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medpundit |
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Sunday, March 14, 2004Cell-phones and new pick-ups—whether they are products of cheap Chinese labor or easy American credit—are nevertheless optional expenditures. One really does make a decision of sorts to buy on credit a 30,000 twin-cab Ford pick-up, or pay $100 a month for a cell-phone family-plan than purchase cheap HMO health insurance. Perhaps there was a general sense then among those waiting for the doctor that while the government does not provide new cars or cell phones it really does, after all, extend free health care. In any case, if the emergency room in one of the poorest towns in this nation is a litmus test of horrific poverty and neglect, then it is a strange sort of poverty that about 5 billion on the planet outside our borders could only envy. UPDATE: A reader notes that someone often ends up paying for that "free" care, even if it's not the patients: I think we need to be honest about the fact that there are a lot of people in the United States who claim medical indigency but who clearly have the means to pay something for their care yet evidently do not, and perhaps with the blessing of our governments and hospitals. Not having insurance is unfortunately sometimes passing as the equivalent of not having any obligation to pay. The implication of the writer is that there are plenty of people in California who think themselves entitled to enter the U.S., legally or illegally, make money, buy what they want with their earnings, but when they need any kind of medical care, even routine care, expect the taxpaying public to foot their bill. I don't know how pervasive this is in California, but I do know it exists in similar ways elsewhere. I know also that in other places--Denver, for instance--hospitals have confronted this kind of behavior more aggressively, demanding deposit payments from patients who use the E.R. for non-life or limb threatening emergencies. What the writer didn't mention is just how much care is provided by way of the E.R. and not paid for by the hospital, the government or by the patient. Hill-Burton and its succeeding legislation may pay for the hospital to keep its E.R. staffed and open, and for the E.R. doctors to be working, but when the E.R. turns to ask for consultation--from non-E.R. doctors, the support often ends. The orthopedist coming in to evaluate that broken arm, or the neurosurgeon called in to treat that threatening aneurysm often get stiffed, many times even when the patient has insurance. Few E.R.s get by without having to call in consultants for anything that is complicated or that requires surgery, and that care, which also carries liability risk and personal cost to the doctor providing it, is not covered by federal funding. In some places, unpaid consulting has reached abusive levels, sufficient to drive doctors to resign from hospital staffs. Many communities have created outsized expectations by letting patients use E.R.s for non-emergencies and allowing politicians to create and define a notion of "rights" to medical care as if these were somehow the same as "rights" to assemble or to enjoy free speech. Letting this kind of behavior pass is really shameful, and it deserves to be called for what it is: poor stewardship of the public treasure under the color of "charity". posted by Sydney on 3/14/2004 02:40:00 PM 0 comments 0 Comments: |
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