Sorry, But You're Out On Your Ass, You've Used Up Your Quota Of Emergency Room Visits
	found on The Washington Post written by 1fastdog, edited by John (Plastic) [ read unedited ] posted Sun 19 Jan 7:28am
		The revision on emergency room use marks the second significant step taken by Bush's health aides to weaken regulations introduced by the Clinton administration to help Medicaid patients obtain proper care. Shortly after Bush took office two years ago, health officials pulled back a broad set of guarantees for Medicaid patients in managed care. "In a little noticed change to Medicaid rules, the Bush administration, in a ruling that was not pursued by state Medicaid administrators or the managed care industry, after an inquiry from Florida (ya know, the state who's Governor is the prez's brother), has put restrictions on the number of times a person with Medicaid may visit the emergency room. This rule affects about 3/5ths of the nation's poor and disabled Medicaid recipients who fall under the managed care umbrella," 1fastdog writes. "Presidential spinmeister, Ari Fleischer, called the ruling an 'equalization' that imposed the same rules on managed care patients that fee for service Medicaid patients fall under: 'The bottom line is that patients will continue to get all the care they need'. What Fleischer doesn't say, is that while no one can be turned away from the ER, the people who can least afford the trip will have to pay for it themselves. Tim Westmoreland, former Medicaid director and Georgetown University professor of law and public policy, disagrees with the ruling. Saying: 'The Bush administration is being unfair one way or the other. Either they are going to require hospitals to take care of Medicaid patients and not pay them, or they are expecting people not to go the emergency room any more.'

	"Opponents of the new rule (including Sen. Bob Graham (D-Fla.), who is exploring how to block the rule) speculate that people in need of emergency care may experience potentially life threatening medical situations that may not be taken care of due to hesitation about personal finances, which, as Ann Labelle, of the American College Of Emergency Physicians noted: patients 'should not be forced to self-diagnose because of the fear that Medicaid won't pay'."

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1.  and...   by colinsky       at Sun 19 Jan 8:01am score of 0.5 astute     people who can least afford the trip will have to pay for it themselves. pay for it themselves? my god! what cheek! i must have missed that moment where everything was free and paying for services you used became passé.   [ ...reply just to this | comment on the story... | next new ]

3.  Re: and...   by CoFenchurch       at Sun 19 Jan 9:08am score of 3 astute   in reply to comment 1     If you are on Medicaid, you are by definition extremely poor. Other things you can put off buying if you can't afford it-- not so medical care. If you've got pneumonia, you need antibiotics whether you can afford them or not. Or I suppose you would prefer that people who can't afford medical care should just have the good taste to die so you won't have to look at them anymore?   [ ...reply just to this | comment on the story... | next new ]   5.  Re: and...   by musiquestar       at Sun 19 Jan 9:36am score of 1.5 interesting   in reply to comment 3     If you've got pneumonia, you need antibiotics whether you can afford them or not. And if this rule goes into effect, those pneumonia drugs will probably be ceased as soon as the symptoms go away, to ration them for the next bout of bacterial infection. Then we can just sit back and watch the resistance skyrocket. What was the rationale for this? I know some patients will go for emergency room care when regular checkups aren't covered by their insurance - but this is hardly the way to fix the system, if that was the problem. Compassionate conservatism, eh? Your fantasies are unlikely, but beautiful.   [ ...reply just to this | comment on the story... | next new ]   32.  Re: and...   by colinsky       at Mon 20 Jan 3:04am score of 0.5 irrelevant   in reply to comment 3     you need antibiotics whether you can afford them or not. you realize, of course, that if the antibiotics in question remain unpaid for, the company manufacturing the antibiotics is going to go out of business, for lack of funds. that won't help anybody either.   [ ...reply just to this | comment on the story... | next new ]   48.  Re: and...   by seans88       at Tue 21 Jan 4:19pm score of 1   in reply to comment 3     Yes, if you are on Medicaid, you ARE extremely poor. Which means that the hospital will do what it does every time it knows it can't get paid - it'll write off the expense. What, do you suppose they're going to send goons after those poor people when they know there's no way they can pay in the first place? Please. Poor people will continue to get medical care, even if they're in the E.R. 100 days a year. The hospital will recoup a little less, and quality of service will get marginally (though probably not noticeably) worse. Peddle your outrage elsewhere.   [ ...reply just to this | comment on the story... | next new ]   37.  Re: and...   by CoFenchurch       at Mon 20 Jan 8:10am score of 1   in reply to comment 32     Sorry, but the pharmaceutical companies aren't going out of business anytime soon. They don't directly dispense the drugs--Doctors (and physician assistants and nurse practitioners) do. It's the hospitals that are taking the hit. And again, what do you propose people do who need a medication but can't afford it? What's the alternative, besides dying? Bush is only presenting one side of the story. Sure, people should go to PCPs with non-emergency illnesses. But what he's not saying is that because Medicaid is so underfunded, and pays doctors at such a piss-poor rate, only a very few doctors will take it. That means ridiculously long waits for appointments, or as I found, an inability to get a PCP to see you AT ALL.   [ ...reply just to this | comment on the story... | next new ]   42.  Re: and...   by furryape       at Mon 20 Jan 11:40am score of 2.5 compelling   in reply to comment 32     Which is why the US needs to get it's finger out, and get a real healthcare system, like the rest of the industrialized world already has. The US pays more per capita on healthcare than any other country in the world, yet gets results beaten by 50 to 70 other countries.   [ ...reply just to this | comment on the story... | next new ]   6.  Re: and...   by moof1138       at Sun 19 Jan 9:47am score of 2 succinct   in reply to comment 1     People on Medicaid by definition cannot pay for healthcare themselves, since it is a program to offer (minimal) healthcare to the poor, especially the poor among the elderly, the handicapped and the blind. Since many hospitals will treat the uninsured, and never recover those costs denying coverage of trips to the ER is either going to put hospitals in even worse financial shape, or increase the already growing number of hospitals that will reject the uninsured and insist they go somewhere else, neither of which is good for society as a whole. Bene agere et laetari   [ ...reply just to this | comment on the story... | next new ]   19.  Hospitals are bad places to be   by ilsa       at Sun 19 Jan 3:43pm score of 2.5 brilliant   in reply to comment 6     Since many hospitals will treat the uninsured, and never recover those costs denying coverage of trips to the ER is either going to put hospitals in even worse financial shape, or increase the already growing number of hospitals that will reject the uninsured and insist they go somewhere else, neither of which is good for society as a whole. Actually, Federal law requires all Emergency Departments to see anyone who comes in the door. And yes, this will put hospitals in worse financial shape. They will try to get out of the situation by raising fees charged to patients; the insurance companies will pay up grudgingly and raise rates, while any money squeezed out of the uninsured will be bonus. Oh, and some hospitals will try to raise revenues by upcoding, performing procedures of debatable necessity, and obtaining "Medicare Outlier Payments." The real issue is that the ability to have emergency care covered under the "prudent layperson standard" (any reasonable person would have considered it an emergency) is in direct conflict with any possible "patients bill of rights." Unless of course you mean "rich patients bill of rights."   [ ...reply just to this | comment on the story... | next new ]

2.  This is the emergency medicine version ...   by MAYORBOB       at Sun 19 Jan 8:32am score of 1.5 astute     ... of a "three strikes and you're out" rule. Perhaps they should call this a "three strokes and you're out" rule. The problem isn't even that the taxpayer is taking a hit over the people who clog up the ER waiting rooms due to sniffles and headaches. Because the rules already dictate that if a reasonable "layperson" could determine that it isn't an emergency procedure, that the taxpayer shouldn't pay for the treatment. I would think that AARP is going to weigh in big time on this one. Because the demographic that is probably going to be hit hardest in the pocketbook by this are the elderly who tend to need more medical care than most other groups. As far as the truly poor, they will probably not feel any real impact by this ruling. They can still take as many trips to the ER as need be and not be turned away. Does it really matter that they might be on their fifth or sixth trip? Probably not, because it's not like they have any money to go after anyhow. Tending to final details.   [ ...reply just to this | comment on the story... | next new ]

4.  Re: This is the emergency medicine version ...   by wetzel       at Sun 19 Jan 9:34am score of 1.5 scholarly   in reply to comment 2     Do the proposed changes affect Medicare as well as Medicaid? If not, then the AARP will probably not be a major factor in the dispute. If it is only Medicaid, then the Children's Defense Fund and certain doctor's groups on the left will be the primary lobbying forces, much less powerful than AARP.   [ ...reply just to this | comment on the story... | next new ]   8.  Re: This is the emergency medicine version ...   by MAYORBOB       at Sun 19 Jan 11:03am score of 1.5 compelling   in reply to comment 4     I think that the impact on the elderly is potentially much more dramatic than you might imagine. For instance, there are close to 500,000 elderly Medicaid recipients in New York State alone. There are over 150,000 elderly eligibles in North Carolina. These are only two states, one large and the other mid-sized, and you have 650,000 people potentially impacted by these rules changes. Remember, not all the elderly are covered by Medicare or private insurance. I would hope that the AARP would have this on their periscope. Tending to final details.   [ ...reply just to this | comment on the story... | next new ]   10.  Re: This is the emergency medicine version ...   by wetzel       at Sun 19 Jan 12:01pm score of 1   in reply to comment 8     But aren't those elderly Medicaid recipients on the program mainly for their nursing home care, which Medicare doesn't cover?   [ ...reply just to this | comment on the story... | next new ]   7.  Re: This is the emergency medicine version ...   by Nephthys       at Sun 19 Jan 10:50am score of 1.5 informative   in reply to comment 2     My first thought in reading this was "AARP will never stand for it". Since they are such a huge lobby, the ruling does not have a chance. I checked the AARP website, where there is nary a word on the ruling. This doesn't mean that they aren't actively persuing it, but it does make me wonder. Cake or Death? Cake, please.   [ ...reply just to this | comment on the story... | next new ]

9.  Duh?   by Victor Lazlo       at Sun 19 Jan 11:51am score of 2 astute     Is there anyone on Plastic naive enough to think "compassionate conservatism" was anything more than a blatant lie to get elected? Does anyone see a pattern here? Tax cuts for rich, affirmative action for legacy alumni, cutting unemployment benefits over Christmas, cutting back on environmental regulations, etc.?   [ ...reply just to this | comment on the story... | next new ]

14.  Hell, No   by SacredGroundChuck       at Sun 19 Jan 12:39pm score of 3 brilliant   in reply to comment 9     This is the same pattern Bush blazed in Texas: cut services through creation/deletion of laws (i.e., pollution) or direct intimidation (two sets of paperwork for CHIP [Children's Health Insurance Program] and Medicaid), collect the difference and give it to the rich in a tax cut. Texas is described as a "low tax, low service" state, and it's becoming clear that Shrub wants to make the country a larger version of Texas. If you look at that state now, it has a large budget deficit and was forced to remove some of the lower taxes that Bush fought for. Next up: Bush will want to completely privatize welfare by handing Social Security over to a defense contractor to manage, probably connected to the Carlysle Group. Remember in 2004: this is a guy who sees nothing wrong with the rich getting richer any way they can, and helping them any way they can. If the little guy gets screwed, well, he should have been born rich, so it's not Shrub's fault. "Did you know that the human brain is the only computer in the universe made of meat?"   [ ...reply just to this | comment on the story... | next new ]   49.  Re: Hell, No   by logbass       at Tue 21 Jan 6:32pm score of 1.5 clever   in reply to comment 14     Filling out a piece of paper to get free stuff is intimidation? Where can I go to get intimidated? Who's got the kibble? - Bad Lieutenant: POCNO   [ ...reply just to this | comment on the story... | next new ]

11.  The deep reason for this ruling   by MonkeyBoy       at Sun 19 Jan 12:06pm score of 1     As far as I can tell the real "deep" reason for this ruling is to benefit HMOs at the expense of non-HMO emergency rooms. Say some guy, who is over his limit of ER visits, breaks his arm. He will not be refused treatment at an ER. It is just that his HMO will not have to pay for it.   [ ...reply just to this | comment on the story... | next new ]

12.  Re: The deep reason for this ruling   by wetzel       at Sun 19 Jan 12:24pm score of 5 compelling   in reply to comment 11     The broken arm isn't the problem. There's no choice with a broken bone. It's the chest pain. Go to the emergency room? What about MBNA and Citibank next month and whose going to fix the transmission? Damn this hurts. It's probably just that thing Bill had. Reflux something or another. Shit.   [ ...reply just to this | comment on the story... | next new ]

13.  Open letter from the Bush Administration   by marduk_kur       at Sun 19 Jan 12:38pm score of 2 nuanced     Dear Poor,       Screw you. Love- George and the gang :-) Sad lad, he really couldn't handle starting from scratch on the very first level. But he died the death of a warrior.   [ ...reply just to this | comment on the story... | next new ]

15.  No more housecalls...   by Bennington       at Sun 19 Jan 12:52pm score of 3.5 astute     Physicians used to make housecalls - they stopped about the time the telephone came into common use. Time was, to get the doctor for a house call, you had to hitch up a horse and ride into town to get him - it was a lot of effort and it made people think twice about going to the trouble, people ended up only doing it when it was really important. With the telephone it became easier to get the doctor to come see you in the middle of the night than to go see him in the morning. The modern emergency department (which is only about twenty years old - before that an ER was just a suture room next to the morgue) has become an analogous situation. It's easier to go see a highly trained physician there any time you want, than it is to wait a couple of weeks and see your family medicine doc or nurse practioner. People should get all the health care they need, but not nessarily all they want, and certainly not all they want at the expense of both the truly critically injured and ill (the only people who have any business in an ED) or the taxpayers footing the bill. To say that people shouldn't self diagnose is rediculous - does any sane person go to the ED everytime he doesn't feel 100 percent? "The plastic virtues: purity, unity, and truth, keep nature in subjection." -- Apollinaire   [ ...reply just to this | comment on the story... | next new ]

20.  Re: No more housecalls...   by Linux Ate My Dog!       at Sun 19 Jan 4:13pm score of 2 astute   in reply to comment 15     It's easier to go see a highly trained physician there any time you want, than it is to wait a couple of weeks and see your family medicine doc or nurse practioner. No it is not, or at least not everywhere. If you do not have something lifethreatening, the ED triage will leave you sitting in a chair for hours upon hours, even if you are in severe pain. Or at least, so I have experienced. Yes you will be seen the same day, but your day will be killed. Somehow what you are saying translates that people who do need weeks to see their doc or NP should be in agony of fever, flu, muscle pain, etc. for longer than they medically need be, just because of the scarcities built into the current system. Symptoms that will be over in weeks, but could have been fixed and made a person get back to work and more productive sooner. Or, more dreaded, symptoms that the affected cannot effectively diagnose as something that will be over in a couple of weeks or something that in a couple of weeks will make your doctor go "If only you had sought help sooner, it wouldn't have become so bad!" Yeah, well, buster, if it didn't take three weeks to get an appointment with you or I wouldn't get not reimbursed for going to an ED since it is not an emergency, I would have. But it is that after-the-fact medicine that is so much more expensive that catching things early. Insurances realize this, so many are setting up instant phone lines to talk to their NPs to avoid these situations in which the insurance will pay a lot more later if they don't get you in care now. And then there is of course the people with lousy or no insurance, the people who don't have general parctitioners and NPs but schlepp themselves from ED visit to ED visit to low-income clinic to low-income clinic. Every clinician in these places has seen them, every clinican knows that their poor health maintenance -- prevention? follow-up? yeah right -- is creating these expensive crises which makes it hard for people to hold down their jobs and leads them to self-medicate outside the system because they got the raw end of the healthcare system that will only help them when something is terribly wrong. The cheapest healthcare is continuous, maintained, follow-up neighbourhood healthcare. It keeps people working and healthy and productive, making them lose the least time off work and extending their productive lives, and can stave off a lot of expensive crises. Instead, we have a system built around the crisis, and it is so expensive only that gets funded. "He's old school." -- byrne   [ ...reply just to this | comment on the story... | next new ]   21.  Re: No more housecalls...   by Bennington       at Sun 19 Jan 4:45pm score of 1 brilliant   in reply to comment 20     >>If you do not have something lifethreatening, the ED triage will leave you sitting in a chair for hours upon hours, That's because you probably shouldn't be there in the first place. >>Somehow what you are saying translates that people who do need weeks to see their doc or NP should be in agony of fever, flu, muscle pain, etc. There is nothing any physician can do treat the flu - they may give you some antibiotics to get you out of their hair, but those do nothing on virial infections. If you are incredibly dehydrated they can give you an IV - otherwise you are wasting time and money. Go home and have some soup. And really - why the hell aren't you getting your flu shot? They are free at your local public health clinic if not at a grocery store near you. "If only you had sought help sooner, it wouldn't have become so bad!" If a medical condition doesn't need immediate attention it can wait two to three weeks. It's a bimodal distribution - there is stuff that needs to be dealt with right now, stuff that can wait a couple of weeks and stuff that has to be watched because one might want to do something about it next week. There is almost nothing that can wait a couple of days but not three weeks. >>The cheapest healthcare is continuous, maintained, follow-up neighbourhood healthcare. No, the cheapest health care is preventative medicine, it also happens to be the best as anyone who's gotten a car back from the bodyshop can tell you - it's good, but it's never as good as it was before it got "fixed." Wash you hands, get your vaccinations, take a vitamin, do a cardio workout everyday - do some lifting a couple of times a week - eat right and don't be fat - and learn to manage stress. Preventative medicine and hygeine are entirely responsible for the lenghtening lifespans in western nations. Medicine, not even the introduction of antibiotics, had nothing to do with it. You can claim you don't have time or resources, but is that really the taxpayers fault? Is it their responsibility to subsidise other people's unhealthy life style choices? One would hope that even someone with private insurance or cash in hand would respect the fact that medical care is a finite resource and use it responsibly - there is no reason not to codify that for people recieving health care at government expense. "The plastic virtues: purity, unity, and truth, keep nature in subjection." -- Apollinaire   [ ...reply just to this | comment on the story... | next new ]   23.  Re: No more housecalls...   by zanzibar       at Sun 19 Jan 6:09pm score of 1.5 nuanced   in reply to comment 21     That's because you probably shouldn't be there in the first place. I'm not a doctor, but even I can see that several of your statements are unsupported. Particularly the one above. I've personally waited for emergency treatment for hours, only to have doctors say "damn, you should have been treated for this hours ago." I've had friends wait for similar periods in agonizing pain, before a doctor looks at them for two minutes and immediately admits them or even sends them to surgery. It strikes me that a hospital admission or trip to the OR really does count your case as serious enough to "be there in the first place." In a very busy or understaffed emergency room, doctors will devote their resources to people who are in critical, obvious need of medical attention. Car crash victims, people who are bleeding to death and can't stand up, etc. If you can talk, stand and aren't oozing too many critical bodily fluids, you stand an excellent chance of being sent to wait-- regardless of the seriousness of your condition. There is nothing any physician can do treat the flu - they may give you some antibiotics to get you out of their hair, but those do nothing on virial infections. The flu kills a lot of people every year, precisely because they don't get those two treatments you casually dismiss. Most of them are old or weakened in some other way. Certainly, lots of people waste their time coming in for the flu, but a four-hour wait and the gentle discouragement of the staff gets rid of a lot of the ones who could just go home and have a bowl of soup. The non-serious cases who remain are usually dealt with in a couple of minutes. >>The cheapest healthcare is continuous, maintained, follow-up neighbourhood healthcare. No, the cheapest health care is preventative medicine Seems to me you're both pretty much agreeing with each other on this, so what's the distinction?   [ ...reply just to this | comment on the story... | next new ]   26.  Re: No more housecalls...   by ekr       at Sun 19 Jan 6:48pm score of 1   in reply to comment 21     There is nothing any physician can do treat the flu - they may give you some antibiotics to get you out of their hair, but those do nothing on virial infections. If you are incredibly dehydrated they can give you an IV - otherwise you are wasting time and money. Actually, this isn't true any more. There are now antivirals that can be used to treat the flu. They don't work very well, but it is better than nothing.   [ ...reply just to this | comment on the story... | next new ]   28.  Re: No more housecalls...   by BatGuano       at Sun 19 Jan 9:04pm score of 2 compelling   in reply to comment 21     "That's because you probably shouldn't be there in the first place." Okay, I'm going to transport myself to the same mindset I was in when I was taken to the emergency room last October. I had my appendix burst, but I didn't know it at the time. All I know is that I was in extream pain. But I was stuck there for about three hours before anyone saw me. I'm going to write in the same tone that I'd have used if you were to tell me this at the time. Please, don't mod me down, I'm only doing this to make a point... YOU COCKSUCKING MOTHERFUCKING SONOFABITCH!!! AAAHHHHHH!!! GET ME MORPHINE!!! WHAT THE FUCK DO YOU MEAN I PROBABLY SHOULDN'T BE HERE?!? YOU SWINE! OH, OH, PLEASE TELL ME WHAT KIND OF PREVENTATIVE MEDICINE WHOULD'VE PREVENTED THIS? MAYBE I ATE TOO MUCH CAKE! MORPHINE!!! DOCTOR!!! SOMEBODY GET THIS ASSHOLE OUT OF HERE! GRRRRRRR!!!!...." You get the point. I was in a lot of pain. Funny thing is, that was the second night I went to the ER. The night before, they had no idea that my appendix was acting up. So I had to go again the next night when the damn thing exploded. What a selfish misuse of the facilities. I should've stayed home and died. That would've saved everyone a lot of money. your radio friend, Bat Guano   [ ...reply just to this | comment on the story... | next new ]   31.  Re: No more housecalls...   by mattegrape       at Mon 20 Jan 1:49am score of 1.5 informative   in reply to comment 28     Here's my version of that story... For Thanksgiving of my Junior year in college, I decided to stay in town with my girlfriend. We were walking back from the grocery store when someone in the neighboring woods shot me, the bullet coming to rest between the two bones of my forearm. Now getting shot is a weird feeling and nothing like you would expect. It felt like someone nailed me with a big brick. Not knowing what happened, we walked home and I rinsed off in the sink. It wouldn't stop bleeding and really hurt, maybe my arm was broken. My girlfriend was freaking out so we headed off on foot to the hospital 3 blocks away to check it out. When I got there, I was literally dripping blood. I told the triage nurse that I someone hit me with a brick and I was bleeding pretty badly. She looked at it briefly and I think maybe gave me some cotton or gauze but put me in the queue where I waited for over an hour before seeing anyone, drip drip drip. It all turned out fine, just as your appendix, but time was of the essense... It could have killed me. I could have lost my arm. So first of all, the comment about hygiene and preventative medicine replacing emergency care is pretty silly. Secondly, my lessons learned: - Self-diagnosis can be tricky. - Triage nurse diagnosis can be tricky. - If you do think it's serious, don't walk or drive yourself. Call 911 and have an ambulance take you. That's the VIP line. ;) ciao / matte   [ ...reply just to this | comment on the story... | next new ]   33.  Re: No more housecalls...   by A. H. Cretin       at Mon 20 Jan 3:25am score of 1   in reply to comment 21     >>If you do not have something lifethreatening, the ED triage will leave you sitting in a chair for hours upon hours, That's because you probably shouldn't be there in the first place. Well, several other people have already raked you over the coals but I think a point's been missed. Might I suggest that you try breaking a bone on a Saturday evening sometime? It's not life-threatening (in general), so by your logic you shouldn't go to the emergency room for it. Enjoy your day-and-a-half of pain and occasional flares of agony, and see what your primary care provider says on Monday. I'll bet it's something along the lines of "Why didn't you go the the ER for this?" If a medical condition doesn't need immediate attention it can wait two to three weeks. Wrong answer, but thanks for playing. Three years ago this week, I had the nasty flu that was going around. It led to a sinus infection. Said sinus infection didn't get immediate treatment (it certainly wasn't ER-worthy), and when all was said & done, I had said sinus infection for the better part of 4 months. $500 worth of antibiotics later, I discovered that I had to go in for sinus surgery because the infection had caused so much scarring that 2 of my sinuses were nearly scarred shut. I went, I had my surgery, and I had some bleeding a few hours afterward. Not life-threatening, no need to go to the ER, right? Well, luckily I was on my way to the ER, because a little bleeding quickly became quite a bit of bleeding. By then I was in the ER where they know how to deal with such things, rather than sitting in my apartment trying to keep my airway clear enough that 911 could understand my call. Not bad for a problem that didn't need immediate attention. (Just for the record, I have health insurance, paid for out of my own pocket, for problems such as this. No Medicaid money was harmed in the making of that emergency.) -A Humorless Cretin   [ ...reply just to this | comment on the story... | next new ]   35.  Re: No more housecalls...   by Bennington       at Mon 20 Jan 7:07am score of 1   in reply to comment 33     next year get a flu shot. "The plastic virtues: purity, unity, and truth, keep nature in subjection." -- Apollinaire   [ ...reply just to this | comment on the story... | next new ]   36.  Re: No more housecalls...   by Bennington       at Mon 20 Jan 7:11am score of 1   in reply to comment 28     I'm not sure how you got "people should stay home and die" from my statement that the ED should be used only for things that need to be treated urgently. Sorry to hear you weren't treated more aggressively. "The plastic virtues: purity, unity, and truth, keep nature in subjection." -- Apollinaire   [ ...reply just to this | comment on the story... | next new ]   39.  Re: No more housecalls...   by zanzibar       at Mon 20 Jan 9:55am score of 1   in reply to comment 35     next year get a flu shot. The same things can happen from a nasty cold or an attack of bronchitis. You can't get shots to prevent those things. I got a flu shot this year and I just spent three days in bed with the nastiest cold I've had in years. Very unpleasant.   [ ...reply just to this | comment on the story... | next new ]   40.  Re: No more housecalls...   by Linux Ate My Dog!       at Mon 20 Jan 9:57am score of 1   in reply to comment 36     I'm not sure how you got "people should stay home and die" from my statement that the ED should be used only for things that need to be treated urgently. No, that is not the message here. The message here is that people are not equipped to be able to tell what is urgent or not, and your suggestion that they a) should or b) just suck it up if they are in pain because it isn't 'urgent', can lead to desperate situations as outlined. "He's old school." -- byrne   [ ...reply just to this | comment on the story... | next new ]   43.  Re: No more housecalls...   by hedgehog       at Mon 20 Jan 12:12pm score of 1   in reply to comment 35     For what it's worth, 'flu shots are practically worthless. What they do, is combine strains of -last years- viruses into the "vaccination". Apparently the hope is that none of these strains have mutated, and maybe just one of them might be the major strain floating around -this- year. Now, I'm basing this on reports from my mother, sister, aunts and cousin, who are a surgical technician, registered and licensed practical nurse(s) and family practitioner, respectively. I have never gotten a 'flu shot, myself, and haven't gotten a hardcore case of the 'flu since I was a teenager. Your mileage may vary, of course, but I personally see no worth in the 'flu shot. It's always a year behind.   [ ...reply just to this | comment on the story... | next new ]   44.  Re: No more housecalls...   by A. H. Cretin       at Mon 20 Jan 2:30pm score of 1   in reply to comment 35     I got a flu shot. Didn't help. Nice to see that you missed the point completely, too. -A Humorless Cretin   [ ...reply just to this | comment on the story... | next new ]

16.  No bearing on treatment   by shagoth       at Sun 19 Jan 2:20pm score of 1.5 interesting     Whether or not medicaid is willing to pay for the ER visit has no bearing on the obligation of the ER to provide care. This was dealt with in federal called EMTALA (The Emergency Medical Treatment and Active Labor Act) a number of years ago. This, of course, means that the ER doctor and hospital simply won't get paid by the medicaid patient since of course there is no way to collect from people who can't afford health insurance in the first place. The result is something that EMTALA was reviled as when it originally passed, federally mandated slave labor. Ethically, ERs should absolutely provide care, but should it have to be free just because the patient overuses the system:? Universal healthcare, anyone?   [ ...reply just to this | comment on the story... | next new ]

38.  Yay! Britain's great.   by idmw       at Mon 20 Jan 9:00am score of 1   in reply to comment 16     We all get as much health care as we want. 'cept dentistry. Guess why that is :€ There is an old concept that deals with the ER problem - triage. When someone turns up, the nurses on the desk say 'you're not ill enough, go upstairs', 'congratulations, you need defribulation(sp?)' or 'go outside and die', depending on the severity of the illness. If a patient makes 10 visits for a cold and then gets turned away with a brain haemorage, this is a breach of the hypocratic oath. Hmm, there was a joke about that in The Onion, but you'll have to get it on back order.   [ ...reply just to this | comment on the story... | next new ]

18.  Let them eat cake   by stogie       at Sun 19 Jan 3:33pm score of 1.5     This simply goes to show that recent accusations of "class warfare" by this administration are hypocritical; they already know that we're in a class war- they're the ones who declared it. Just as we "need" tort reform to protect corporations from all of those frivolous lawsuits arising from their introduction of poisonous chemicals into our environment and bodies, a la Dow and Eli Lilly, we "need" to make the great unwashed fear the economic consequences of going in for emergency medical treatment. Hey, I know I'll be looking both ways before crossing the street from now on. "I'd rather have a bottle in front of me, than a frontal lobotomy." -Tom Waits   [ ...reply just to this | comment on the story... | next new ]

22.  Bush's reasoning   by Blue Dot       at Sun 19 Jan 6:01pm score of 1.5 informative     Bush mentioned in an address in Scranton, PA that the reason he has done this is so Medicaid patients will no longer substitute emergency rooms for primary care physicians. His reasoning was that such non-emergency visits to the ER clog up those facilities and keep emergencies from being addressed. It's a shame the write-up doesn't even mention Bush's logic behind the policy.   [ ...reply just to this | comment on the story... | next new ]

24.  Re: Bush's reasoning   by MAYORBOB       at Sun 19 Jan 6:10pm score of 1.5 helpful   in reply to comment 22     Good for Bush that he had some sort of logic to attach to the ruling. But for the fact that some people either don't have a primary physician because they don't have insurance or they turn ill at the most inconvenient of times: holidays, weekends, middle of the night. When you call a primary physician with a complaint more complicated than you have the sniffles or a cough or a headache, they will likely tell you to go to the Emergency Room to be seen by a doctor. Tending to final details.   [ ...reply just to this | comment on the story... | next new ]   27.  Re: Bush's reasoning   by boosman       at Sun 19 Jan 8:41pm score of 1   in reply to comment 22     So what we're saying is that in the context of an overall health care policy that provides reliable neighborhood local care for the poor, it might well make sense to take steps to discourage unnecessary use of ERs... but without such an overall policy, the Bush action just comes off as cruel to the poor and an unfunded mandate on hospitals and/or insurance companies?   [ ...reply just to this | comment on the story... | next new ]   45.  Re: Bush's reasoning   by Blue Dot       at Mon 20 Jan 4:25pm score of 1   in reply to comment 27     My initial reaction is "yes, that's what I'm saying." I don't know much more about Bush's health care agenda but I think this, as a PART of a program, is fine: increasing the efficiency of ERs is a noble aim, as long as people can still get care. That last part, people getting care, is the most important thing after all, and it seems that any discussion about this policy is nearly impossible without a coherent picture of the policy and existing laws as a whole. The post below illustrates a horrible pitfall in the system (untreated pneumonia for an asthmatic can be fatal), but I hope some segment of the President's plan deals with that. If not, it's as rotten as this thread makes it seem.   [ ...reply just to this | comment on the story... | next new ]   41.  "Free emergency room" is overused   by LostBoyJim       at Mon 20 Jan 10:37am score of 1.5 intriguing   in reply to comment 22     In Tennessee the TennCare program is abused by the patients. TennCare is free (or with minimal co-pay). My doctor didn't receive a paycheck last month because a large enough % of her TennCare patients (which she cannot turn away) didn't bother to pay. In a larger sense, TennCare patience go to the Emergency room to get a Dr.'s note for why their child missed school. The fact that is is TOTALLY FREE really is a big deal. If it were just slightly costly (perhaps $50/visit) then it would encourage people NOT to use this service as a "fix my headache, write my child a Dr. excuse") visit, and more of an emergency room. jim   [ ...reply just to this | comment on the story... | next new ]

29.  You wonder why spurious ER visits happen?   by CoFenchurch       at Mon 20 Jan 12:42am score of 4 compelling     This is a true story-- it happened to me. I used to be on Medicaid. I was sick, and two days in a row, I coughed up some pink sputum on awakening. Took me a while to realize why it was pink-- there were tiny flecks of blood in it. It was a very small amount, and only in the morning, but when you are coughing up blood, you need immediate medical attention. I didn't feel that bad, and the blood was not very much, so I knew what I needed was not a trip to the ER, but to see a doctor. So I called the clinic that I had previously been assigned to. They told me there would be a MONTH wait for an appointment. I explained that I was coughing up blood. Then, suddenly, an appointment came open-- UNTIL I told them which particular Medicaid HMO I used. They said they stopped taking that one. I had only signed up with them a few months previously. They had made no effort to let me know they weren't taking it anymore. So I called the HMO. They gave me the name of another clinic in a very crappy part of town (in Denver). I called them. They also told me no appointments for a MONTH. I explained, again, that I was coughing up blood. I was then ALLOWED to leave a VOICEMAIL for the triage nurse. He called me back several hours later and told me they didn't take that Medicaid HMO either-- I should just go to the ER. In the meantime, I had been calling all over town to try to find a doctor who took the HMO-- no dice. So, I ended up going to the ER. They took a chest X-ray, discovered I had the very beginnings of pneumonia, gave me antibiotics and strong cough syrup, and sent me on my way. Any doctor could have done this, but no one would see me. If I had waited, my condition would have likely gone from easily treatable to life-threatening (given that I have asthma). This is the reality of Medicaid-- if you need immediate (but not emergency) medical treatment, you have nowhere to go but the ER. Interestingly, since I got married, I now have Blue Cross/Blue Shield through my husband's work. When I or my son or stepdaughters have called with an illness, we have never failed to get in the same day. However, I don't think most Medicaid recipients are going to be lucky enough to marry people who work for large multinational corporations and thereby have access to decent health care plans.   [ ...reply just to this | comment on the story... | next new ]

46.  An overlooked problem   by crowley       at Tue 21 Jan 11:52am score of 1     One of the problems with health care in this country is that there aren't enough doctors to have a policy that actually is concerned with people's health. The AMA has done all it can to stop new med schools from being formed, so that it can keep its status as a medical cartel, on rank with OPEC.   [ ...reply just to this | comment on the story... | next new ]

47.  One improvement that would help...   by waldeaux       at Tue 21 Jan 3:10pm score of 1     ... would to require people (when possible) to be screened before coming to the ER. Now, I don't mean that people should not call 911 when there's a dire accident and call the ER first, but a LOT of people in emergency rooms do not have emergencies. The last time I was in an ER for myself, I had sliced my hand pretty bad. While I'm waiting, bleeding on the floor (literally), the nurse kept avoiding my pleas for help while she took the blood pressure of an elderly person ahead of me. No, he wasn't having a stroke, or a heart attack, or anything. He just came in every week to the ER to have his blood pressure taken. That's the sort of thing that shouldn't be allowed. Actually there should be two levels of ER-like care: health care that needs general attention (I'm sick and need an Rx, or I've broken my wrist), and life/limb-threatening cases. The latter gets prioritized, the former gets treatment with a small co-pay (relative to your ability). However, I have NO problem identifying people who "cry wolf" with ER's and requiring them to screen unless the situation falls into the "dire" category. Then call 911, and let the ambulance bring you in for immediate treatment. Life is a peanut butter and liverwurst sandwich --- Me, 1977   [ ...reply just to this | comment on the story... | next new ]

50.  They withdrew the new policy   by Fionas Guy       at Thu 23 Jan 1:16am score of 1     The Bush folk have now announced that they're withdrawing their new ER limitation policy. They were about to lose an amendment on the Senate floor because so many people (R and D) thought that it was objectionable. Hurrah for common decency. And, by the way, the policy would have allowed States to limit visits for true emergencies (i.e., ones that meet the "prudent layperson" standard of fear for life and limb) by Medicaid patients. Limits on visits to the ER for trivial stuff have been permissibly limited under Medicaid for years.   [ ...reply just to this | comment on the story... | next new ]