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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 76
    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»



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2013-10-15 07:58:38 PM
20 votes:
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 09:01:11 PM
11 votes:
"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 10:55:05 PM
7 votes:
The only reason for the high cost of hospitalization in America: the insurance industry.
2013-10-15 09:09:19 PM
7 votes:

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 08:39:14 PM
6 votes:

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 10:49:01 PM
5 votes:
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 11:44:27 PM
4 votes:

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.
2013-10-16 10:26:10 AM
3 votes:
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 12:15:13 AM
3 votes:
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.
2013-10-15 10:38:46 PM
3 votes:
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 09:16:26 PM
3 votes:

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 08:44:07 PM
3 votes:
Free treatment in the ER?

That's the joke, right?

/EMTALA is not free.
2013-10-15 08:37:41 PM
3 votes:
AKA "The uninsured".
2013-10-16 12:27:44 AM
2 votes:

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 12:22:12 AM
2 votes:

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 12:08:31 AM
2 votes:

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:(
2013-10-15 11:40:19 PM
2 votes:

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 11:22:30 PM
2 votes:

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 11:21:41 PM
2 votes:

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 11:18:10 PM
2 votes:
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 10:52:56 PM
2 votes:

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 10:42:40 PM
2 votes:

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 10:42:36 PM
2 votes:

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 10:41:16 PM
2 votes:
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 10:19:19 PM
2 votes:

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 09:30:27 PM
2 votes:

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 09:12:12 PM
2 votes:

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 09:07:39 PM
2 votes:

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 07:44:00 PM
2 votes:
But I've been assured by very serious people that our health care system is perfect as it is?
2013-10-16 10:24:24 PM
1 votes:

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.
2013-10-16 10:35:04 AM
1 votes:

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 10:30:57 AM
1 votes:

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 10:24:14 AM
1 votes:

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 09:27:41 AM
1 votes:

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 08:45:15 AM
1 votes:

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 04:00:23 AM
1 votes:
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 01:27:45 AM
1 votes:
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 01:02:26 AM
1 votes:

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 12:58:16 AM
1 votes:

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 12:34:48 AM
1 votes:
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 12:32:40 AM
1 votes:
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 12:28:44 AM
1 votes:

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 12:24:50 AM
1 votes:

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 12:21:16 AM
1 votes:

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 12:10:50 AM
1 votes:

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 12:08:51 AM
1 votes:
have more walk-in clinics open in evenings.

problem solved.
2013-10-16 12:06:53 AM
1 votes:
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 12:02:02 AM
1 votes:

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?
2013-10-15 11:59:13 PM
1 votes:

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 11:54:31 PM
1 votes:
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 11:51:37 PM
1 votes:

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 11:51:35 PM
1 votes:

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 11:49:46 PM
1 votes:
Stop blaming the victim.
2013-10-15 11:35:39 PM
1 votes:

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 11:31:54 PM
1 votes:
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 11:20:07 PM
1 votes:
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 11:16:23 PM
1 votes:
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 11:04:51 PM
1 votes:
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 11:03:05 PM
1 votes:

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 11:01:27 PM
1 votes:
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 10:58:48 PM
1 votes:
sudo give me some oxycontin
2013-10-15 10:53:36 PM
1 votes:
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 10:52:43 PM
1 votes:

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 10:49:46 PM
1 votes:

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 10:45:53 PM
1 votes:
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 10:44:43 PM
1 votes:
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 10:36:36 PM
1 votes:

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 10:30:53 PM
1 votes:

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 10:26:57 PM
1 votes:
Ice water IV's for all frequent fliers.
2013-10-15 10:25:18 PM
1 votes:
I believe the correct nomenclature is frequent flyers
2013-10-15 09:22:09 PM
1 votes:

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 09:16:02 PM
1 votes:

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 08:53:43 PM
1 votes:

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 08:46:32 PM
1 votes:

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 08:04:08 PM
1 votes:
I blame Fartbong0

Why won't he pass some sort of health care improvement act?
2013-10-15 07:53:57 PM
1 votes:
I wants mah oxybamacotton an skrimps!
 
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