-air paycheck. That and the time off were hard to beat.


I stand corrected, sorry. You must have a very good plan. The last time I went to the ER, my bill was over $400 just for an x-ray and visit to see if my arm was broken... it was not.  And I thought I had a good plan.

/pays for the premium plan at work.
 
2013-10-16 08:24:56 AM

Cold_Sassy: Honestly, the ER should just turn away "patients" who do not have a life-threatening emergency


This idea is the reason we have EMTALA in the first place. They used to do that in the 1960s and 70s. It resulted in people giving birth to dead babies in the hospital parking lot, and people setting on an ambulance for five hours because every hospital in the area was full when they found out they didn't have insurance during radio report.

Americans today aren't familiar with the idea that they could be turned away from emergency medical care if they were the wrong race, or didn't have the ability to pay up front.
 
2013-10-16 08:31:10 AM

AlwaysRightBoy: ginandbacon: AlwaysRightBoy: If I remember right, you're a teacher. Of course you have no worries. Most people in the private sector have worries.

Ah no! I have tutored kids in reading but it is a volunteer gig. It's insanely gratifying and something I would recommend to anyone. I have had insurance through the private sector and the public though. Both were wonderful. My private sector insurance was top notch. I think it was $10 to see my PCP, $40 for ambulance or ER visits, and $5 for meds. Admissions and diagnostic tests were free. I pay less with my gubmint one but it is a little more restrictive and I can't just do whatever my PCP wants whenever we want to. I have no real complaints though. Everything I have needed on it has been covered. The private insurance I had when all of this first started really needing insurance was through a very well known university and was one of the things that made up for the thin-as-air paycheck. That and the time off were hard to beat.

I stand corrected, sorry. You must have a very good plan. The last time I went to the ER, my bill was over $400 just for an x-ray and visit to see if my arm was broken... it was not.  And I thought I had a good plan.

/pays for the premium plan at work.


OMG that's awful! My BF got an ER bill for $250 that I thought was just outrageous given what he's paid in contributions. Good lord.

I hope you're arm's okay at least.
 
2013-10-16 08:38:08 AM

hardinparamedic: Cold_Sassy: Honestly, the ER should just turn away "patients" who do not have a life-threatening emergency

This idea is the reason we have EMTALA in the first place. They used to do that in the 1960s and 70s. It resulted in people giving birth to dead babies in the hospital parking lot, and people setting on an ambulance for five hours because every hospital in the area was full when they found out they didn't have insurance during radio report.

Americans today aren't familiar with the idea that they could be turned away from emergency medical care if they were the wrong race, or didn't have the ability to pay up front.


When I was young, my mam used the story of how Bessie Smith died as a parable. (Although I guess it's been somewhat discredited, it's not like it wasn't believable for a very good reason.) This country has a lot of shame it has yet to acknowledge and make right.
 
2013-10-16 08:45:15 AM

AliceBToklasLives: Nice article - good job mentioned the key reason there are "superusers" - lack of health insurance.  For many people, the only way to see a doctor is to go to the ER.

And no, no one gets "free" treatment at the ER.  They send a bill and the patient is responsible for his care.  Of course hospitals have a hard time collecting since lack of health insurance is generally accompanied by a lack of monetary resources.  So who pays for a good chunk of ER visits?  Everyone else.

Also, you cannot get just any kind of treatment at the ER.  Sure, if you are having a heart attack they will stabilize you, and if you have a primary care physician you might (as TFA suggests) get some needed tests.  But it's not like you can walk in and say "I have a family history of colon cancer, I'm 50 and I'd like a colonoscopy."  Well, you can say that but you ain't getting no colonoscopy.  So you don't get the preventative treatment.  Who pays for your frequent visits during your bout with colon cancer?  You know who.


Hmm.

Maybe a bootstrappy political party that values personal responsibility will create a plan that makes people insure themselves. Then some years later a black man will agree that it is a good idea and then suddenly that party will hate that plan and go full retard to block it.

Lol, that would be a ridiculous plot for a crappy sitcom even.
 
2013-10-16 08:45:46 AM

vudukungfu: I wants mah oxybamacotton an skrimps!


jesus this is the second overtly racist post I've read from you in two days. Do you press your clan robes before you put them on?

you farking disgust me.
 
2013-10-16 08:48:17 AM

ginandbacon: When I was young, my mam used the story of how Bessie Smith died as a parable. (Although I guess it's been somewhat discredited, it's not like it wasn't believable for a very good reason.) This country has a lot of shame it has yet to acknowledge and make right.


I had to look this up to see what you were talking about. The actual story is far worse than people might think.
 
2013-10-16 08:50:58 AM
houseofgeekery.files.wordpress.com

When I get overcrowded, I just start sending people to the auto-autopsy machine. It thins the herd, and advances the cause of medical science.

/Although it gets kinda funny when I send a whole bunch at one time, and they have to wait in line. Not one of them seems to care that people go into the machine, but don't come back out.
 
2013-10-16 09:19:58 AM

thegreatmurgatroid: The average lay person is so ill informed regarding healthcare.

Most 'superusers' usually have some form of insurance...the most common offender is medicaid patients. They often pay nothing for their ER visits and thus have not a single disincentive to wait to see their primary doctor. If you ask them why they are in the ER for a minor ailment, they are usually very up front that their doctor cant see them for a few day and they didnt feel like waiting. Its a matter of convenience and there is no cost to them.

Other forms of 'Superusers' come in the form of privately insured or medicare patients with some variety of personality disorder which drives their need for repeated er visits. Typical examples are the chronic pain patient who is never given enough pain medication or the borderline personality patients that fabricate a variety or nonsepific symptos in order to get attention and create a disturbance.

The fear of legal consequences permits the continuation of this behavior at the detriment of care to others. Even without all of these people abusing the system, emergency services are already struggling to meet demand.

And if I can give one piece of advice, it is for lay people to please stay out of healthcare decision-making. The reality is that most people are ignorant of the actual problems and their good intentions often only make things worse.


This, plus in Kentucky, you have to pay a $2 copay for your doctor, nothing for the ER. That caused more problems than it solved.

/former ER worker
//some of the patients were there more than I was and I was getting paid for it
///slashies in threes
 
2013-10-16 09:21:22 AM

hardinparamedic: ginandbacon: When I was young, my mam used the story of how Bessie Smith died as a parable. (Although I guess it's been somewhat discredited, it's not like it wasn't believable for a very good reason.) This country has a lot of shame it has yet to acknowledge and make right.

I had to look this up to see what you were talking about. The actual story is far worse than people might think.


Oh sorry! I grew up in a bubble and that story was common knowledge like the Kennedy assassination. We all knew it and took away lessons from it about the imbalances in this country when it comes to healthcare.

My mam used it often to get me to pull my arm in whenever I stuck it out the window of her car. "You don't want to end up like Bessie Smith!" I still think of Smith if I roll down the window and have a smoke with my elbow out. The things that stay with you, right?
 
2013-10-16 09:27:41 AM

QueenMamaBee: This, plus in Kentucky, you have to pay a $2 copay for your doctor, nothing for the ER. That caused more problems than it solved.


One thing I've learned over my short career is that the people abusing the 911 and ER system in the US are overwhelmingly medicare patients with either COPD, Diabetes, or CHF. People who claim it's typically illegal immigrants can safely be ignored as political hacks OR people who have no idea what they're talking about.

In our area, the illegal population will overwhelmingly use the church-affiliated free clinics in the area, because there is less of a chance of running into law enforcement.

Which is why when MedStar EMS in Fort Worth, TX targeted these populations for their community care paramedic program, they saved millions of dollars in unnecessary admissions in the first year of the program alone, and cut the system abuse in their area by around 90%.

/so, why are we not funding that.
 
2013-10-16 09:34:27 AM

hardinparamedic: Urgent care centers still cost more than a family doctor will typically charge up front per visit for the uninsured, and unless they are within 100 yards of an ER, or meet certain requirements outlined under EMTALA, they are under no obligation to see you or treat you if you cannot meet the up-front fee. (Typically 75 to 200 dollars)


If they are within 100 yards of an ER they have to take you, but if the nearest ER is miles away they can just let you bleed?  That sounds completely backwards.
 
2013-10-16 09:35:25 AM

Cold_Sassy: Honestly, the ER should just turn away "patients" who do not have a life-threatening emergency. Let them go to the local welfare clinic the next day.


What welfare clinic?
 
2013-10-16 09:38:38 AM

flondrix: but if the nearest ER is miles away they can just let you bleed?


As I understand it, it actually depends on if they are in a healthcare system which offers ER care. For example, a clinic which is owned and operated by a hospital system which has an ER which they can transfer to can activate the EMTALA obligation for that system, while an independent provider has no EMTALA obligation. When you presented to that clinic, it's the same as you presented to the ER.

It's the same with ambulances. A hospital-owned ambulance activates the EMTALA obligation for that facility the moment you initiate care, but a private or government-based ambulance does not.
 
2013-10-16 09:46:29 AM

flondrix: hardinparamedic: Urgent care centers still cost more than a family doctor will typically charge up front per visit for the uninsured, and unless they are within 100 yards of an ER, or meet certain requirements outlined under EMTALA, they are under no obligation to see you or treat you if you cannot meet the up-front fee. (Typically 75 to 200 dollars)

If they are within 100 yards of an ER they have to take you, but if the nearest ER is miles away they can just let you bleed?  That sounds completely backwards.


To elaborate:  My home town has an urgent care clinic, but no ER.  If the urgent care clinic can turn you away for not having the bucks...I guess you're dead.
 
2013-10-16 09:46:42 AM

hardinparamedic: flondrix: but if the nearest ER is miles away they can just let you bleed?

As I understand it, it actually depends on if they are in a healthcare system which offers ER care. For example, a clinic which is owned and operated by a hospital system which has an ER which they can transfer to can activate the EMTALA obligation for that system, while an independent provider has no EMTALA obligation. When you presented to that clinic, it's the same as you presented to the ER.

It's the same with ambulances. A hospital-owned ambulance activates the EMTALA obligation for that facility the moment you initiate care, but a private or government-based ambulance does not.


Okay wait, I have a question about this. When I get picked up by the fire department ambulance, they initiate care immediately: I get a bag put in, AND they take me where I want to go. When I get picked up by a private company, they won't do anything and the take me wherever the dispatcher tells them which is usually the last place I want to go.

What the actual fark? What gives?
 
2013-10-16 09:47:33 AM

Flashlight: pete1729: What my girlfriend who is an ER doc has to deal with on a regular basis.

http://www.youtube.com/watch?v=Q6sRyrB_UMA

I see stuff like this all the time. Most frequent fliers are on Medicaid. And unfortunately in this state there is a (small) copay for the primary care doctor but not for the ER and everything is paid for. So they have no incentive to go see their primary care doctor. They come in for any reason at all and mostly they are desperate for attention. There is a collective groan among every employee in the ED when frequent flier's name appears on the tracker and the person is there for insomnia at 3PM. Yes it has happened. This is why we need to stigmatize people like this


I worked at a hospital and got to know the frequent fliers. One was a man who had mental problems--and a crush on an ER admitting employee. He rode the ambulance 4-5 times a week to the ER for vague symptoms. He lived close enough to walk to the ER, but where's the fun of that? He mainly wanted attention and human interaction. Due to his psych problems, he had no friends. The hospital staff served as (very costly) surrogates for a social network for him.

This hospital did not have a psych ward or any psychiatrists on staff. Occasionally, we would transfer him to the VA for mental health care, but more often than not, he'd ride the amberlamps back home after having enough testing and examination to determine he was in no physical crisis.

We had other FF's who would come in with a raft of meds. One patient brought hers in a kitchen trash bag; a regular grocery bag would not hold them all. I always wondered if her "problem" was simply that she took so many meds, because her complaints were all very vague.
 
2013-10-16 09:50:05 AM

flondrix: To elaborate:  My home town has an urgent care clinic, but no ER.  If the urgent care clinic can turn you away for not having the bucks...I guess you're dead.


It depends. Under EMTALA, they can, because unless the clinic is affiliated with a local hospital system providing ER care, it doesn't fall under their jurisdiction. Under various state laws, there is a duty to act that exists for healthcare professionals who are advertising their services as a clinic when an emergency medical condition is reasonably believed to exist. And that clinic is still, then, only required to treat them to the level they can reasonably be expected to provide.

Fulfilling that duty can extend to simply offering to call 911 for someone if they cannot afford to pay - especially if they need resources that clinic cannot offer, and that duty is subject to weird state law stipulations. And there is no duty to act if an emergency medical condition doesn't exist.
 
2013-10-16 09:53:13 AM

ginandbacon: Okay wait, I have a question about this. When I get picked up by the fire department ambulance, they initiate care immediately: I get a bag put in, AND they take me where I want to go. When I get picked up by a private company, they won't do anything and the take me wherever the dispatcher tells them which is usually the last place I want to go.

What the actual fark? What gives?


If you called 911 and got that, my recommendation would be to contact your State's EMS Board and report that. Especially if you feel they are not treating you to the standard another provider would.

If that's not the case, can you explain the situation? Were you being transferred to another hospital? If that was the case, there may not be anything to do except for monitor you during the transport and be prepared to intervene.

Destination determination is not subject to the dispatcher's whims, but is your decision within certain limiting factors. (I.e. Paramedic feels that diverting to closest is the best for your continued survival, that's the only unit in the county and they can't leave, 911 system won't transport out of county because there are various high level hospitals in county - which is what Memphis has)
 
2013-10-16 10:01:33 AM

TelJanin: Welfare/low income people are coached the following: "Go only to the ER, walk up to the desk person and say 'I cannot pay, I require Pro-Bono health care' ". This is the source for tons of spurious ER visit. From a few years in the ER, I would say probably 1/2 the traffic is pro-bono/welfare/medicare/medicaid related work.


Please don't lump Medicare recipients in there disparagingly, those people are either retired or disabled (supposedly) and the vast majority have paid their dues to society. Many have been forced out of their employer sponsored health plans intentionally.
 
2013-10-16 10:05:29 AM

ginandbacon: hardinparamedic: flondrix: but if the nearest ER is miles away they can just let you bleed?

As I understand it, it actually depends on if they are in a healthcare system which offers ER care. For example, a clinic which is owned and operated by a hospital system which has an ER which they can transfer to can activate the EMTALA obligation for that system, while an independent provider has no EMTALA obligation. When you presented to that clinic, it's the same as you presented to the ER.

It's the same with ambulances. A hospital-owned ambulance activates the EMTALA obligation for that facility the moment you initiate care, but a private or government-based ambulance does not.

Okay wait, I have a question about this. When I get picked up by the fire department ambulance, they initiate care immediately: I get a bag put in, AND they take me where I want to go. When I get picked up by a private company, they won't do anything and the take me wherever the dispatcher tells them which is usually the last place I want to go.

What the actual fark? What gives?


If it's a life threatening emergency, they have to take you to the closest appropriate facility. If not, it's supposed to be your choice unless for whatever reason, that facility may be on diversion (mass trauma coming in, etc).
 
2013-10-16 10:15:36 AM

whatshisname: TyrantII: Those uninsured drive up your health insurance costs

More than the healthcare lobby and their shareholders in government? America's health care industry even drives up costs in neighboring countries. The provision of health care should be a regulated, compassionate and efficient venture, not the loot-and-pillage for profits situation in the US.


Kinda surprised there haven't been any MSM stories about how the insurance companies are driving up rates 3-400% above what the ACA alone would require this year, because starting next year rate increases will be regulated. I was discussing the ACA/shutdown with my aunt who is a billing officer for a national HMO, according to her the rate gouging is an 'open secret' in the corporation. (yes it's anecdotal evidence/etc...)

/something something job creation
 
2013-10-16 10:16:30 AM

hardinparamedic: Cold_Sassy: Honestly, the ER should just turn away "patients" who do not have a life-threatening emergency

This idea is the reason we have EMTALA in the first place. They used to do that in the 1960s and 70s. It resulted in people giving birth to dead babies in the hospital parking lot, and people setting on an ambulance for five hours because every hospital in the area was full when they found out they didn't have insurance during radio report.

Americans today aren't familiar with the idea that they could be turned away from emergency medical care if they were the wrong race, or didn't have the ability to pay up front.


Did you miss the bolded part?  I'm not talking about dead babies, I'm talking about some knob with a splinter who could wait until the next day.  Everybody has insurance, it's called Medicaid.  Even illegals get it, free of charge (except to American taxpayers, of course.)
 
2013-10-16 10:19:20 AM

hardinparamedic: ginandbacon: Okay wait, I have a question about this. When I get picked up by the fire department ambulance, they initiate care immediately: I get a bag put in, AND they take me where I want to go. When I get picked up by a private company, they won't do anything and the take me wherever the dispatcher tells them which is usually the last place I want to go.

What the actual fark? What gives?

If you called 911 and got that, my recommendation would be to contact your State's EMS Board and report that. Especially if you feel they are not treating you to the standard another provider would.

If that's not the case, can you explain the situation? Were you being transferred to another hospital? If that was the case, there may not be anything to do except for monitor you during the transport and be prepared to intervene.

Destination determination is not subject to the dispatcher's whims, but is your decision within certain limiting factors. (I.e. Paramedic feels that diverting to closest is the best for your continued survival, that's the only unit in the county and they can't leave, 911 system won't transport out of county because there are various high level hospitals in county - which is what Memphis has)


Huh. Yeah this was just a normal pick up from my house and I wasn't in any acute distress other than being seriously dehydrated and having my normal issues. I asked them to start a bag which they refused to do and then asked to be transported to Mercy which has all of my records and has always been great with me which they also refused to do. I ended up at Johns Hopkins Bayview which SUUUUUUUUCKS!!!! It took six hours to even get saline. I was ready to call an ambulance to pick me up from there to get transferred. And then the asshats admitted me even though I told them exactly what I needed because the attending wanted to write me up. So then I had to deal with armies of residents during rounds until I finally got out of there. 

And they put me on a farking low sodium diet WHICH ALWAYS HAPPENS even though my cardiologist has me on a high sodium diet for my hypotension. Good lordee that food is inedible. I mean hospital food is bad enough but saltless hospital food is just torture, especially if you have gotten used to 4-6,000 mgs of salt per day.

And you can't smoke. *sniff* And the attending wouldn't give me any anti-anxiety meds for the withdrawal. 

Sorry...ending rant now. That was a bad experience.
 
2013-10-16 10:24:14 AM

Cold_Sassy: hardinparamedic: Cold_Sassy: Honestly, the ER should just turn away "patients" who do not have a life-threatening emergency

This idea is the reason we have EMTALA in the first place. They used to do that in the 1960s and 70s. It resulted in people giving birth to dead babies in the hospital parking lot, and people setting on an ambulance for five hours because every hospital in the area was full when they found out they didn't have insurance during radio report.

Americans today aren't familiar with the idea that they could be turned away from emergency medical care if they were the wrong race, or didn't have the ability to pay up front.

Did you miss the bolded part?  I'm not talking about dead babies, I'm talking about some knob with a splinter who could wait until the next day.  Everybody has insurance, it's called Medicaid.  Even illegals get it, free of charge (except to American taxpayers, of course.)


Ummm Medicaid is very hard to get. Children get it fairly easily but adults have few options whether or not they possess papers. That would be why we have those nearly 50 million uninsured Americans.
 
2013-10-16 10:24:59 AM
Well, I can tell the majority of you couldn't be bothered to RTFA. A superuser is defined as someone who visits the ER ten or more times in a year. This is not what the uninsured are doing. The uninsured still have to PAY for their hospital visit. If they do not pay, then the bill goes to COLLECTORS. Those scum of the earth go after their money. If they can't get it, they sue. No one goes to the ER ten times in a year if they are going to get a bunch of lawsuits for their trouble. The superusers are people with real chronic problems as well as a few hypochondriac attention whores.
 
2013-10-16 10:25:00 AM

Cold_Sassy: I'm talking about some knob with a splinter who could wait until the next day.  Everybody has insurance, it's called Medicaid.  Even illegals get it, free of charge (except to American taxpayers, of course.)


HAHAHAHAHAHAHAHAHAHAHAHA.

You have no idea what you're talking about if you think everyone can qualify for state medicaid. Illegals DO NOT get Medicaid legally, and instead will often lie about their demographic information on hospital admission and triage forms, including giving fake phone numbers, so that billing departments cannot track them down to collect later.

ginandbacon: I asked them to start a bag which they refused to do and then asked to be transported to Mercy which has all of my records and has always been great with me which they also refused to do.


Are you sure they weren't a basic unit? Basic EMTs in Maryland cannot start IVs.
 
2013-10-16 10:26:10 AM
So much fail, there's plenty to go around.
I've spent 22 years in emergency medicine (No, no medical school.  I'd rather not have the insane amount of debt that goes along with it).  I've practiced in many different environments, taught every level of provider, and at the end helped run the admin sides of things.  A couple of points.

When we talk about the "Healthcare System", we're talking about the whole shebang.  Doctors, medics, nurses, techs, administrators, and yes, patients.  Patients are a massive part of that system, and the whole system needs reform, of one form or another.

As a "Master of my Trade" (Got that on two evaluations, it made me chuckle) I took home less money than the local "living wage".  I taught in my spare time, and 90% of the time I had some kind of student attached to my hip while I was working the floor in a busy level 1 trauma center.  At least one day a week was spent coming back in to work for meetings on how we could make things better.  When a budget crunch hit, the good bosses told me they didn't have the budget for the overtime.  The obnoxious bosses forbid me from doing any kind of work in the facility (no meetings, technically no teaching).  Despite the hours and performance, why can't I get a good wage?  Despite my people working their asses off, why can't they get more than a twenty cent raise each year (cost of living far far FAR exceeded that).  My student loans have barely been touched, and I get no service credit because my hospital was for-profit.

Frequent Flyers...  A couple folks talked about being in the ER several times per month.  I'm not staring at you, yet.  I'm really eyeballing the guys that come in every day, or sometimes multiple times each day.  We have a guy that's been in the newspaper he's been in the ER so many times that the EMS crews greet him by name.  I lump these folks in with the people that manipulate the system to get what they want.  Drug seekers, food needers, bed wanters.  If your expertise with your condition is so incredibly high that you can demand something when you come through the doors of the ER, then you should consider talking to your primary care physician about having what you need at home.  Why do we put you through the wringer in the emergency room, and make you go through all the tests and exams?  Because it is our ass on the line if you have a severe complication or reaction.  Because we don't know who the fark you are.  And because even if we do know exactly who you are, we're trained in emergency medicine.  That means we HAVE to rule out the worst case scenario before we settle down on your presumed diagnosis.

Despite all of this, sometimes these frequently flyers die.  In fact, it's a guarantee that all of them will eventually die.  If it happens due to your negligence, it's not going to matter that they presented the exact same way that they did for the last five years.  When they die, the family is going to turn up, they're going to demand answers, and if they don't like them they're going to summon lawyers.

What happens then?  Then an entire team of dedicated workers is facing some nasty stuff.  The black mark on the record, the horrible interviews and depositions, and the possibility of a loss of a job or even loss of license.  All those years of schooling, the time and experience to get where you are, undone.  You've got nothing.  You're done.
Most of us know someone that this has happened to, so we work hard to make sure it isn't us.
Yeah, you mentioned you were stuck in an ER for six hours for something minor?  Do you know how often we've been ready to discharge a minor headache, some slight chest pain, even a sore throat, when we have to suddenly drop everything and panic because the patient is actually having a true medical emergency?  Do you know how often I've had to talk patients down, and convince them to stay because the discovered condition isn't matching up with their sunny diagnosis?  You freakin' bonehead!?
If you just want drugs, go hit up the guy on the street corner.  If he sells you some bad stuff, you can still come in, and we'll still be open and ready to take care of you.  His stuff is probably cheaper than our stuff.
If you want some specific medical procedure, you can actually schedule them with your primary care and a specialist.  You don't have to sit in the ER and wait for a bed to become available.

People are very happy to compare the US system with every other system out there.  It's a pretty apples and oranges comparison.  They may kinda look the same, but underneath they're completely different animals.
In the US, if you come to the ER (barring an unusual event within the hospital infrastructure), you can be assured that you will be able to get an x-ray and have it read almost immediately (same day).  You can have lab work drawn, analyzed, and reported immediately (for many tests).  There will be a doctor there.  The equipment is new, clean, current, and free from defects. The water is clean.  There is oxygen coming from those ports on the wall. They can provide certain immediately life saving treatments.  You will receive an exam and stabilization of your emergent condition no matter what your ability to pay is.
All of this, and more is true.  When it doesn't happen, the liability fairy comes visiting and liberally sprinkles the hospital with fines and malpractice lawyers.
The same is not true in many countries around the world (I've been fortunate enough to visit many of them.  Sometimes it's good enough to write a book about it).  In many countries with socialized medicine, they've had to cut some of those services, or at least curtail them.

I love medicine.  I really do.  If I win the lottery, I'll go back into it.  I might even take up the medical school on their offer of a spot.
But it's a sick, sick system (yeah, pun intended).  It's broke, folks, and people have been letting it break down for the 22 years that I've been intimately involved in it.

You biatch about the Affordable Care Act?  It's not perfect, I grant you that. We probably should have started smaller and just worked to insure kids universally.
But you know what?  It's progress.  It's drawing attention to a system that is crumbling (ask anyone in healthcare how functional the whole system is.  They're going to point out problems, chronic ones).  It may not fix the system, but for once the general population is starting to pay attention to some of the issues.  We've been calling for help for decades.

We've been calling for help, you know, us, the guys that come running when you call for help?

//sorry for the rant, but someone needs to say it
 
2013-10-16 10:30:57 AM

Shryke: Second, the for-profit U.S. system you decry so vociferously is, in fact, responsible for over half of the WORLD's medical research and advancement. Now, do you know why that is? Can you possibly contemplate the *fact* that the capitalist system produces so much incentive for progress it manages to almost single-handedly advance medicine for the globe? You god damned myopic collectivist?


That basic research that you are so proud of is funded by the NIH which, in turn, is funded by YOUR TAX DOLLARS!   There is some private funding of research, but the lion's share is funded by evil socialism.
 
2013-10-16 10:35:04 AM

Shryke: Second, the for-profit U.S. system you decry so vociferously is, in fact, responsible for over half of the WORLD's medical research and advancement.


Uh, yeah. Not so much.

Most of that research is subsidized by the NIH. Hell, even Viagra was subsidized because of it's promise in treating pulmonary hypertension.
 
2013-10-16 10:43:20 AM

hardinparamedic: Cold_Sassy: I'm talking about some knob with a splinter who could wait until the next day.  Everybody has insurance, it's called Medicaid.  Even illegals get it, free of charge (except to American taxpayers, of course.)

HAHAHAHAHAHAHAHAHAHAHAHA.

You have no idea what you're talking about if you think everyone can qualify for state medicaid. Illegals DO NOT get Medicaid legally, and instead will often lie about their demographic information on hospital admission and triage forms, including giving fake phone numbers, so that billing departments cannot track them down to collect later.

ginandbacon: I asked them to start a bag which they refused to do and then asked to be transported to Mercy which has all of my records and has always been great with me which they also refused to do.

Are you sure they weren't a basic unit? Basic EMTs in Maryland cannot start IVs.


Ahhhhhhh!!!! That must be it! I've never experienced that in Mass or DC until I got here and it was only the one time. They have all without exception started a drip which is the most important first step in my treatment plan. It helps raise my BP and cuts the dehydration. After that it;s mostly just a massive dose of anti-emetics and some Ativan to stop the vomiting. 

Do all states have basic units? I really have never encountered that before.

QueenMamaBee:

If it's a life threatening emergency, they have to take you to the closest appropriate facility. If not, it's supposed to be your choice unless for whatever reason, that facility may be on diversion (mass trauma coming in, etc).

Not life-threatening (it rarely is with me thank goodness) but they never even checked to see if my hospital of choice could take me. And I am stupid picky about when I go in. I mean literally stupid. I will wait so that I am not going in on a weekend night or during shift change even if it means I get sicker. It's just worth it to me to avoid the chaos. I actually had to go in once on the first day of rotation one time and I wanted to discharge myself as soon as I realized what day it was.
 
2013-10-16 10:56:35 AM

Cold_Sassy: hardinparamedic: Cold_Sassy: Honestly, the ER should just turn away "patients" who do not have a life-threatening emergency

This idea is the reason we have EMTALA in the first place. They used to do that in the 1960s and 70s. It resulted in people giving birth to dead babies in the hospital parking lot, and people setting on an ambulance for five hours because every hospital in the area was full when they found out they didn't have insurance during radio report.

Americans today aren't familiar with the idea that they could be turned away from emergency medical care if they were the wrong race, or didn't have the ability to pay up front.

Did you miss the bolded part?  I'm not talking about dead babies, I'm talking about some knob with a splinter who could wait until the next day.  Everybody has insurance, it's called Medicaid.  Even illegals get it, free of charge (except to American taxpayers, of course.)


I don't have Medicaid. I don't qualify. You probably don't either. But even for people who do qualify, they don't have it unless they apply for it. But there are a lot of people who don't apply for one reason or another. Either they don't know about it, don't think it's worth the hassle, don't have their shiat together enough to apply, or--as is frequently the case for illegal aliens--are trying to stay of the government's radar. And typically they have to reapply every month. Of course the hospital can try to get them to apply, but they can't force them to. And there's always the possibility that they won't actually qualify, which the hospital won't find out about until long after the patient has been treated and released. Or the patient will qualify, but the hospital didn't get the procedure precertified correctly, or they used drug A.124 instead of A.121, and Medicaid doesn't cover A.124. Granted, Medicaid is a lot better about paying for things in the inpatient or emergency settings, but even when they do pay it's frequently below the hospital's cost. Any time a hospital trays an uninsured patient, even one they think will qualify for Medicaid, they're taking a flier on it. They'll never see a dime on a lot of those. Many of the rest they treat for pennies on the dollar.
 
2013-10-16 10:56:47 AM

ginandbacon: Do all states have basic units? I really have never encountered that before.


Yeah, but in some states EMT-Basics can do more than in others. Tennessee and Colorado allow theirs to do basic IV therapy and use isotonic solutions to treat patients, while in others they can do nothing more than give oxygen if it's indicated, do basic first aid and trauma care, and monitor during transport.

To contrast what I know, Alabama's EMT-Basic course in 2005 was 120 hours. Tennessee's was nearly 400 hours. (8 hours a day, two days a week for three semesters.)

Do you happen to live in a rural area, by any chance? It's more common up in Yankee territory that the volunteer ambulance squads and services in the rural areas employ more EMT-EMT units than EMT-Paramedic or Paramedic-Paramedic units because of the cost of training and employing Paramedics.

ginandbacon: They have all without exception started a drip which is the most important first step in my treatment plan. It helps raise my BP and cuts the dehydration. After that it;s mostly just a massive dose of anti-emetics and some Ativan to stop the vomiting.


What do you have, if you don't mind me asking?
 
2013-10-16 11:19:00 AM

hardinparamedic: ginandbacon: Do all states have basic units? I really have never encountered that before.

Yeah, but in some states EMT-Basics can do more than in others. Tennessee and Colorado allow theirs to do basic IV therapy and use isotonic solutions to treat patients, while in others they can do nothing more than give oxygen if it's indicated, do basic first aid and trauma care, and monitor during transport.

To contrast what I know, Alabama's EMT-Basic course in 2005 was 120 hours. Tennessee's was nearly 400 hours. (8 hours a day, two days a week for three semesters.)

Do you happen to live in a rural area, by any chance? It's more common up in Yankee territory that the volunteer ambulance squads and services in the rural areas employ more EMT-EMT units than EMT-Paramedic or Paramedic-Paramedic units because of the cost of training and employing Paramedics.

ginandbacon: They have all without exception started a drip which is the most important first step in my treatment plan. It helps raise my BP and cuts the dehydration. After that it;s mostly just a massive dose of anti-emetics and some Ativan to stop the vomiting.

What do you have, if you don't mind me asking?


I don't think Baltimore counts as rural even if it does seem a little country to me sometimes ;)

I have neurally mediated hypotension, cyclical vomiting syndrome (don't ask, you don't want to know,) fibromyalgia, and neuropathy in both of my feet and into my right calf. 

The NMH has been the most crippling. As well as the CVS. The other two are really about pain management and I am doing really well with neurontin. The NMH has completely flattened me. I was so bedridden from it at one point that I got multiple pulmonary embolisms which could have killed me and rickets which just hurt like hell.

NMH is not very common and I was lucky that one of my PCP's students has it (she is much more functional than I am) so I finally had someone other than my cardiologist who got what my life is like without me having to explain it. Most of my doctors have to go Google it so I really loved being able to laugh and talk with her about it. 

My PCP is amazing though. I am really fortunate to have access to him and I bless him every day. He's a saint. I often end up spending 5 hours in his office when I go in because he wants to see me in between other patients instead of just spending ten minutes with me. He's a really good doctor and a really good teacher.
 
2013-10-16 11:32:28 AM

ginandbacon: I don't think Baltimore counts as rural even if it does seem a little country to me sometimes


Ah ha. Baltimore is a tiered EMS response system. Only certain calls will get a paramedic sent to it.
 
2013-10-16 11:36:22 AM

ginandbacon: Not life-threatening (it rarely is with me thank goodness) but they never even checked to see if my hospital of choice could take me. And I am stupid picky about when I go in. I mean literally stupid. I will wait so that I am not going in on a weekend night or during shift change even if it means I get sicker. It's just worth it to me to avoid the chaos. I actually had to go in once on the first day of rotation one time and I wanted to discharge myself as soon as I realized what day it was.


That's wrong, and you should file a complaint with the state EMS board. 

Are the private companies receiving some kind of fee from the hospital for bringing people in? Sounds fishy to me. We have some really crappy local private companies (and a few good ones, and a great county system) and I've never heard of that going on here.
 
2013-10-16 11:36:35 AM

hardinparamedic: ginandbacon: I don't think Baltimore counts as rural even if it does seem a little country to me sometimes

Ah ha. Baltimore is a tiered EMS response system. Only certain calls will get a paramedic sent to it.


LOL I always knew there was something strange afoot here! So how do they tier these calls? Out of five? calls for the same thing, I've only had that bad experience the one time.
 
2013-10-16 11:44:57 AM

QueenMamaBee: ginandbacon: Not life-threatening (it rarely is with me thank goodness) but they never even checked to see if my hospital of choice could take me. And I am stupid picky about when I go in. I mean literally stupid. I will wait so that I am not going in on a weekend night or during shift change even if it means I get sicker. It's just worth it to me to avoid the chaos. I actually had to go in once on the first day of rotation one time and I wanted to discharge myself as soon as I realized what day it was.

That's wrong, and you should file a complaint with the state EMS board. 

Are the private companies receiving some kind of fee from the hospital for bringing people in? Sounds fishy to me. We have some really crappy local private companies (and a few good ones, and a great county system) and I've never heard of that going on here.


Oooof. So much work! but you're probably right. I'd hate for someone else to go through this. The other thing that really got me is that the nurses wouldn't give me a bag until a doctor ordered it which took SIX HOURS. I've never been in a hospital ER where that wasn't step 1 and fine for RNs to initiate on their own. I have no idea what kind of incentives the private company might have had. I was just used to one thing: getting a bag immediately and being asked where I wanted to go, and these guys flat out told me they wouldn't put a line in or take me to my choice. 

I wasn't a very happy camper.
 
2013-10-16 11:51:44 AM

QueenMamaBee: That's wrong, and you should file a complaint with the state EMS board. 

Are the private companies receiving some kind of fee from the hospital for bringing people in? Sounds fishy to me. We have some really crappy local private companies (and a few good ones, and a great county system) and I've never heard of that going on here.


Baltimore has a tiered response system, which is where he lives. The Basic EMT unit that responded to him wouldn't have been able to do anything but transport him, as they cannot start IVs.

ginandbacon: LOL I always knew there was something strange afoot here! So how do they tier these calls? Out of five? calls for the same thing, I've only had that bad experience the one time.


The Medical Priority Dispatch System. Omega, Alpha and Charlie level calls get a BLS response, while Bravo, Delta, and Echo get an ALS (Paramedic) level response.
 
2013-10-16 11:57:44 AM

hardinparamedic: QueenMamaBee: That's wrong, and you should file a complaint with the state EMS board. 

Are the private companies receiving some kind of fee from the hospital for bringing people in? Sounds fishy to me. We have some really crappy local private companies (and a few good ones, and a great county system) and I've never heard of that going on here.

Baltimore has a tiered response system, which is where he lives. The Basic EMT unit that responded to him wouldn't have been able to do anything but transport him, as they cannot start IVs.

ginandbacon: LOL I always knew there was something strange afoot here! So how do they tier these calls? Out of five? calls for the same thing, I've only had that bad experience the one time.

The Medical Priority Dispatch System. Omega, Alpha and Charlie level calls get a BLS response, while Bravo, Delta, and Echo get an ALS (Paramedic) level response.


I'm a she ;)

And that's really interesting. I wonder if that one time was because my BF was the one calling 911? Usually I call in but I was too sick too that time. That's the only variable I can come up with.
 
2013-10-16 12:01:45 PM
*too? Really I meant to. 

I wish I could still drink coffee. I obviously need it.
 
2013-10-16 12:03:00 PM

ginandbacon: And that's really interesting. I wonder if that one time was because my BF was the one calling 911? Usually I call in but I was too sick too that time. That's the only variable I can come up with.


Possibly. If they rule out priority symptoms, the MPDS assigns a code of either 26 Alpha 1-11, or if you have a fainting spell without cardiac problems a 31 Alpha 1-3
 
2013-10-16 12:05:45 PM

hardinparamedic: QueenMamaBee: That's wrong, and you should file a complaint with the state EMS board. 

Are the private companies receiving some kind of fee from the hospital for bringing people in? Sounds fishy to me. We have some really crappy local private companies (and a few good ones, and a great county system) and I've never heard of that going on here.

Baltimore has a tiered response system, which is where he lives. The Basic EMT unit that responded to him wouldn't have been able to do anything but transport him, as they cannot start IVs.

ginandbacon: LOL I always knew there was something strange afoot here! So how do they tier these calls? Out of five? calls for the same thing, I've only had that bad experience the one time.

The Medical Priority Dispatch System. Omega, Alpha and Charlie level calls get a BLS response, while Bravo, Delta, and Echo get an ALS (Paramedic) level response.


But they can still take her where she wants to go. As far as I know, Basic EMTs can read maps.
 
2013-10-16 12:14:07 PM

hardinparamedic: ginandbacon: And that's really interesting. I wonder if that one time was because my BF was the one calling 911? Usually I call in but I was too sick too that time. That's the only variable I can come up with.

Possibly. If they rule out priority symptoms, the MPDS assigns a code of either 26 Alpha 1-11, or if you have a fainting spell without cardiac problems a 31 Alpha 1-3


I usually refuse an ambulance for the syncope episodes. I know how to manage those on my own. There's not much any medical team can do for me except the saline drip which actually does help but I find that just lying down with my feet up accomplishes the same outcome. I mostly only call for the CVS and that's because I ended up in acute renal failure from it once so that kind of put the fear of God in me. I don't screw around with that now. I learned it can kill me and I didn't enjoy the whole dying thing while I was going through it.

If I could start my own line of saline and glucose, add some anti-emetics, and throw in some Ativan, I would never call 911 ever. I'd just handle it on my own.
 
2013-10-16 12:15:40 PM

QueenMamaBee: But they can still take her where she wants to go. As far as I know, Basic EMTs can read maps.


LOL ya'd think, right?
 
2013-10-16 12:21:19 PM

QueenMamaBee: But they can still take her where she wants to go. As far as I know, Basic EMTs can read maps.


True. And on the second part...well....
 
2013-10-16 12:23:58 PM

hardinparamedic: Most of that research is subsidized by the NIH. Hell, even Viagra was subsidized because of it's promise in treating pulmonary hypertension.


And Minoxidil started out as a high blood pressure medication that turned out to have a side effect of causing hair to grow on bald heads.
 
2013-10-16 12:26:12 PM

hardinparamedic: QueenMamaBee: But they can still take her where she wants to go. As far as I know, Basic EMTs can read maps.

True. And on the second part...well....


Okay you're probably right. But geez, Mapquest will even read the directions to you out loud.
 
2013-10-16 12:38:16 PM

flondrix: hardinparamedic: Most of that research is subsidized by the NIH. Hell, even Viagra was subsidized because of it's promise in treating pulmonary hypertension.

And Minoxidil started out as a high blood pressure medication that turned out to have a side effect of causing hair to grow on bald heads.


Also had a side effect of making a great Simpsons episode
 
2013-10-16 12:49:53 PM
... Superusers that who are using ...

FTFY

/I despair
 
2013-10-16 01:43:32 PM
I'd like to see an end to all employer provided insurance coverage, and the elimination to all bars to nationanwide insurance exchanges. just give employees that money that was going to health benefits. I'd like all of the limitations on Medical savings accounts lifted as well, allowing people to take high deductible medical insurance plans when they are young, save up the deductible in a tax deferred MSA that can roll over--and earn interest.  Those who don't buy insurance dont get treatment beyond emergency stabilization at an ER. After that, hope for charity or pro-bono care.  We'll make seperate arrangements for the elderly who qualify based on income, and the truly disabled 9not counting fatties as disabled, those who claim their disability is due to addiction, pain med seekers, and other leeches claiming vague pain related complexes as a disability.)  Make it easier for medical consumers to chnage care providers based on performance and cost.

Do this, and poof, watch things get better.
I'll never support any unconstitutional law saying poeple must by inurance. (Yes, I know what the Supreme court said--and that ruling was stupidly wrong.)
 
2013-10-16 01:54:47 PM
stop forcing emergency rooms/hospitals to stabilize people regardless of ability to pay

poof, health care "crisis" solved
 
2013-10-16 03:10:36 PM

RembrandtQEinstein: stop forcing emergency rooms/hospitals to stabilize people regardless of ability to pay

poof, health care "crisis" solved


Works for the third world, so why not us?  Heck, I bet their health care costs are way way less than ours too.
 
2013-10-16 08:32:32 PM

AliceBToklasLives: Nice article - good job mentioned the key reason there are "superusers" - lack of health insurance. For many people, the only way to see a doctor is to go to the ER.


I didnt read the article; assumed the above.
 
2013-10-16 09:02:03 PM

KrispyKritter: worked for a major medical x ray film company based in Japan. we were the first customer, their USA division. they marked up what they sold/shipped to our warehouses.

the USA salesmen would pursue major accounts. they would give away huge dollars worth of hi tech equipment with free install and maintenance to help land a film contract. since they were stepping on the toes of a local dealer (who carried multiple brands of film & equipment) that dealer would get a cut right off the bat. if the local dealer was trained & under contract to service that equipment they would get fat dollars annually regardless if they went on site 1 time or 10 times.

the USA division marked up film and equipment sold to x-ray film & equipment dealers.

the x-ray film & equipment dealers marked up the film, equipment & service contracts they sold to every doc-in-the-box, vet, dentist, hospital, clinic, you name it.

it costs a bundle to cover the overhead of any doc-in-the-box, vet, dentist, hospital, clinic, you name it. so they mark up every x-ray sky high to cover expenses and make a profit at the end of the day.

whole lot of people making a whole lot of money.


Clearly the answer is for consumers to give the insurance companies more money.

I voted for Obama, and I support universal healthcare, but making consumers buy more private insurance is like treating an open wound with multiple blood transfusions and hoping things get better.  I'm self employed, healthy, and have paid about $200 a month for a high deductible policy- my new premium is $400 per month, though my deductible is much lower.  The inanity is that the vast majority of the uninsured are never going to be able to pay $400 per month, so we've barely addressed the problem while driving insurance company profits through the roof.
 
2013-10-16 09:07:56 PM
I just thought of a resolution.  minimum copay at ER is $200.  Doctors, at their discretion, can wave the fee and be reimbursed by insurance/medicare.  Would it cause problems?  probably.  Would it solve more than it caused?  probably.
 
2013-10-16 10:24:24 PM

Marcus Aurelius: sno man: The actual one is paying for all the people between you and your doctor.  Yea free market!

All civilized nations provide basic health care for free to everyone.


Given what passes for modern medicine, I'll pass, thanks.

You are responsible for your own health, the way I see it.  You can get information (one of my favorite sites is mercola.com), but it's up to you to implement it.

Don't be gorging on sugar then whining about diabetes down the road and demanding free diabetic stuff.  Just an example.

I would say a civilized nation wouldn't be trying to steer people away from "alternative" medicine, and would stop giving in to Big Pharma.

As my dad would say, money talks, BS walks.
 
2013-10-17 09:52:01 AM

The Beatings Will Continue Until Morale Improves: One thing health care plans provide is discounting. If you have insurance and even if you are paying out-of-pocket with a high deductible, hospitals will bill you at a much lower rate for care (saw a hospital stay of $30k get billed to Blue Cross for $9k). With no insurance you pay full retail. Also you can set up an HSA with high-deductible insurance so your health care is tax-free. Without an HSA you pay after-tax dollars and you can't even start to write it off until it's around 7% of your income.


My uninsured brother often gets even better discounts via obscure methods called 'bargaining', 'cash on barrelhead', and 'shopping around'.  He earns so little money that it's tax free anyways, and I very much support HSAs.

Matter of fact, some of my proposals are:
1.  Eligibility for HSAs is expanded to, essentially speaking, 'everybody'.
2.  Any company that doesn't provide a qualifying healthcare plan will instead be forced to deposit $1-2/hour* into the employee's HSA.
3.  Money in an HSA can be used to purchase healthcare insurance/plans

Benefits I see:
1.  It's a simple system.  A company that does direct deposit simply needs to DD two accounts rather than one.
2.  It eliminates the 'cliffs' of 50 employees/30 hours a week that have generated so many complaints
3.  A person can leverage multiple part time jobs to provision their healthcare costs
4.  If they work overtime they end up with extra money in their HSA to cover the extra expenses from working so hard.  ;)

*Actual amount to be set at somewhere around the median indivual healthcare costs.

hardinparamedic: I had to look this up to see what you were talking about. The actual story is far worse than people might think.


I'm not sure how much 'worse' that article makes out Bessie Smith's death.  Given the described injuries and what I know(admittably limited) about medical care of the time, the story is indeed tragic but not something that you can automatically blame her death on the existence of segregated hospitals.  Not that I approve of segregated hospitals, but in any attack on them you should be able to quote clear statistics, or at least clear cases.

flondrix: To elaborate: My home town has an urgent care clinic, but no ER. If the urgent care clinic can turn you away for not having the bucks...I guess you're dead.


If it's a condition that you'll end up dead from quickly enough that you can't reach an actual ER, it's not a condition for 'urgent care' in the first place.
 
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