home
RSS
September 24th, 2010
11:39 AM ET

Opinion: Emergency care as the new primary care

George Bush once famously (or infamously) commented that health care is indeed available for all:  You just go to the emergency room.

Unfortunately, this is a reality for a significant swath of the American people, and the problem continues to worsen.  A report in the September issue of Health Affairs points out that less than half of the 345 million annual visits for acute-care problems take place with a patient’s personal physician.

Nearly a third of these visits takes place in the emergency room.  The ER is of course the right place for bleeding wounds, crushing chest pain, and motor-vehicle accidents, but an enormous chunk of these visits are not actually emergencies.

Most of these visits more properly belong in the category of “urgent care” — rashes, mild-moderate pains, urinary infections, coughs, fevers, and so on.  The type of things that are easily and routinely handled by outpatient primary-care doctors.

Some of this misuse of the ER falls under the rubric of access: patients have primary-care doctors, but are unable to obtain timely appointments. But most of this is attributed to patients who do not have primary care doctors, usually because they don’t have insurance.

The latter is one of the key pillars of the health-care reform bill that passed this year. Providing health insurance for all its people is an obvious basic tenet of civilized society.

To hear that Republican politicians, unable to repeal the reform bill, are now working to chip away at it is infuriating. Where are our ethical priorities as a nation? Somehow we can afford tax cuts for the wealthy, but we can’t afford health coverage for our fellow Americans.

I invite these politicians vowing to undo health-care reform to spend a year without health insurance.  See what it’s like to take care of your children without reliable primary care medicine.

Oh, and I recommend picking up a few hefty novels; it can be quite a long wait in the emergency rooms.

The opinions in this commentary are solely those of the authors.

Danielle Ofri is associate professor of medicine at New York University School of Medicine and editor-in-chief of the Bellevue Literary Review. Her most recent book, “Medicine in Translation: Journeys with My Patients.” is about the care of immigrants and Americans in the U.S. health care system.


soundoff (235 Responses)
  1. WakeUpCNN

    ER has been a primary care facility for the past decade.Also a shelter for the homeless people on cold nights..Where have you been?
    It is what it is.......................

    September 24, 2010 at 13:29 | Report abuse | Reply
    • RICHARD57

      MY EXPERIENCE is that the ER is over used by non-acute and psychiatric clients too often. The NEW HEALTH CARE PROVIDERS will be CLINIC DRIVEN...which is why so many new clinic chains are springing up in central Texas. Additionally, I'd like to say that many foreigners come here for medical care..it is still the best in the world. Finally it is important to point out that SIXTY PERCENT OF ALL HEALTH CARE DOLLARS ARE SPENT IN THE LAST THREE WEEKS OF LIFE...this means.........

      September 24, 2010 at 21:50 | Report abuse |
    • wahughes

      There are several problems.
      Americans eat too much, weight too much, smoke too much, and drink too much etoh. This produces a lot of our health care problems.
      My clinic is open 7 days a wk and til 9 pm on weeknights and 6 pm on sat and sun. Keeps our patients out of the er a lot. More clinics should do this.
      Fear of being sued drives a lot of medical providers to send people to er at the drop of a hat which increases cost .
      A lot of people are not motivated to even try to come to a clinic like ours even though we are open nights and weekends. They just go to er for minor things. I guess they have nothing else to do and it is not their money.

      September 25, 2010 at 07:02 | Report abuse |
    • Liutgard

      Richard57, if our healthcare is the best in the world, why are we using it so inefficiently? And for all our having the very latest in technology, we're getting the worst return on our expenditures. Just as an example, google up the numbers on our rates of maternal and infant mortality compared to the rest of the world. It will (or should at least) shock you. You know those little -stan countries where 8 people live in a two bedroom apartment and they drive cardboard cars? They have better maternal survival rates than we do, even with our intervention and nearly criminal 30% c-section rate. There is no excuse for people to not have decent medical care in this country.

      Oh, and guys? You can't get cancer treatment in ER or urgent care. Or long-term cardiac care, or treatment for chronic asthma, or dialysis, or... yeah. Not a solution.

      September 25, 2010 at 09:39 | Report abuse |
    • Kevin

      Obama isn't providing health care to anyone. Where do you get this idea? Is he footing the bill? Is he down there with a stethoscope? Of course not. Tax payers are providing health care as tax payers have a right to agree OR disagree with being forced to pay for it.

      September 25, 2010 at 09:51 | Report abuse |
    • Jen

      True, the ER has been primary care for a long, long time. This is not new at all. Really, people have to take a good look aroiund outside of their cozy suburban neighborhoods to see what reality is.

      September 26, 2010 at 07:39 | Report abuse |
    • Professor

      One problem with your post Dan, you mentioned that "we can’t afford health coverage for our fellow Americans", but last I checked illegal citizens are not Americans. I am curious why you failed to mention that it is illegals whom are overcrowding our hospitals these days. Ask any professional in the health care sector and they will tell you this precisely. I am not sure where you got your journalism degree, but I would ask for a refund....as they obviously did not do their job in teaching you. Class is dismissed!

      September 26, 2010 at 10:02 | Report abuse |
    • tiffany

      yes allowing replublicans back in control, would surely fatten their wallets, its not a better education its not a better family and it damn sure isnt better financial planning, its greed. and its clear they are scared of our president, got thier nasty good ole boy balls in a bunch. It should be, 2010 education is available and the resources to hold those accountable will not be back in power!!!! by the way i am a 25 year old Veteran, turned 19 on my first day in Iraq. Im poor and fighting fraud against vets from white collar ass holes like Republicans. This is America, we fight for this shit and all i see are dollar signs in Capitol Hill!!! Help our president, he cant force congress do to the morally and ethical obligations their took an oath for. Lock thier ass up!!! in Iraq!! lol

      September 26, 2010 at 23:22 | Report abuse |
    • Crystal

      Doctors are getting overwhelmed with all the patient concerns and small problems. All About HealthCARE Advocates is a great referral center to solve these problems. They provide the referral service to aviod the primary doctors and take you straight to the doctor that suits you. They also do research on illness and disease, patient reminder call about appointments and medicine, also education on bills and coverage. http://www.AllAboutHealthCAREAdvocates.com

      October 20, 2010 at 15:59 | Report abuse |
  2. JJ Stuart1

    Do you know of any doctors available 24/7? Some aren't available 5 days a week. So when it's 3:00AM on a Sunday and there's a health crisis what do you do? True, we need to have every American insured to stop "misuse" of ERs but we also need more access to healthcare providers as well and we need providers that don't need us to sign our rights away on the dotted line before surgery so when something goes wrong the provider is in the clear. Horse manure. You want to operate on a bad surgical candidate because your eyes are flashing dollar signs at the lucrative fee, then pay the price when the patient goes belly-up.

    September 24, 2010 at 14:44 | Report abuse | Reply
    • Dan mason

      You are a moron. There is no high dollar sign falshing in front of a doctor when the operate. Just a hughe sign saying risk. Surgery is risky, so it is not uncommon for bad things to happen. That is what all those forms are for you moron. If dumb asses like you did not expect perfect outcomes from risky things and sue at the drop of a hat, then helath care might be cheaper and there would be less forms. You get what you pay for.

      September 24, 2010 at 15:12 | Report abuse |
    • Xilo

      If it's 3 AM and you have a health crisis you go to the ER. Crisis, being synonymous with emergency, is exactly what the ER is for. What the ER is not for is "I've been throwing up and I feel bad," "I've had a cough for three weeks but just now decided to do something about it," or anything else that won't kill you before morning when your doc's office opens. It's not a convenience like cable TV to be used because you can't be bothered to make an appointment. It's there for people who are in need of medical attention RIGHT NOW.

      Easily half the people we see in a day could have saved themselves (or their insurance company, and by extension all of us that pay taxes or pay ever-increasing insurance premiums) hundreds of dollars by having the common sense to wait and see. Granted, not everyone knows what is truly emergent and what can wait, but most people can answer the question "Am I dying?" reasonably well. If the answer is no then don't go to the ER.

      September 24, 2010 at 20:54 | Report abuse |
    • J Klempen

      Maybe you should be blaming the trial lawyers for " the dotted line signing" I don't know what type of work you are in, but when a doctor in the ER is requried to see everyone that walks through the door, that patient doesn't need to pay his bill, and can sue if he isn't happy with the treatment, it is a receipe for failure. Show me a mechanic that has that job description and I'll gladly take my car to him.

      September 24, 2010 at 23:01 | Report abuse |
    • Robert Meek

      @ JJ Stuart1 "...we need providers that don't need us to sign our rights away on the dotted line before surgery so when something goes wrong the provider is in the clear."

      You, sir, are an idiot. Signing a consent form is merely that – documentation that you consent to have the surgery, and what the risks are, and that you have been informed. There is nothing on a surgical consent form that makes "the provider in the clear" "when something goes wrong" – and I speak as both an ex-RN with 25 years experience, and a patient with heart disease, lung disease, HIV, diabetes, and hypertension who is now disabled wearing oxygen 24/7. So I have been on both sides of the fence.

      If what you allege were even half true, we'd not have all these successful lawsuits making people money after errors happen.

      "You want to operate on a bad surgical candidate because your eyes are flashing dollar signs at the lucrative fee, then pay the price when the patient goes belly-up."

      You are beyond idiot, sir. First, a healthy person, truly healthy, does not need surgery. One needs surgery because of a health problem. Second, there are degrees as to the type of surgery (minor versus complex and radical), and the quality of the risk factors for the patient (minor versus severe).

      "eyes flashing dollar signs"? BS, and more than BS. Most doctors make plenty of money without having to do surgery merely for a "lucrative fee"!

      Furthermore, I have seen many a surgeon operate on people who needed it to save their lives who had NO insurance AT ALL, and who KNEW that they would not make one red cent off of them.

      I hope and pray with all of your vitriolic lies that someday YOU have to have a life-saving procedure, sign the consent form you disparage with you massive ignorance, and get a much needed real life lesson.

      September 25, 2010 at 06:29 | Report abuse |
    • Will S

      "So when it's 3:00AM on a Sunday and there's a health crisis what do you do" Your definition of a health crisis is probably a stomach ache. Wait until Monday unless it is an emergency, in which case you go to the ER, where 99 times out of 100 you will receive treatment as triage dictates.

      September 26, 2010 at 20:02 | Report abuse |
  3. ICUnurse

    At one hospital I worked at, one third - one THIRD - of the patients who came in never paid a dime. How long could WalMart stay open if one third of the people who came in took a cart full of goods out without paying? If you've got a stroke, or a heart attack, or trauma, you absolutely should be seen and worked up in the ER. However, hospitals are going to have to start turning away the folks who show up with a kid with a fever of 104 and say - no kidding, this is verbatum - "no, I didn't give her Tylenol, why should I when I can get it here for free?" This parent then got angry when I told her there was no cigarette machine in our hospital, and she left her kid in the ER while she drove to the gas station to get her smokes...

    No one's going to care about healthcare until we lose someone who's important (or popular) because they're in a rural area like we are and the local hospitals have closed because they've been driven into bankruptcy by people who think ER means "free."

    September 24, 2010 at 14:47 | Report abuse | Reply
    • Jaci

      As someone who works on the finance side for a group of rural hospitals in the Midwest, I can't agree more. The reimbursement rates that the current government healthcare programs pay are a joke too, which means that the rest of us are charged more in order to cover the costs of treating Medicare and Medicaid patients.

      Why they didn't fix the EXISTING government programs before screwing up everything else is beyond me....

      September 24, 2010 at 17:12 | Report abuse |
    • Sergio

      As a former Hospital Corpsman, who served in the USN for 15 years. I believe we all should be asking ourselves, "what can we do to fix it"? We as a Nation need to figure out how to not have to keep paying increased Insurance rates every year. I took a job once in KS and applied for all the benefits that the job would give me and I paid for those benefits. What made me mad and my co workers was the 21% increase in those benefits the following year when it was time to renew our benefits. I remember going to the V.A. For much needed help and I knew what they were going to do for me, but it took all day for them to admit me, and it took them a few more days to get me toiletry items that I should have received on day one. I currently live in work outside of the US, and this is no better. I am required by my host country to have prof of insurance, however when I went to the Dr. the billing department wanted to know if I had insurance and I provided all of my documentation. they thanked me and then informed me that I had to pay in cash before I could leave. So I paid for a policy, have to file the claim myself and pay cash. We just need to get it right and affordable for all people.

      September 25, 2010 at 09:05 | Report abuse |
    • Sergio

      As a former Hospital Corpsman, who served in the USN for 15 years. I believe we all should be asking ourselves, "what can we do to fix it"? We as a Nation need to figure out how to not have to keep paying increased Insurance rates every year. I took a job once in KS and applied for all the benefits that the job would give me and I paid for those benefits. What made me mad and my co workers was the 21% increase in those benefits the following year when it was time to renew our benefits. I remember going to the V.A. For much needed help and I knew what they were going to do for me, but it took all day for them to admit me, and it took them a few more days to get me toiletry items that I should have received on day one. I currently live in work outside of the US, and this is no better. I am required by my host country to have prof of insurance, however when I went to the Dr. the billing department wanted to know if I had insurance and I provided all of my documentation. they thanked me and then informed me that I had to pay in cash before I could leave. So I paid for a policy, have to file the claim myself and pay cash. We just need to get it right and affordable for all people. I worked in a Nurse on Call program for a Insurance company once and the other key is we as a nation also need to educate the public as to what is an Emergency and what is not. Many a time I had to tell the ER to refuse to see the patient, and the patient would want to talk to me ad I would explain to the patient that this is not an emergency and that need to see their Primary Care Physician, during normal working hours and they would get mad, because they would lose pay from their job if they did that. again we need to look at the system and fix it. it's not broken everywhere just in some places.

      September 25, 2010 at 09:12 | Report abuse |
    • Kmarie

      I am 100% on board with what you are saying. My husband works in the ER and 75% of the cases are NON-Emergent!!! Ridiculous! Bronchitis, drug-seekers, yeast infections, nausea...REALLY??? Half of them on Medicaid, living off the system, young mothers with 3 kids cause they are too damn lazy to work...! I'm not syaing all people are like this, but I know second-hand it's the majority of cases because 3 of the docs are my friends. They complain because they have to wait to be seen, go out for 12 cigarette breaks, but continue to come into the ER for "coughs." UGH...I so frustrated with everything lately.

      The government allows this! Maybe if the government treated the really problem with medicaid coverage with people who abuse it, then maybe our healthcare crisis wouldn't be as bad. I have health care coverage and end up still having thousands of dollars in bills. Then I see these people walking out of the ER not paying a cent. They smoke, they're obese and tax payers are flipping the bill. I know so many young women/men in their early 20's collecting medicaid, getting housing paid, so they can sit around on their rears all day and do nothing. Why work, when you can get it for free?? Let's continue to allow these women to pop out more kids so their welfare check get fatter each year, then nothing will change. How about putting them on mandatory birth-control or cutting them off.

      September 27, 2010 at 14:30 | Report abuse |
  4. HS

    Maybe if there were more non-emergency 24 hr clinics then there would be less emergency room visits. These clinics should cost people the same as a regular doctor not an ER, all doctors should expect to work overnight if it seems that most people now a days have to as well.

    September 24, 2010 at 14:55 | Report abuse | Reply
    • Dan mason

      And you should have to work 24 hours too.

      September 24, 2010 at 15:13 | Report abuse |
    • Michelle

      Dan, we're not saying that the doctors at 24-hour clinics should have to work 24 hours. That's why they're called SHIFTS. If a convenience store is opened 24 hours a day, is the same person there at 8:00 AM as at 8:00 PM? Of course not.

      Hospitals are staffed 24/7. I know – I work at one, and so does my wife. She used to work a night shift. And the people in her department rotate to cover weekends. Why? Because you can't decide when to get sick. And people in inpatient care don't go home until they're ready, REGARDLESS of what time of day, or day of the week.

      Are you capable of wrapping your head around that?

      September 24, 2010 at 15:27 | Report abuse |
    • JC

      They do have 24/7 Urgent Care clinics, the main reason people don't go to them is that they require full payment after services rendered, with or without insurance! Where an ER will usually ask for some money down if you can that is!

      September 24, 2010 at 15:49 | Report abuse |
    • hmmm

      JC, some Urgent Care clinics may require full payment after services, but not all of them. I went to one just a few weeks ago and didn't have to pay a dime before I left. The clinic did, however, have a sign posted on the front door that said that they do not prescribe narcotics. I have to wonder if that is perhaps a major reason as to why there was no wait.

      September 24, 2010 at 16:05 | Report abuse |
    • Ryan

      Primary care is already suffering from a paucity of physicians, forcing 24 service would only worsen that.

      September 24, 2010 at 19:05 | Report abuse |
    • Clutzycook

      This is absolutely true. I grew up in a rural area where the nearest ER is 20 miles away (and it's a joke)! There are no 24hr urgent care centers anywhere nearby so your only option is to drive (or call the ambulance) and go to the ER. By contrast, I now live 150 miles away in an area where I have at least 3 or 4 urgent care centers and at least a half dozen ER's within a 15 minute drive from my house. Talk about extremes.

      September 24, 2010 at 22:00 | Report abuse |
  5. j~go

    I understand the health care reform debate and respect the differing of opinions that help make our country so strong, but I haven't heard an inteligent argument that details why the health care reform is a negative. It seems to me that we currently have a system where the have's are paying for the health care of the have nots, whether that is in the form of higher taxes or medical costs billed to insurrers. What I haven't been told from those opposing the reform is why I should be against the deflection of at least a portion of these costs from my by forcing the majority of us to pay for some level of costs. I encourage someone that seel the other side to give me their argument; maybe I am just missing something.

    September 24, 2010 at 14:55 | Report abuse | Reply
    • hmmm

      To me, it isn't that health care reform is a negative. Health care reform and health insurance for everyone are not the same thing. Health insurance for everyone is a TYPE of health care reform, not the only option. If you look at Medicare and Medicaid as examples, sure – they help a lot of people, and I'm ok with helping people... but they bring about an awful lot of restrictions on how a doctor's office functions. It is my understanding that the government workers (and Congress) who decide what will and won't be covered under Medicare influences the insurance companies and helps guide what they will and will not cover. I'm not saying we should get rid of Medicare, but I do wonder if less government control might level things out a bit... it might give doctors more freedom to practice they way they used to, with bartering or charity cases, so to speak. Now, if you are a Medicare recipient, there is an awful lot of red tape to deal with and if you choose not to deal with it, you can lose your right to serve Medicare recipients and accept government payments for those patients. I'm afraid this might happen with health insurance if they government has their hands in it.

      The individuals in our country are generally very generous. It is not within the historical nature of our country to provide basic needs for all. This is a sticky issue, because it seems that one side believes that individuals should be charitable and the other side believes that it is the government that should be charitable. When I give of my own money to help someone, I control who gets my help. When the government takes my money and gives it to help someone, I don't know where it's going. I think that's where some people have a problem with it. It isn't about not helping people... many of the folks that I know that oppose the health care bill that we got donate to charity and help people in a lot of ways.

      Another issue is, once again, a bit sticky... but those of us that are fortunate enough to have health insurance will probably see a decrease in services covered and an increase in premiums due. We very well might not have a choice to purchase a "good" insurance because it will be too expensive, or the employer will be penalized for offering it, etc. I'm not saying that my insurance should be better than that of others, and I'm not saying that I'm not willing to let go of some of my insurance so that someone else can have a little insurance. I don't like not having the option. My husband has pre-existing conditions, and we have worked hard and paid hard-earned money to be able to keep him insured. I can't blame the insurance companies for not wanting to cover him – he's a bigger risk to them than a healthy person is. But we were lucky and were able to sacrifice personal wants so we could afford the insurance to keep him insured. What if a routine test for him is now not covered so someone else can have insurance? Not sure I like that. I'd be much more willing to give out of my pocket to help someone with medical bills or insurance than see my options potentially go away. I'm already seeing a change in Flexible Spending Accounts because of the new health care changes: i can no longer purchase over-the-counter medications with a Flexible Spending Account. Why? The money that I put into that account is pre-tax. Americans buy a LOT of OTC drugs... now they will have to be purchased with taxed income. So... there's one example of "raising taxes" on many of us who are NOT rich to help pay for this. Note: I am not advocating for the rich to pay for this either! I don't know what the right answer is, but I'm just not sure this was a good idea now, when the entire economy is in the tank.

      And I don't think this will deflect any of the costs. Those of us that have insurance will still pay higher premiums for less coverage, our taxes will still increase by things like the changes to the Flexible Spending accounts, and we'll still be paying for the federal and state programs (Medicare, Medicaid, etc). I honestly think that there are just two basic ways of seeing the issue, and one usually just can't see the other. I personally feel that it is my individual responsibility to take care of myself to the best of my ability (temporary help is ok and often needed!), and my individual responsibility to help others to the best of my ability. If we did more of this, rather than giving that responsibility to someone else (the government), I think we'd be in better shape. But letting someone else handle the problem is far too easy, especially when we have to struggle and sacrifice to give. Just my opinion.

      September 24, 2010 at 16:58 | Report abuse |
    • Valerie

      I'm not going to try and convince you of anything, but I do have some concern I will share. Already, it is just under $300 for myself to be insured through my job, if I wanted to add all of my family members to the coverage, it would be $1000 per month. This is through Cigna for a small-medium sized company. If I weren't already spending that amount on daycare just so that I can actually go to work, I would definitely pay for the family coverage. I like the idea of everyone being in the system and everyone having healthcare, including the new provisions to make sure that insurance companies can't drop you or refuse to pay for your care, however I am concerned about the rising costs. Without some sort of cap on what they can charge, I think a LOT of people will be either paying penalties or owing the IRS every year. I don't like the idea of funneling money into the insurance companies. Other than that, no objections.

      September 24, 2010 at 17:13 | Report abuse |
    • Sue

      I worked and paid health insurance premiums for 31 years until I was laid off from my job. Then I paid COBRA premiums for 18 months to keep my insurance. I still have not found a job and am no longer eligible for COBRA. I have tried to find private insurance but have been turned down because of pre-existing conditions. The state high risk pool is too expensive (it is a sliding scale from $900/month with $1000 deductible to $500/month with a $10000 deductible) for someone who is scraping by on odd jobs and savings.

      So now I am one of the uninsured people other people love to hate.

      September 24, 2010 at 19:48 | Report abuse |
  6. Michael

    Where in the health care bill did it address these uninsured ILLEGAL ALIENS? It doesn't, so ER as primary care will still be the case.

    September 24, 2010 at 15:04 | Report abuse | Reply
    • American

      There are only a few million illegall immigrants out of 300 MILLION Americans. Actually the number is declining. Many of them probably don't go to the hospital anyway. Stop making them the scapegoat for America's problems.

      September 24, 2010 at 17:31 | Report abuse |
    • Jake ER

      Wow. You have not been to an ER lately. I wish I could speak Spanish because then I wouldn't have any problems speaking to about 60% of our patients! Yeah, they aren't using the ER at all.... :P

      September 24, 2010 at 21:38 | Report abuse |
    • Jake ER

      That's supposed to be a mean face because you obviously don't get it. :( >:(

      September 24, 2010 at 21:39 | Report abuse |
    • Liutgard

      Jake (and anyone else out there who is using the 'illegal' card), I would like to point out that NOT EVERY HISPANIC PERSON IS ILLEGAL! For crying in a bucket! The vast majority of Hispanic folks in the US are here legally, and FAR more were born here than not. Those people in the waiting room probably are simply too poor to get insurance (Just how much do you pay the lawn guy? Or the woman who clean toilets at your office? Have you offered either of them insurance that is affordable on the wages you pay them?). And the handful who might be illegal probably figure it is safer for them to go to ER than a regular doctor.

      September 25, 2010 at 09:49 | Report abuse |
    • Jeremy

      @ Liutgard: By "safer" you mean "cheaper" correct? How is visiting a doctors office unsafe?

      September 27, 2010 at 12:45 | Report abuse |
  7. hmmm

    So, I understand the author to say that there are two main reasons why non-emergency health issues end up in the ER: they can't get a timely appointment with their primary care physician or they don't have health insurance. Unless I'm missing something here, providing people with health insurance isn't going to fix the problem. So, now "everyone" has insurance... but it's an even longer wait to see your primary doctor. Personal experience: just a few weeks ago, I called my primary doctor's office to get a sore throat looked at – to be sure it wasn't strep. Because my doctor had the gall to take a vacation (oh, the horrors!), her partner doctor was overloaded. No open appointment, but I could just come in for a shot. Really? Wow.

    I invite the author, who appears to be an MD, to spend a year WITH health insurance but without your convenient access to medical care. See what it’s like to take care of your children without reliable AND TIMELY primary care medicine.

    Oh, and I recommend picking up a few hefty novels; it can be quite a long wait in the primary care waiting rooms. That is if you don't give up and just go to the ER anyway, because your doctor's office is now closed for the day.

    September 24, 2010 at 15:14 | Report abuse | Reply
    • Maries

      Perhaps if Americans practiced a little patience and bucked-up a bit primary care offices would no longer be flooded with those who panic at the first sign of a cough or want a prescription for anxiety medication because they can't balance their checkbook this month. Instant gratification has pervaded every aspect of life at this point and people feel entitled to get everything they want when they want it. If people would look more realistically at what they are dealing with instead of dialing up their PCP instantly, people with alarming problems that actually need medical attention would not have to wait two weeks to get an appointment. And yes, increased access to PCPs will mean longer waits, however if you did some research you would also realize that medical school classes are beginning to double at many schools and accelerated programs for students who wish to go into primary care are getting students out in 6 years rather than 7 or 8 without skipping any of the important information. Not everyone in the health care industry is a complete idiot with "dollar signs flashing in their eyes," people are actually doing something about. But alas! it goes unrecognized because everybody wants everything right now.

      September 24, 2010 at 17:04 | Report abuse |
  8. Okiegal

    Kaiser Roll is asinine. You don't have to make 100K a year in order to HAVE A JOB, and opt in for HEALTH BENIFITS. Even Wal*Mart and Burger King offer benefits to their employees. But people CHOOSE NOT TO opt in. Then they go to the ER, because they can for 'free'. Which means that my child with a broken Tibia must WAIT 7 hours, while the illegals and idots with bloody noses, fevers, and rashes get seen FIRST. DON'T BE LAZY PEOPLE! Be here legally, and get a job, and if YOU care about YOUR family, then OPT IN for health insurance at YOUR JOB. Or if they don't offer it, then purchase from a 3rd party. Yes, we ALL (and I mean responsible hard working Americans) pay monthly premiums, and yes that cuts into our bottom line of net-takehome pay. BUT, it is the RESPONSIBLE THING to do. Not to rely on the taxpayers to give you something you aren't willing to work for!!! Here in Oklahoma at St. Anthony Hospital ER, they have even started a "Call ahead and reserve your appointment" at the ER. Now just WHO do you think this service is catering to? People who use the ER as a primary care facility, and sure as he11 don't pay those ER bills. ASININE!!!

    September 24, 2010 at 15:17 | Report abuse | Reply
    • chris

      The problem is they cannot opt in at their employers because they are using 2 different social security numbers or TIN #'s and are trying to avoid legal ways to have to pay taxes and avoid legal citizenship. There is no additional benefit for those groups of people to become legal, as they get more for free and more options available when they are illegal. Wonder if I went to a hospital in Mexico City if I could get free everything?? hmmmm

      September 24, 2010 at 16:46 | Report abuse |
    • SOMEONE

      It is not always possible for people who are responsible and work lower paying jobs to the "RESPONSIBLE THING " when it comes to purchasing health care. I live in AK and know many people that simply cannot afford a basic health plan through their job. IE: a man between 20 and 30, white, no children, no spouse, not eligible for Medicaid. He makes $9.00 per hour working in fast food. General math: $9.00/hr x 40 hrs/wk = gross income of about $1,400.00 per month, taxes (from 2010 table) average 180.00/month this leaves the young man $1260.00 per month budget. Average rent for a small 1 bedroom apt is $700.00/month + heat and electric of approx $100.00/ month depending on the time of year, lets say he spends an average of $400.00/month on food, clothing and household necessities, and purchase a public transportation (bus pass) for 45.00/month. This leaves a balance of $15.00 month for "other" expenses including health care etc. Where is the money comming from to buy into the company policy?

      The reality is he and so many others are not going to be able to afford health insurance even when it is manditory. His parents may not be able to afford to carry insurance for him until he is 26. And if they are already on Medicare or Medicaid themselves, it becomes a dead end. What then? put thes people in our already overcrowed prison system becase they can't afford health insurance? Slap them with federal fines that accrue massive amount of interest because they cannot affrod to pay those either? The bigger picture has been missed and the problem will remain unsolved with a higher tax burden to all of us.

      September 24, 2010 at 17:01 | Report abuse |
    • WakeUpCNN

      I was not being "cold-hearted" with my post.I was just trying to say what is going on in ERs.We don't kick out the homeless on cold nights.Some one brought up psych patients and ERs it is true they are usually how people with mental illness get diagnosed and treated.I hope the new healthcare relieves the ERs of primary care but we will see.My personal opinion it is going to cost much much more than what Harry Reid is claiming.How can old Harry Reid not know about the doughnut hole in medicare d coverage and if it could have been closed so easily why wasn't it done in the original bill.It is a slap to senior citizens who have contributed to medicare since day 1.That is what I am trying to find in this new healthcare bill the "new doughnut hole"...

      September 25, 2010 at 05:43 | Report abuse |
    • Liutgard

      Okiegal, do you know what someone employed at Wal-Mart makes? Did you know that they are paid so badly that HR hands out FOODSTAMP APPLICATIONS in their orientation kit? Some people are simply trying to keep a roof over their heads. Health care comes after that. Sometimes a long time after.

      And Chris, even if you're using a fake SS#, they still take money out of your check. Those people you refer to ARE paying taxes. But they don't get to file a return and get any back. So *you* are benefitting from that.

      September 25, 2010 at 09:56 | Report abuse |
  9. ER doc

    Everyone deserves health care, but everyone also wants a free ride in the most advanced health care system there is. I have no problem paying taxes, so long as everyone else who can does so as well. In 1985, 16 % of federal tax returns paid nothing in federal taxes. In 2009, that number was 48%. Congress needs to stop spending money they're too chicken to ask for, and Americans need to stop expecting the "rich" to pay all their bills.

    September 24, 2010 at 15:17 | Report abuse | Reply
    • Liutgard

      A false understanding of the realities. Yes, more people are not having to pay taxes when they're returns are filed. This is not because they proportion of taxes is lower on the middle class: it is because so many of us have slid down into a lower tax bracket. Our middle class is getting soaked. (Which, incidentally, is why the President is trying to get them some relief.)

      During the Eisenhower Administration, when our middle class was at it's largest and healthiest- the days we look back to as 'glory days', the upper 2% was paying 91% in taxes. This did not prevent them from giving to charity and to the arts, from investing in our infastructure and creating jobs. Quite the contrary- they were doing all of those things. Now the top 2% screams about their tax rates, that depending on their loopholes and shelters they have, ranges from 40-60%. And they are not reinvesting in America and creating jobs. They are putting it in their pockets- that is, when they don't have their hands out demanding more.

      If the people as a whole really understood what is going on, there'd be pitch warming and torches flaring.

      September 25, 2010 at 10:04 | Report abuse |
  10. JC

    I've worked in health care for 10 years and have dealt with patients from all over the world, Africa, Europe, Asia, South America where health care is free to them. NOT ONE OF THEM WHERE HAPPY WITH THE CARE THEY RECEIVED IN THERE HOME LANDS! They would take our system over there's any day of the week. I agree that health care needs change but not to the extent that these !@##$ heads on both sides are trying to do, I would be happy to show these people how health care in USA works and what we need to work on!!!!

    September 24, 2010 at 15:32 | Report abuse | Reply
    • Ozmodius

      Really? You mean to tell me that, for instance, people in the UK DON'T like the fact that their doctor actually makes house calls compared to the US where you ahve to sit and wait 2 hours just to see a doctor? You mean to tell me that, for instance, people in France don't like that fact that they have just one micro-chip card that stores all their medical information, compared to the US where you ahve to fill out reams and reams of paperwork? You mean to tell me that German citizens don't like that fact the the basic care is free and they have HUNDREDS of companies to chose from for additional coverage, compared to the US where you either take what your employer offers you, or pay through the nose for private coverage?

      I could go on and on, and YOU should actually do some basic research about the health care models in other countries!

      September 24, 2010 at 21:58 | Report abuse |
    • Softship

      Very interesting... I live in Europe, and I have never met anybody here in Europe how wants to trade their health system for the one in the US. Yes, there are certainly competent physicians in the US, but what good does it do a sick person if they can't afford to be treated by them. The United States has the most expensive health care system in the world, but the average life expectancy and the maternal death rate – two indicators of the quality of a system – are closer to third-world.

      Not everything in the US s better – maybe you should travel the world a bit to learn about it. I happened to have a double lung transplantation performed over 7 years ago. It didn't cost me a dime, because I had good health insurance – health insurance that is available to everybody here in Germany. Now THAT's good health care.

      September 26, 2010 at 14:17 | Report abuse |
    • Candlesticks

      Healthcare in Germany is not free for everyone. You pay for it out of your paycheck. We pay about the same in Euros as health insurance cost us in dollars in the U.S. through our jobs (however, no high deductibles in Germany, so that is wonderful. People in Germany who are unemployed or employed part-time do not have to pay for insurance, though, just as with the Medicaid program in the U.S.)

      I believe everyone should have to pay for their health insurance on a sliding scale. No one capable of working should get it completely for free. (Even if you are unemployed, almost anyone could come up with $20 to see a doctor. Let's be honest.)

      E.Rs should require payment before seeing non-true-emergency patients.

      September 27, 2010 at 08:57 | Report abuse |
  11. Mike

    "Providing health insurance for all its people is an obvious basic tenet of civilized society." Really? Oh yea, I forgot that the Romans and Greeks and Mayans had universal healtcare. What a silly statement.

    September 24, 2010 at 16:07 | Report abuse | Reply
    • Liutgard

      I suspect that the write meant the inclusion of the word 'modern' to be understood.

      September 25, 2010 at 10:06 | Report abuse |
  12. Joan

    Unfortunately, the experience in Massachusetts is that even with guaranteed primary care, people still go the to ER for these urgent care visits.

    I have insurance, I have a primary care doctor, and I'm very familiar with the healthcare system but last year when I had sinusitis I went to the ER. Why? Because the earliest I could see my PCP was 2 weeks.

    If we want to offload the ER, we need to require that PCP offices make urgent care available.

    September 24, 2010 at 16:27 | Report abuse | Reply
    • American

      agreed. Fortunately, I got to a PCP in the middle of nowhere, because there's never a wait and they have same day appts and Saturday appts. All minute clinic is an option. All PCP offices should at least hold a few appts a day for "urgent" appts. Also they should have more urgent care clinics.

      September 24, 2010 at 17:41 | Report abuse |
  13. chris

    This story is no revelation. Most people do go to emergency rooms for treatment.....why? because those who are fortunate enough to have insurance have policies that for the most part pay 100% of ER visits, while there is an 80/20 provision for urgent care/doctors office care....Its probably an accounting nightmare for insurance companies to have to keep track of their coverage clients who may have to go to urgent care, outside clinics, the primary care doctors office, x-ray appointment at urgent care, blood test at clinic, untrasound at outisde facility, etc etc....send them all to the ER and streamline the billing process, at the same time have in place CHEAPER negotiated contract fees for services rendered at the ER.. its all dollars and sense.......If you want real healthcare reform, then start by taking down the restrictions which prevent people from shopping around to other states for coverage. Locking people in to get insurance offered only in their state is rediculous....LET ME decide where I purchase my coverage from! That regulation needs to be changed, whether legally or by the manipulating money mongers at the insurance companies....you want better rates, take down the barriers by which real competition can happen and tue heathcare reform can begin.....

    September 24, 2010 at 16:33 | Report abuse | Reply
  14. Thomas

    The reason that Urgent Care clinics charge full payment up front and hospital E.R.s don't is that hospital E.R.s are required by law to treat everybody you presents to them, regardless of their ability to pay, while clinics are not required to do so. The result is that a lot of patients simply choose not to pay, othrs claim an inability to pay, and still others give false information so that the business office cannot locate them later. This amounts basically to free health care.

    September 24, 2010 at 16:37 | Report abuse | Reply
    • Liutgard

      The hospitals are only required to treat you if they are accepting federal funding. And then all they have to do is stabilize you. They can stop the bleeding and stitch you up and then boot you out. There's plenty of cases where they've done that and similar things.

      Try to go to a hospital with an obstructed bowel. We have ON TAPE a woman dying from it after laying in the hallway for something like a dozen hours without being treated.

      September 25, 2010 at 10:10 | Report abuse |
    • Luci

      No, hospitals are required to provide an EMERGENCY MEDICAL SCREENING, to determine if you have an EMERGENCY. They can then say "you do not have an EMERGENCY, We require $ up front to complete treatment in the ER." It's amazing how many people leave when they are told they have to pay something up front to be treated. I have to pay my co-pay to be seen in the ER and am asked "HOW would you like to pay your co-pay today?" Don't see anything wrong with EVERYONE paying something up front if they are not having a heart attack, stroke or are a true trauma patient. Hospitals are not REQUIRED to treat everyone.

      September 27, 2010 at 14:03 | Report abuse |
  15. AvgAmerican

    Talking about illegals is a smokescreen for not addressing the real issue. The fact is that many people, particularly the ones who have a LOT, don't want to be inconvenienced by having to wait for doctors, or by having to pay a little more to "spread the wealth around" for those who have less. They then rant to others who don't have much that this is about illegal aliens or you won't be able to see a doctor.

    If we all have access to healthcare, then yes, we might have to wait a little longer. Does that mean some people shouldn't get healthcare??! No. That means we get more healthcare workers to actually support the number of people who need help! And to those of you who want to bust on illegal immigrants, if there is indeed an emergency, are you going to deny someone who needs serious help attention b/c they snuck into America to make a decent living for their family. What would YOU do?! Do you still get denied healthcare if you do not take preventive measures to take care of yourself and get sick or do something stupid and get injured? No, you still get help. So should others who need help. And sorry, but just as many people abuse the system who are Americans as people who are illegals and have no choice.

    September 24, 2010 at 16:43 | Report abuse | Reply
    • hmmm

      AvgAmerican, people aren't turned away from ERs, regardless of ability to pay. That's a fact. There have been incentives for people to become medical professionals for years now, and the status of being "short" hasn't changed much. I can't blame them... patients expect you to fix them NOW, even when they did something stupid or won't take care of themselves, and they don't want to have to pay for it. Doesn't matter if they are citizens or not – you are right about that. We have created an environment where we expect to be able to eat what we want, sit all we want, and go to the doctor all we want without ever taking responsibility for ourselves. THIS is the root of the problem... we want what we want – iphones, entertainment and large portions – and we don't want to have any self-control. "spreading the wealth" so to speak only reinforces this, and that's a problem... not only for those of us who pay taxes, but also for our healthcare workers.

      September 24, 2010 at 17:08 | Report abuse |
    • nope_noteven

      I have to differ with your comment about the illegals having no choice, they apparently chose to come here illegally and remain here illegally. The fact that they entered this country illegally was a crime, and every second they remain in this country is a continuance of that initial FEDERAL CRIME. They're called illegal aliens for a reason, they are here illegally, their very presence in this country is illegal.

      September 24, 2010 at 17:22 | Report abuse |
    • Liutgard

      Uh-huh. Choosing between starving at home or sneaking into the US in hopes of finding work? It's a Hobson's choice, which is to say, no choice at all.

      September 25, 2010 at 10:13 | Report abuse |
  16. chris

    Allow competition.....Allow me to go to Nevada, or Ohio, or Florida to get my healthcare coverage.....tear down the barriers....real heathcare reform starts when the barriers are removed. We call ourselves a free market society, then let me "go to market" and allow me to shop around. How dare anyone or anything tell us we cannot shop for insurance out of our home state....Insurance companies would drop a brick if that happened....I don't want Obamacare.......funny the government is going to require us to legally carry health insurance but "legally" will not let us shop wherever we want for it!! PLEASE EVERYONE.....WAKE UP......WE NEED TO STOP THIS REGULATION/STRANGULATION!!

    September 24, 2010 at 16:55 | Report abuse | Reply
  17. Dena

    I want to say upfront that I am an ER nurse. I am begging Americans-PLEASE, PLEASE, PLEASE, stop using ER's as primary care!!!! We are understaffed, overworked, exhausted and fed up with entitled Americans thinking that we have Burger King medicine. I'm tired of taking care of people who demand tests, procedures and medications just because they've seen it on TV, read about it online or their neighbor/friend got it the last time THEY came to the ER. I'm tired of people working the system just so they don't have to live responsible adult lives coming in the ER requesting pysch care wearing the ID bands from the last 4 ER's they've been to for the same reason. I'm tired of mothers' coming in with their sick children then talking on their cell phones the entire time we're trying to do anything with the kids so they can't be involved in their care, then telling me they can't get the prescription filled because they don't have the money while they're texting on their Blackberry with the IPod earbuds in their ears and wearing enough bling to support a small country. That all being said, I love the patients who come in for the true emergencies. I love caring for them, making them feel better, sending on their way upstairs, out the door or to Heaven if that's the way it's meant to be. ER's should never be considered primary care. But as long as primary care doctors are required by the health systems that own them to see as many patients as they can squeeze in during 8 hours so they can make a profit and paid very little for the hassle they go through, compared to radiologists, anesthesiologists, orthopaedic surgeons and neurosurgeons, then few medical students will enter the field. It's like a running argument I have with my brother in law about the priorities in this country. He is a mechanic; I hold the power in my hands to save a life and yet he is paid twice what I make in a year to repair cars. Sports figures in this country make obscene amounts of money a year and yet that poor school teacher who taught them in high school cannot scrape together enough money for the ticket to go see a former student play in the big leagues. This country has a completely warped sense of what is right. Money is king and those that have will always spend their time making sure that those that don't never will.

    September 24, 2010 at 16:58 | Report abuse | Reply
    • Ryan

      Like!

      There was no like button.

      September 24, 2010 at 19:13 | Report abuse |
    • hmmm

      also like!

      September 24, 2010 at 22:46 | Report abuse |
    • Liutgard

      Dena, I like your post. I have only one amendment.

      Theses mothers you mentioned- are they getting any education or support at home? Do they know anything about caring for their babies? Have they had any instruction on money management? I see these girls in the grocery and on the bus. As a general rule, they're too young and too ignorant of the realities of having children. They spend money on bling because that is how you secure status in their world. We need to: EDUCATEEDUCATEEDUCATE! Give them realistic and straightforward education about birth control. Give them some sobering reality teaching about parenting. Teach them to budget and how to manage money. Teach them what they need to do for themselves to make them decent mothers.

      My youngest is pregnant with twins. She and her husband are scared to death. (Ok, part of that is because his job went to India and he's frantically trying to find a new one in this economy.) They really want to be good parents. And that's just it- they want to be good parents. They know that comes first, before social activities and 'fun'. And part of that is because I drilled those ideas into my kids when they were young. Some of these girls never got that though. And I think that we could spend one buck and save ten by giving them the education they need.

      September 25, 2010 at 10:26 | Report abuse |
  18. danielle

    I have a job, I pay my bills. I have no health insurance and to get insurance for my family and I it would cost me nearly 3,000 a month thru the health risk pool due to us all having pre-exsisting conditions. My husband has end stage disease and is dieing, and I have cancer. I am not lazy nor looking for a free ride, but something has to give. We have a right to live but no right to a qaulity of life? We pay athletes millions of dollars to play a stupid game but dont pay drs or scientist crap, kind of screwed up aint it? to the idiot who thinks anyone can get a job making $100,000 a year, where do i find one of those jobs? last time i checked most people cant find a job as there are none out there?

    September 24, 2010 at 17:02 | Report abuse | Reply
  19. André

    I have on occasion worked for several days in "A&E" (Emergency medicine) without admitting a single patient to hospital: It is true that this facility has become just so much easier to use than a family doctor who chooses to work office hours and have you wait up to 3 weeks for an appointment.

    September 24, 2010 at 17:08 | Report abuse | Reply
  20. Appalled

    My uninsured son is still paying on a $4,000 ER visit year from before last. He went in on a Sunday with debilitating stomach pain. They ran some expensive tests, including a CT scan, proclaimed it was a virus and sent him home. Two days later he was so sick he could hardly walk, so he visited the urgent care center (not open Sundays). They did a simple blood test, diagnosed him with a bacterial infection, and $67.00 and an antibiotic later, he was restored to health. The medical bill has been a huge struggle to pay off, but he continues to chip away at it, even though they nag for more than what he has been paying. And I say, what is wrong with socialized medicine? Medical care is a basic human right, and why some of us can have it and others can't is a difficult thing to understand. Dena has it right. We live in a warped society where money is king.

    September 24, 2010 at 17:16 | Report abuse | Reply
    • fred

      Medical care is not a basic human right. Check your constitution. Perhaps when everyone has a home and everyone is fed properly, then we can worry about covering everyone with healthcare.

      September 24, 2010 at 21:43 | Report abuse |
    • B.S.

      You should consider having the hospital business office credit you for your entire visit. It's like going to a mechanic with your car – if they diagnose the problem incorrectly and charge you for work without fixing the problem, you shouldn't have to pay for it.

      September 24, 2010 at 23:00 | Report abuse |
    • hmmm

      No offense intended here, but... you said your son is uninsured, yet he got medical care for his illness twice. Lack of insurance and lack of money didn't keep him from getting medical care. Do you expect those expensive tests to not cost anything? What if he went to the urgent care center first... perhaps they would have done more extensive testing so the ER doctors would do the simple test next. I'm not a doctor, but I'm just saying that it could be logical. He has also been able to pay on that medical bill for about two years, likely with no interest added. You certainly wouldn't have interest-free payments from your credit card company, or most other people who are collecting money. Lastly, doctors often run tests that aren't necessary to cover themselves. We live in such a litigious society that medical professionals aren't allowed to use their knowledge to make reasonable decisions... so now they have to run every possible test so they can prove they didn't miss anything.

      Again, I mean no offense here, but you have to consider what we've done to ourselves to get to this point. This is just opinion, but I think that socialized medicine will remove most of the innovation out of medicine. Medicine on a budget doesn't usually encourage finding cures for diseases or better equipment for tests. Unfortunately, that all costs money. Besides, these people have the ability to save your life! They can look inside us and fix what's broken! That is simply amazing, and I don't think the government can manage our money well enough for us to continue innovating and improving our medical knowledge. They can't seem to manage it for issues that don't involve life and death.

      I'm sorry your son has had this issue, but I'm glad they were able to treat him successfully.

      September 24, 2010 at 23:12 | Report abuse |
    • Liutgard

      Fred, she said _HUMAN_ right, not Constitutional right. There IS a difference.

      September 25, 2010 at 10:29 | Report abuse |
    • jim

      health care a basic human right?? really? really???? where did you read that??

      September 25, 2010 at 15:34 | Report abuse |
    • Liutgard

      Read? Since when are basic human rights contractual?

      September 25, 2010 at 15:37 | Report abuse |
    • ER MD

      I have to call BS on your story. Blood cultures take at least 12-24 hours come back positive, so there's no possible way that the urgent care center could have done a blood test and diagnosed your son with bacteremia (bacteria in blood) within a 30 minute or hour long window. Somebody lied to you at the urgent care center.

      As for coming to the ER, I dont admit kids with stomach pain if the relevant tests (ultrasound or CT scan) are negative UNLESS they cant tolerate liquids. Then I will give them IV fluids and admit them for dehydration. But if stomach pain is all they are having and they are otherwise non-toxic appearing and not dehydrated, there's no reason to admit them to the hospital.

      September 26, 2010 at 14:45 | Report abuse |
  21. Seteven392

    All these talk about health care for poor.
    I am for free housing for poor. I am for free food for poor. I am for free car for poor. I am for free clothes for poor. I am for free money for poor as long as liberal pay for it.
    Now despite all liberal's delusion about free things for poor, free things are not free.
    Let the supporter of free things for poor pay for it.

    September 24, 2010 at 17:24 | Report abuse | Reply
    • Liutgard

      Did you read the article? It's not necessarily about health care for the poor, in case you didn't notice. When the ERs are full, they're full to everyone, regardless of monetary status.

      September 25, 2010 at 10:31 | Report abuse |
  22. Lexi

    I am 24 years old and Obama's new healthcare plan is going to pay for my BOOB JOB....woo-hoo...Thanks OBAMA!

    September 24, 2010 at 18:28 | Report abuse | Reply
    • Liutgard

      The President's health care plan does not and never has covered cosmetic breast augmentation. If you're 24 I presume you can read at least at a high school level. Perhaps you should read the bill before saying such silly things.

      September 25, 2010 at 10:34 | Report abuse |
    • ER MD

      It wont pay for cosmetic breast surgery but there are negotiations under way to pay for other ridiculous things such as IVF or other assisted reproductive technologies; they are enormously expensive but all the special interest groups want to classify infertililty as a medical disease and thus have the taxpayers foot the bill so a 45 year old woman can get her 8 cycles of IVF at a cost of 500k to the taxpayers.

      September 26, 2010 at 14:48 | Report abuse |
  23. Kate Gosselin

    Obama's new health care reform is going to allow me to have more KIDS free!...Watch my new TV Show................................
    KATE PLUS 80....woo-hoo THANKS OBAMA!

    September 24, 2010 at 18:38 | Report abuse | Reply
  24. Bill

    I'm a healthcare professional currently in Los Angeles because my wife needs the type of surgery that only a teaching hospital can provide. The stay out here has been an eye opening experience. English is a second language here. Everyone keeps their own neighborhoods according to their ethnic background, and the city looks like the United Nations. Those who do not have insurance show up at the ER's because they know that federal law will not let the ER turn them away. But they have i-pods, drive large SUV's, and have enough gold jewelry on to risk a holdup.

    September 24, 2010 at 18:45 | Report abuse | Reply
    • name withheld by request

      This is happening across the U.S. we were told by our supervisors we cannot judge.That they may have just lost their job and have fallen on hard times. There have been cases in my area where people get reported and are charged with fraud.There are scams going on where they use each others medicaid number and under reporting/hiding income..An Indian doctor took a lot of heat by saying americans have access to the best healthcare in the world they just don't want to pay for it.We won't know how the health reform is until it goes into effect.Expect the worse hope for the best.Good Luck

      September 24, 2010 at 19:13 | Report abuse |
  25. Dee

    I live in a rural area of the US with very few doctors–and a lot of sick folks (diabetes and related complications are common). One can bank on at least a week's wait to get an appointment–even with chest pain, UTI/kidney stone, and strep throat (just speaking from personal experience here). I don't blame the doctors–they work very hard. But what are we supposed to do when we are 45 minutes from the nearest urgent care (closes at 7 PM and not open all weekend), 1 hour from a decent hospital, and sick after hours? I'm stumped (and luckily, my 'chest pain' was merely a herniated spinal disk)...wish we had better solutions.

    September 24, 2010 at 18:56 | Report abuse | Reply
    • ER MD

      Again, I call BS on this story. Give me your zip code, and I'll find a clinic that will see you within 3 days.

      September 26, 2010 at 14:49 | Report abuse |
    • Dee

      Gee, that's mean....and judgmental. Sure, within a 45 minute drive, there are places. It's not a problem for me personally–but what about people who have no transportation? It's a poor county with a high unemployment rate. 80% of kids are on free lunches. There are high teen pregnancy rates, and even some pre-teen pregnancies. It's not BS at all. I think you might be a bit out of touch with reality, especially if you have never lived in a poor, rural area of the country. Dee McKinney, Ph.D.

      September 27, 2010 at 12:55 | Report abuse |
  26. Ryan

    Expanding health insurance is merely a distraction and a band aid. It will do nothing to help control costs which is the root of the problem. Cost are atrocious in the ER for a couple of reasons.

    1) The people who do pay have to cover the cost for all of those who don't pay. That is why an aspirin costs $25 a pill.

    2) The ER mentality is "what is going to kill this patient" and rightfully so because if someone is going to the EMERGENCY room, there should be a potentially deadly reason. That is why when you go to the ER for a headache the Dr. thinks well is this meningitis? Sub-arachnoid hemorrhage? Because those are dangerous. So you get a CT, LP, couple hours stay, lab work, IV medications. In the end you just had a headache like everyone else. The ER doc works from deadly to benign which is opposite of a primary care doc who works from most common to most rare. The ER way is expensive, but good if you are seriously ill. The PCP way is cheaper and works fantastic for most problems.

    3) You cant afford to be wrong. Lets face it, in our litigious society we don't tolerate medical error of any sort. Back to the headache. You go to the ER with a headache that presents in a non-concerning fashion. The doc is unimpressed with history and physical examination so you get sent home. Turns out you had bacterial meningitis or a head bleed and now have serious complications. What happens now. Law suit. Docs in the ED order tests all the time that don't really need to be done to catch that one that might slip through.They do this partially because they don't want people to die, after all they are doctors, and two they don't want to get sued.

    September 24, 2010 at 19:30 | Report abuse | Reply
    • downtownjb

      You are very wise, Ryan!

      September 25, 2010 at 08:01 | Report abuse |
  27. Scott Mcclure

    Ambulances are the medicaid taxi's that get them to their PRIMARY CARE PHYSICIANS in the E.R. As a paramedic, I see too much abuse of the system. Peole calling for ingrown hairs on their chin, tooth aches, ect...it is a burden on the system. Pre-hospital and Hospitals, as a whole. We, in EMS, cannot refuse to transport them to the ER either. The other thing here is, they can choose what hospital they want to go to. For example: John Doe has a tooth ache and he lives in Smalltown, USA with a local ER, more than capable of handling the situation, they can still say they want to go to BIG CITY Hospital an extra 40 miles away and guess what....we cannot refuse to take them to the hospital of their choice. the average cost for that patient would be $750 plus $7.00/mile to transport them...that is MY MONEY being wasted on a trip to a hospital 50 miles away....well, in all actuality, it is MY MONEY wasted, PERIOD!

    Now that we have John at the ER...he's held a room that may have been needed my a critical patient, treated and discharged...guess what....He calls the same ambulance to come get him. The state of GA has a medicaid brokerage system that pays for their return trip home after the tooch ache ER trip. Thats another $150 to take this dead beat back home...and tying up SMALL TOWN, USA's 9-1-1 response unit to get him back home....and while this is happening, there is a cardiac arrest in that ambulances call zone....a person that normally would've had a 3 min response time, in cardiac arrest, now has a 10 min response time because the next cloest ambulance has to respond to the call.

    I am against nationalized healthcare for many reasons:

    1. IT PROMOTES EVEN MORE LAZINESS FROM THOSE THAT CAN WORK BUT JUST DONT WANT TO...ANOTHER FREEBIE FOR THEM, AT THE TAXPAYERS EXPENSE, LON TOP OF $800/WK WELFARE THAT WE PAY FOR.

    2. OUR COUNTRY HAS ENOUGH DEBT, BESIDES ADDING THIS EXTRA BURDEN TO THE SYSTEM

    3. IT WILL DELAY CARE TO THOSE THAT NEED IT BY USING A SORT OF TRIAGE SYSTEM, BASED ON AGE AND NEED OF CARE. So, if 75 yr old granny has a broken hip from a fall she sustained while working in her flower garden, granny was the picture of health prior to this;no mental issues, heart issues or anything. She will probably be denied this needed hip replacement , due to her age and survival probability.

    4.THERE'S THAT CHANCE THAT YOU MAY LOSE YOUR PERSONAL PHYSICIAN THAT YOU HAVE HAD FOR 30 YEARS BECASUE THE GOV'T WILL WANT YOU TO SEE THE DOC OF THEIR CHOOSING.

    5.IT WILL GIVE THE GOV'T FULL CONTROL OF YOU, YOUR PRIVATE MEDICAL INFORMATION AND YOUR CARE, INCLUDING WHAT FOOD YOU CAN AND CANNOT EAT AND DENY YOU NEEDED CARE BECASUE YOU "BROUGHT THIS ON YOURSELF BY NOT EATING WHAT THEY THINK YOU SHOULD EAT"

    6. THIS OBAMACARE LAW WILL LEAD TO EVEN MORE OF OUR PERSONAL FREEDOM AND LIBERTIES TAKEN AWAY BECASUE THEY THINK THEY KNOW MORE ABOUT HOW TO TAKE CARE OF OUR AILMENTS BETTER THAN WE CAN. IT WILL TAKE OUR FREEDOM OF CHOICE AWAY. This will just be the beginning of socialism taking our right to life, liberty and the pursuit of happiness, guarenteed by our foiunding fathers.

    7. IT WILL GIVE ANY ILLEGAL FREE HEATHCARE, PAID FOR BY US, THE ONES THAT WORK AND PAY TAXES LEGALLY. BE GUARENTEED, THE MASSIVE REDISTRIBUTION OF WEATH PLANS THAT OBAMA HAS AND THE AMNISTY THAT WILL BE GIVEN TO THOUSANDS OF ILLEGALS WILL BANKRUPT OUR NATION AND LETS US SLIP FROM THE GREATEST NATION ON EARTH TO THE PAN-HADLER ON THE SIDE OF THE ROAD, BEGGING FOR QUARTERS.

    People we need to wake up and stop this madness being fored on us my the people that we elected that are purposfully going against our loud cries to them. Get those in office out and elect someonw that listens, lowers spending, forces those that recieve welfare to work for the federal gov't or state gov't to pay for their FREEBIES by work details, just like that of prison trustees and reduces the size of the gov't to have a better account of checks and balances, instead of letting outside agencies continue the same ol' same ol'.

    September 24, 2010 at 20:48 | Report abuse | Reply
    • Sparticus

      we're already bankrupt you fool.

      September 24, 2010 at 21:16 | Report abuse |
    • HealthcareWorker

      I am in healthcare also and paramedics have it rough. I honestly don't think I could do what you do.Starting with the ungrateful bitching patients "what took you so long" then the drive where no one moves to the right so you can pass and there is always the possibility of being exposed HIV,Hep C,gunshots and who knows what else.THANKS

      September 25, 2010 at 05:56 | Report abuse |
    • Jake

      It's very sad that even our health care workers in this country are filled with the ignorant rhetoric that partisan politicians are spewing out. This is all in interest of themselves in a mid-term election year. Fear-mongering takes a pretty deep hold even in a paramedic just because no time was taken to educate himself on what actually is going to happen with the health care reform. EMTALA laws, passed during your beloved president Reagan's tenure, is behind the headaches that you face daily. The Federal Emergency Medical Treatment and Labor Act's main provision is to ensure "medical evaluation/screening" for any patient presenting with a possible emergency condition regardless of ability to pay, citizenship, and basically for anything. While in principal, this is a necessary protection for proper health care, it has subsequently been perverted by money-hungry lawyers and irresponsible, uneducated individuals into full evaluation and treatment for even obvious non-emergent medical conditions. This causes expensive cost-shifting by hospitals and insurance companies to covered individuals and cash-paying uninsured patients who are the ones paying for this exorbitant, less efficacious care.

      This idea that Government is going to ultimately control your health care is ludicrous. If you believe that, then you shouldn't advise any elderly family member to use their Medicare coverage. That's government health care. Yeah, it needs some sprucing up but you need to look to our politicians bickering over it in Congress. Your health care will always be based on decisions between you and your doctors. And your doctors are going to fight for what is right for you. They will ensure that grandma gets that hip fixed and that you get what is actually needed for your health. The government is not going to be making health care decisions for you. It hopefully will help curb the excessive quick-fix medical care in exchange for more beneficial preventative care.

      And when it comes to health care for illegal immigrants...you are already paying for it now. EMTALA laws guarantee care for them and will continue to give them health care with whatever political group passes health care reform. We pay it through cost-shifting and will continue to do so. Obamacare isn't giving them the same option to health care as the uninsured patients will get to choose. So focus on immigration reform with your state politicians.

      It's time for people in this country to put partisan politics and extreme ideology aside. Health care reform needs to happen. End of story. If not, things are going to continue to get worse for people until the wheels literally fall of the wagon. It is going to be a work in progress. The Democrats are not going to get it right the first go-round. Neither would the Republicans, nor the Libertarians. Politicians need to stop the partisan politics and throw away the special-interest and lobbyist $$ on this issue. They need to work together to improve health care for ALL US citizens. And then culturally, Americans need to change a lot of things with how we view our health care.

      September 25, 2010 at 06:57 | Report abuse |
    • Liutgard

      Dude, every one of your shouted bullet points is ludicrous. I have just a couple specific things to say.

      You are delusional if you think that in any place in the nation welfare is $800/week. $400-500 a MONTH is average.

      And the govt is not going to control your life. Ask any German (where they've had problems in the past with such things, if you'll remember) if that is the case for them, with their nationalized health care. How about the English? Is Big Brother watching them? Norway? How about any other of the industrialized nations in the world? Any- we're the only ones who don't have some sort of nationalized care.

      The state of healthcare in this country is already bankrupting us. And the numbers are available- if we nationalized healthcare we could actually save money. You want to know who doesn't want you to believe that? The insurance companies. Big pharma. Trial attorneys. And anyone else who has their hand out and stands to benefit from this crash cart we're on.

      September 25, 2010 at 10:47 | Report abuse |
    • jim

      I have been a paramedic since before you could tie your own shoes and it's embarrassing that you can't write a proper sentence with good spellling/grammar/punctuation,etc. Do your PCR look like that also?? Note to kind readers: Please don't judge all EMS personnel by this moron.

      September 25, 2010 at 15:52 | Report abuse |
  28. Poor for a reason

    We're poor. Wanna know why? Because my husband has cancer and can't work. I am deemed his caregiver plus I have an autistic kiddo. My husband had a job before he got sick and we were doing fine. So on to welfare we go. I'm not happy or proud of it but we'll do whatever we need to do to survive.

    Thank you all for keeping my husband alive while he's undergoing chemo.

    September 24, 2010 at 21:34 | Report abuse | Reply
    • hmmm

      I'm sorry for what you are going through. Your circumstances are terrible... and I don't think anybody would want to deny you help. Your circumstances are not what's draining the system, and I hope that your husband gets well soon. Good luck to your family.

      September 24, 2010 at 23:31 | Report abuse |
  29. fred

    The problem with the ER is that people with Medicaid and other government assistance insurance have NO COPAYS and therefore no dis-incentive to go to the ER. People without insurance don't go to the Er because they will be presented with a bill. But with Medicaid, you can go anytime day or night and get free care. That's the big problem.

    September 24, 2010 at 21:36 | Report abuse | Reply
    • Medic

      False.

      These days, a lot of ERs are making it so that they're blind as to what the patient has for insurance, to promote equality in treatment.

      Also, people without insurance are MORE likely to go to the ER because they know that if they do have to pay, it will actually be very, very little, and they can actually get out of a bill entirely sometimes, simply by giving false information and skipping out early. I've seen it.

      September 25, 2010 at 17:10 | Report abuse |
    • ERstaff

      I work in the ED and it is mostly medicaid insured patients taking up space with minimal complaints. These are also the patients demanding a hamburger at midnight and complaining when not getting enough narcotics. I have only working in large urban ERs so my perspective might be skewed. A suburban ER might have a different patient population.

      September 25, 2010 at 19:44 | Report abuse |
    • ER MD

      In my ER, patients with insurance generally have to give a co-pay of at least $50-$150 depending on their insurance plan. For Medicaid and Medicare? Its $0. Absolutely absurd incentives that encourage people to abuse taxpayer dollars for stupid non-emergency complaints.

      September 26, 2010 at 14:53 | Report abuse |
  30. chad

    I believe ALL people should have healthcare. Tax me, and the rest of America and pay for it. Easy peasy lemon squeezy.

    September 25, 2010 at 00:29 | Report abuse | Reply
  31. RN

    The majority of people do not know if they truly are having a medical emergency. Hospitals should staff 24 hour ER's and Urgent Care Centers at the same facility.... a triage nurse would determine if you need to be seen in the ER or UCC. It would be a win/win situation....ER's would be available for the true life threatening emergencies, it would be more cost effective if you are seen at the proper type of setting, lab and xray are available for all, and if something changes in your condition you can quickly be transfered to the ER side.

    September 25, 2010 at 00:47 | Report abuse | Reply
    • Need Insurance

      This is a genius idea. I hope someone actually implements it.

      September 25, 2010 at 02:28 | Report abuse |
    • NotAnERDoc

      It has been implemented in the past (although I am not sure that the triage was done without some oversight by the ER physicians). It was standard operation at Denver General more than twenty years ago (Denver General was also a safety net county hospital). I am sure it was implemented in some other major metropolitan centers. I do not known if it is currently used (Denver General has changed to a private hospital, and changed it's name).

      It was very effective. I am not sure if it is still possible because of malpractice issues, and government rules.

      September 25, 2010 at 03:41 | Report abuse |
    • name withheld by request

      I hope RN is your initials and not your profession...Maybe you live in another country(not U.S.) or in a rural rural area....
      @Need Insurance is laughing too........My hospital has an ER and a ambulatory facility........and most of the hospitals in our city do too.I don't even live in a city that breaks the top 50

      September 25, 2010 at 05:04 | Report abuse |
    • bloorain

      name withheld-you are obviously not in the medical profession. i am also an rn and i think this would be a wonderful idea. in my area there are several urgent care centers that all close by 8pm so if you have an issue after 8pm you have to go to the ER. when i lived in tampa there were several urgent cares open until 11pm, which makes much more sense.

      September 25, 2010 at 07:00 | Report abuse |
    • RedRedRain

      some hospital emergency room have a "fast track" unit which deals with primary care and non-life threatening issues.You can see their current wait times on their web pages.I hope the quality of care does not go down with fast-food mentality.Patients should have patience....Unfortunately the me me me mentality is what is driving this.Doctors and health care providers don't want any one to wait ...Quality over quanity

      September 25, 2010 at 08:08 | Report abuse |
    • RedRedRain

      hey bloorain what did you score on your nyclex? Are you an RN ,LPN or CNA? Did you go to college for 4 years,2 years or 6months?HAHAHAHAHAHAHAHA

      September 25, 2010 at 08:14 | Report abuse |
  32. Bad Patient

    Not sure about other people, but I don't have good luck in primary care. I do well in the ER if I tell them that I don't have a doctor...otherwise they will try to send me back to the primary that wasn't doing me a speck of good anyway. They give the worst drugs first and make you come back all the time...ER docs will just kill it...no need to go back. Save time, effort, trauma.

    September 25, 2010 at 01:11 | Report abuse | Reply
  33. Need Insurance

    My family and I have been without insurance since my husband and I both lost our jobs. We can not afford to pay for insurance, or pay out of pocket for dr appts. We DO however have the common sense to use the ER for true emergencies. I have 3 children and have learned what to do for most of the common illnesses. I am however NOT a dr. When my son came down with strep, I had no option but to take him to an ER. As for the bill, I have set up a payment arrangement to pay it off. The point is, a lot of things people go to the ER for can be treated at home with a little common sense. The problem is most people don't have it. There should be clinics open all over the country with fees based on your income. We have 2 in my area, which have opened recently. I will be using these more, and hopefully the ER less.

    September 25, 2010 at 02:27 | Report abuse | Reply
    • NotAnERDoc

      A safety network of charitable clinics and hospitals was much more extensive 20 years ago. Federal, state, and local governments all cut back on taxpayer funded support of the safety net. Then the politicians blamed the healthcare system for not providing for uninsured patients.Even now, it does provide much more than it is given credit for (and GW Bush did increase funding of the safety net). The safety network was cost effective because it focused on providing healthcare that saved lives and prevented disabilities. Universal health insurance is not as cost effective because it will pay for a host of treatments that provide comfort, but do not save lives or prevent disability.

      You not only avoid excessive charges and unnecessary tests from defensive medicine by taking your nonemergent care to the charitable clinic, you make it possible for the ER physician to more rapidly address true emergencies, saving more lives.

      September 25, 2010 at 03:29 | Report abuse |
    • ER MD

      A sore throat (whether its strep or not, 90% of sore throats are viruses, not strep) does not require an ER visit UNLESS the child is dehydrated and wont drink fluids. Otherwise, you should wait to see your PCP or go to an urgent care center the next day. There is no reason to bring him in at 4 AM for a simple sore throat.

      September 26, 2010 at 14:56 | Report abuse |
  34. bloorain

    i'll never forget the night i brought my 2 week old in for fever and there was a lady there with her 11 yr old daughter, at 11pm, for a uti. in the ER. it didn't suprise me though.

    September 25, 2010 at 06:57 | Report abuse | Reply
    • Candlesticks

      I have had UTIs that were so excruciatingly painful, I could barely stand it and could hardly stop crying. Some UTIs are just that bad. I wouldn't expect an 11-year-old to suffer all night. Let her get some antibiotics at the E.R. so she will start feeling better within a few hours.

      September 27, 2010 at 09:20 | Report abuse |
  35. Jake

    It's very sad that even our health care workers in this country are filled with the ignorant rhetoric that partisan politicians are spewing out. This is all in interest of themselves in a mid-term election year. Fear-mongering takes a pretty deep hold even in a paramedic just because no time was taken to educate himself on what actually is going to happen with the health care reform. EMTALA laws, passed during your beloved president Reagan's tenure, is behind the headaches that you face daily. The Federal Emergency Medical Treatment and Labor Act's main provision is to ensure "medical evaluation/screening" for any patient presenting with a possible emergency condition regardless of ability to pay, citizenship, and basically for anything. While in principal, this is a necessary protection for proper health care, it has subsequently been perverted by money-hungry lawyers and irresponsible, uneducated individuals into full evaluation and treatment for even obvious non-emergent medical conditions. This causes expensive cost-shifting by hospitals and insurance companies to covered individuals and cash-paying uninsured patients who are the ones paying for this exorbitant, less efficacious care.

    This idea that Government is going to ultimately control your health care is ludicrous. If you believe that, then you shouldn't advise any elderly family member to use their Medicare coverage. That's government health care. Yeah, it needs some sprucing up but you need to look to our politicians bickering over it in Congress. Your health care will always be based on decisions between you and your doctors. And your doctors are going to fight for what is right for you. They will ensure that grandma gets that hip fixed and that you get what is actually needed for your health. The government is not going to be making health care decisions for you. It hopefully will help curb the excessive quick-fix medical care in exchange for more beneficial preventative care.

    And when it comes to health care for illegal immigrants...you are already paying for it now. EMTALA laws guarantee care for them and will continue to give them health care with whatever political group passes health care reform. We pay it through cost-shifting and will continue to do so. Obamacare isn't giving them the same option to health care as the uninsured patients will get to choose. So focus on immigration reform with your state politicians.

    It's time for people in this country to put partisan politics and extreme ideology aside. Health care reform needs to happen. End of story. If not, things are going to continue to get worse for people until the wheels literally fall of the wagon. It is going to be a work in progress. The Democrats are not going to get it right the first go-round. Neither would the Republicans, nor the Libertarians. Politicians need to stop the partisan politics and throw away the special-interest and lobbyist $$ on this issue. They need to work together to improve health care for ALL US citizens. And then culturally, Americans need to change a lot of things with how we view our health care.

    September 25, 2010 at 07:29 | Report abuse | Reply
    • Liutgard

      Jake, picture me bowing and chanting "I am not worthy! I am not worthy!" :-)

      September 25, 2010 at 10:53 | Report abuse |
  36. RedRedRain

    hey bloorain what did you score on your nyclex? Are you an RN ,LPN or CNA? Did you go to college for 4 years,2 years or 6months?HAHAHAHAHAHAHAHA

    September 25, 2010 at 08:12 | Report abuse | Reply
  37. steeve-o

    I agree with this article. Like when Rush Limbaugh had chest pains and went to the hospital, he later toted how there's absolutely nothing wrong with our health care system... you dolt, because YOU have insurance! And you're a celebrity!
    If he was really going to make a point, he should've donned a fake mustache and tried to slip into the ER, in line with everybody else, and pretend like he didn't have any insurance. Then tell us how his experience was (if he lived).

    September 25, 2010 at 08:15 | Report abuse | Reply
  38. RedRedRain

    Since ERs are the topic.Try to avoid a visit tonight because Saturday nights are the worst time period to enter an emergency room..The wait times are the worst and they are usually packed but you will more than likely see some crazy stuff.....Peace Out!

    September 25, 2010 at 08:27 | Report abuse | Reply
  39. ERHusband

    I am the husband of an ER physician. I hear every day about how people use the ER for pregnancy tests and stubbed toes but what this article fails to mention is that a huge percentage of these people are addicted to prescription meds and are just fishing for a few more pills until tomorrow when they will go to the urgent care down the road or the other ER to get a few more. It is a epidemic in this country that is not being talked about.

    September 25, 2010 at 08:47 | Report abuse | Reply
    • SadButTrue

      You are 100 percent correct....People are coming up strange stories,surreal events and even self-afflicted wounds.Then TELL or DEMAND the ER staff to prescribe a certain medication.....Then head off to the next ER. We would love to help them BUT they have to help themselves first by going to Detox/Rehab.....The sad thing is they are getting younger and younger.I am sure your wife did not want to "play cop" but that has become part of the job........

      September 25, 2010 at 13:21 | Report abuse |
    • Ituri

      Thats one of the realities of drug addiction. Do NOT punish me when I need genuine pain relief, and do NOT call me a druggy, just because you want to talk about your epidemic.

      I've been in an ER where they thought I was lying about my pain to get drugs. They only started believing me when I PEED on myself from the pain of the BROKEN BONES in my body. How about not assuming people are just there with ill intent and realizing that people genuinely go to the ER for help too? Your "epidemic" does not beat my broken bones.

      September 25, 2010 at 13:23 | Report abuse |
    • How D.A.R.E you

      I have been waiting in this ER for 10 hours...I want my 20 PERKS!!!!!
      Hold the anti-inflammatory and antibiotic meds.............................

      September 25, 2010 at 13:53 | Report abuse |
    • How D.A.R.E you

      those darn X-rays and MRIs are wrong!!!!!

      I WANT MY 20 OXYS.................................

      September 25, 2010 at 13:56 | Report abuse |
    • How D.A.R.E you

      MY ZANNIES FELL INTO THE SINK............

      I WANT MY ZANNIES NOWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWW!

      September 25, 2010 at 13:58 | Report abuse |
    • How D.A.R.E you

      I WANT VIKES TOO!!!!!!!

      Rotflmao.............................................sound familiar?

      September 25, 2010 at 14:00 | Report abuse |
    • How D.A.R.E you

      Someone stole my purse.....

      I WANT MY SOMAS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

      getting close?

      September 25, 2010 at 14:01 | Report abuse |
  40. How D.A.R.E you

    those darn X-rays and MRIs are wrong!!!!!

    I WANT MY 20 OXYS

    September 25, 2010 at 13:54 | Report abuse | Reply
  41. Baron Baucom

    OH ! So now its the right thing to do. Where were you when the the Democrats were fighting the Repuplicans to try to get a public option! So I don't want to hear it now! Its to late they passed a half ass bill that is still a disgrace for a country like the Great USA. But will somebody explain to me why poor states like Missisippi and alabama vote Republican. Do they not understand that they use them to fight their stupid wars and their vote only. Wake up poor white people that health care reform bill was also for you! The Repuplicans have no other use for them . In fact they despise them!

    September 25, 2010 at 14:08 | Report abuse | Reply
    • Goober

      I think but I don't know that the republicans say they are Christians and give them a low paying job.The problem is that the GOP is big business and big business is for deregulation so they can do whatever they choose. BP using the Gulf Of Mexico as a dumping /retention pond and Big Pharma using people as the Guinea pigs.....I don't know I am not in those states and an Independent. I am not sold on the Tea Party and that O'Donnell is making me laugh...what a nutter...good luck delaware

      September 25, 2010 at 14:19 | Report abuse |
  42. DM

    You don't have 7 hour waits in ERs in countries with socialized medicine. Just saying. They know how to efficiently run healthcare, which is why the cost of healthcare in those countries is about half of what it is in the U.S. And despite the lies of the Tea Party and Republicans, people there are generally very satisfied with their healthcare – AND they're healthier. Get rid of your stubborn, uninformed idealogy and we will improve healthcare in this country.

    September 25, 2010 at 14:15 | Report abuse | Reply
    • Goober

      If you want to laugh go the Huffington Post...they have all the Christine O'Donnell clips...what a NUTTER! Sharon Angle too ...so this is the Tea Party? What a bunch of nutters

      September 25, 2010 at 14:22 | Report abuse |
    • Goober

      http://www.huffingtonpost.com/2010/09/24/christine-odonnell-will-s_n_738276.html

      O'Donnell is a NUTTER...PLus she used campaign contributions to pay her mortgage and she was not running for office yet..I WANT to do that!

      September 25, 2010 at 14:27 | Report abuse |
  43. HAVE YOU HEARD OF PHARMACY?

    If you have to stop at Church's Fried Chicken and get your 20 member family a meal and bring it and all the family members to the ER with you, then it's not an emergency. If you are more worried about your child throwing up on your Coach purse then him/her feeling better it is not an emergency. 99.9% of reasons most go to the ER can be taken care of with a stop at a pharmacy. Tylenol, Pepto, and TheraFlu work wonders. Also, if you live in this country (USA) and can't speak English don't get mad when we can't speak yours. GO HOME where you belong

    September 25, 2010 at 14:31 | Report abuse | Reply
    • ER Staff Strike Back

      Feels good and cathartic doesn't it!!!! ER Staff Strike Back.....

      "My doctor's office is closed can I get a refill on my prescription?"
      Patients who can't remember what medications they take "its that little white one"

      Insurance cards that are 5 years old...Play find my "insurance plan" with patients

      I was here before that Gunshot patient I should be next.........LMAO!!!!

      September 25, 2010 at 14:50 | Report abuse |
  44. RN

    I work in an ER in a Veterans Hospital and I can tell you that at least 90% of our patients are not emergencies, and it is NOT because they don't have insurance. These Vets have a wonderful primary care system that costs them NOTHING. It is because we as a society demand instant everything, from soup to seeing a doctor when we believe we need to. Insurance will not solve this problem. We must educate the population in the appropriate use of emergency rooms and provide some form of deterant to abuse.

    September 25, 2010 at 14:47 | Report abuse | Reply
    • ObamaCareIsComing!

      We are hoping this new government health care reform is like Tricare maybe medicare b(it has too much paperwork but still has some good qualities for the patient)...not like medicare part D which confuses everyone involved..Only time will tell

      September 25, 2010 at 15:30 | Report abuse |
  45. Em resident

    I am a resident physician in emergency medicine. There are a number of contributing factors to the current healthcare crisis and abuse of the system.

    The ER should be used for life-threatening or potentially life-threatening problems. Classic traumas- car accidents, gun shot wounds, broken bones. Medical emergencies include crushing chest pain that could represent heart attack. Inability to speak or move an arm/leg that could be stroke. The worst bone-crushing headache of your life (could be subarachnoid hemorrhage). Passing out is also concerning in older populations- can be heart irregularities or acute GI bleeds etc. High fevers in adults or immunocompromised people. Unfortunately, sites like CNN have run articles telling people how to get seen quicker at the ER including saying you have chest pain. Guess what if you tell me you have chest pain and you have a hx of diabetes or high blood pressure, you are going to get thousands of dollars in tests to make sure you are not in the early stages of a heart attack that has not yet showed up on an EKG or on your cardiac markers and probably get admitted to the hospital at least overnight. This will be the case even if the real secret reason you are here is because your indigestion is bothering you and you want an acid blocker. Missed heart attacks are the #1 reason ER docs get sued. Missed strokes are #2. We are supposed to think life-threatening than serious than common/benign.

    Inappropriate uses of the ER- women who complain of vaginal bleeding- unless it is substantially more than your period or you are pregnant, you do not need to come to the ER. Uncomfortable though it may be. Go to an OB/GYN if it happens frequently. Do not come to get a pregnancy test or if you do, tell the truth that that is why you are here. You will get a pelvic examination but do not complain of abdominal pain/pelvic pain or you may get a full workup to rule out serious things like appendicitis, ovarian torsion etc. Do not come to the ER complaining of back pain x1 month or 7 years. Intermittent abdominal pain x4 months. If you have a doctor, call them and let them know you are going to the ER. Other inappropriate uses of the ER- I need a XRAY, CT scan, MRI. There are outpatient radiology services- granted not most convenient- I know I have been waiting almost a year for an MRI of my ankle. But if you tie up the CT scan/mri, someone may not get it who really needs it.

    First, as had been said, even for those with insurance, access is a problem. I live in tampa and while there are a few after hours clinics (particulary one well known one for peds), it pales in comparison to likely need. Most people still work and cannot get into see the doctor during normal business hours. And patient education is a problem here too- most patients don't know about these clinics (some of the doctors don't even have a list) and then there is the rather large subset that won't go anyway because they will have to pay out of pocket up to $150/visit and they will not be immediately charged in the ER.

    Second, we have a society that expect immediate relief. I'm in pain and want to feel better NOW. This is understandable. Most people, however, do not even try anything before they come in. At least try the aleve/advil/benadryl. If the aleve does't cut it. I want oxycodone. In florida, we do not have a state database like they do in Tennessee that allows physicians to check how many Rx you have gotten for percocet/vicodin/xanax/soma etc.

    Third, when you are diagnosed by a primary care physician with ANY medical condition, know what it is and what you are supposed to take for it (including dose) and then actually take the medication as directed. Write it down and put it in your wallet. That cough you have might be from the new high blood pressure med your PCP started you on instead of the possible pneumonia/URI I might initially be thinking of.

    Fourth, our safety net for psych patients is pitiful. They use a huge percentage of resources without easy ways to deal with this. Also, patients with psychiatric issues (anxiety/depression) who are not suicidal tend to use resources more.

    September 25, 2010 at 16:40 | Report abuse | Reply
    • Medic

      And then you've us idiots who insist on going to our PCPs for even those potentially life-threatening issues because "oh, it's just a headache/heartburn/sunburn" and we "don't want to bother the folks at the ER, they see me enough." Mostly we're EMS workers and nurses, and we REALLY don't want to risk our coworkers seeing us in those dratted gowns and socks that can be worn every possible way. =P

      September 25, 2010 at 17:26 | Report abuse |
    • ControlDrugDatabase

      The control or schedule drug database just rolled out in Florida July 1st went "beta" online....If the hospital you are at does have the software yet it will shortly.You bring up some valid points but the "standard set" of patients and psych patients will still be coming to the ER because they just don't know any better.Hopefully the health care reform will relieve some case load in ERs but we won't know until the bill goes full effect.I wish people would be more show more patience...Quality Health Care....not fast "street them mentality" and the patients need to follow up with their primary care doctors or the specialists that they were referred to but for some reason they don't and then they are back in the ER.

      September 25, 2010 at 17:41 | Report abuse |
    • ControlDrugDatabase

      The control or schedule drug database just rolled out in Florida July 1st went "beta" online....If the hospital you are at does NOT have the software yet it will shortly.Oops!...Talk to the docs at the hospital the control drug DATABASE is going live soon and IS long overdue.It was a massive fight(10 years) because of "privacy issues" by certain groups..I am OLD I have see many changes in medicine some good some bad.Since you are just starting out ..PROTECT your Patients AND protect your license.....BYE! Saturday NIGHT

      September 25, 2010 at 17:59 | Report abuse |
    • Candlesticks

      Why would anyone go to the E.R. for a pregnancy test when they can buy one for a few dollars at the store? Why doesn't the E.R. tell them they don't offer pregnancy tests and to buy one at the store or see their PCP tomorrow?

      My mind is boggled.

      September 27, 2010 at 09:30 | Report abuse |
  46. Em resident

    And the biggest problem of all..... Malpractice lawyers. ER docs would love to rely on their clinical judgment and practice responsible cost-saving medicine. Do you think everyone in New Zealand, UK, France gets a CT scan for a headache? Of course not. We do it because of fear that we will be sued if we miss something. Good patient instructions and patient responsibility for follow up can avoid some unnecessary testing.

    September 25, 2010 at 16:49 | Report abuse | Reply
    • Ryan

      Amen brother. Can I get an AMEN!

      September 25, 2010 at 19:54 | Report abuse |
  47. mMckeyOregon

    the author is confused, there is no coverage for the uninsured in the passed bill. There is nothing for the unemployed and the broke. It is, as always, a rook, a bunch of fluff – all D.C gabbing but nothing solid and nothing that will or can work. the republicans are just like the President and the democrats in having no interest in actually solving any problems including health care. As they one and all said, they didn't even bother reading the bill they passed. Shame on them all.

    September 25, 2010 at 17:49 | Report abuse | Reply
  48. WILLIAM SAMS

    Its FUNNY how the REPUBLICANS say to HELL with White America and does'nt want to help us by extending the Unemployed till we atleast half of us get jobs

    September 25, 2010 at 21:09 | Report abuse | Reply
  49. Khan MD

    The biggest problem which is making things worse is most of the ER physicians are acting like triage nurses where instead of treating the patient, they end up consulting every speciality is the hospital to get burden off their shoulder and put it on someone else . It's just big defensive medicine being practiced on a mega scale with huge cost on government and insurance companies .

    September 25, 2010 at 22:33 | Report abuse | Reply
  50. Jennifer C.

    "Providing health insurance for all its people is an obvious basic tenet of civilized society."

    Obviously, INSURANCE provision is NOT a basic tenet of civilized society! What a society must do is be pragmatic in solving the problems of its citizens; otherwise they all may perish. Using modern management knowledge, this would be finding where problems can be stopped before they become problems and intervening. Obvious areas for intervention include measures to stop over-population. We know that over-population is THE main contributor to shortages of food, medicine, and other resources globally as well as the source of pollution and practices that may contribute to climate change. Next, unless something is sustainable, we cannot reasonably agree to do it. For example, we simply lack the carrying capacity to provide medical care for not only people who contribute money and/or work to provide medical care, education, etc., but to those who either don't contribute or and endless influx of illegal immigrants. It's simply not sustainable.

    No matter how we feel about these issues, Reality is what it is, and if we keep avoiding facing facts by supporting either the left's push to try to fund everything on the backs of taxpayers or the right's push to make all decisions based on religious doctrine, we are going to destroy the economy such that even fewer people have access to medicine, education, food, housing, and other resources.

    Litigation is also a problem. Doctors try to cover their behinds to avoid lawsuits. Again, as good as it makes us feel, we simply can't afford to allow endless lawsuits.

    We need to make some very hard but pragmatic decisions, or we will bankrupt the taxpayers and all of this will be moot.

    September 26, 2010 at 00:22 | Report abuse | Reply
1 2

Post a comment


 

CNN welcomes a lively and courteous discussion as long as you follow the Rules of Conduct set forth in our Terms of Service. Comments are not pre-screened before they post. You agree that anything you post may be used, along with your name and profile picture, in accordance with our Privacy Policy and the license you have granted pursuant to our Terms of Service.

Advertisement
About this blog

Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.