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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. |
  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. Recent Comments
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I am a former primary care physician. Our practice got so busy because to make money ( not get rich but just pay our overhead and fairly modest salaries ) we had to book every appointment and double book some. When patients would call sick we would have no appointments, would be running late, and therefore could not squeeze them in. Over and over patients would be getting referred to the ER from us just because we couldn't accomodate them. Urgent visit was available at night but not during the day. Hence I left a failing system- couldn't stand to be part of it. Making the primary care shortage worse I understand. I think every ER should have a small clinic/ urgent visit attached or adjacent to it. During triage if it is not emergent patients go to urgent visit/clinic. Fees would be less than $100 per visit on average. Even if this is somehow passed to the government/ absorbed somehow by us the fee is a lot less. ER waits for emergent issues would be much improved as well.
What I can tell you from 12 years as an ER doc: Most patients I see have "insurance", AKA Medicaid/welfare, and they come in because it's free. Need a pregnancy test? $12 at walmart, free if you go to the ER. Want a picture of your baby? Just go to the ER and tell them you have a bellyache. Need some income. The ER will give you narcs to resell. And we have to be nice to y'all because we are being graded by "patient satisfaction scores". And with this onslaught of patients, as well as the addicted society we live in, people get sick and they die. And I get sued. But Obamacare says it's not drug addiction, smoking obesity and mother nature that causes lawsuits, it's "medical errors". So despite this ridiculous healthcare bill they put in, which will triple ER volume, did they adress tort reform? Of course not.
Have fun America, cause in 3 months I'll be an ER doc..........but this time in Canada.
Whats super ironic? You WHINE about "Obamacare," ignoring entirely that he wanted, as did the nation, a public option leading to universal care... and then you talk about going to a Canadian ER, implying it would be so much better, where they have... what again? UNIVERSAL CARE.
I bet you oppossed the same healthcare reform that would have given us a similar Canadian and effective system, ending the need to save $12 so you can FEED YOUR FAMILY IN A RECESSION WITH THE WORST UNEMPLOYMENT SINCE 1994.
Your whining is typical of a spoiled little medical fiend. Whine, whine, whine. Why can't they pay $12 bucks for a pregnancy test? Oh, how dare people be sick! How dare women get pregnant! How dare patients expect (low and behold) MEDICAL CARE. Its doctors like you that have kept me from going to one in 6 years. All bitter and hateful toward the people you serve.
Or do you only serve your checking account?
Yeah you hate all doctors. Thats fine, but in the end you are ALWAYS going to come back to us. Might not be in the immediate future, but you guys are all the same. Hate on all the doctors until your belly hurts and I guarantee you are going to come knockin on our door. Please do us a favor and deal with it yourself, if you are going to talk the talk then you need to back it up. Dont ever step foot in an ER or clinic again for the rest of your life. Take your natural herb supplements and deal with it yourself. After all we wouldnt want to expose you to our "incompetence."
I don't hate doctors or patients. I just wish we had a more affordable system.
I understand why you're sick of it all, but since you can't change human nature, why don't you just go along with it? Pregnancy tests to the end of the line after everyone else, stomach pain gets an ultrasound but tell them you can't print the picture but that their baby is beautiful and doing fine, and shrug at the silliness of it all.
Again, I understand your feelings, but please try to find a way to love your job and just go along with the craziness, because having a caring and kind doctor (instead of one who's acting rushed or like he/she thinks you're an idiot) makes all the difference in the world to patients. It's wonderful to think of the kind and loving doctors and nurses.
I would LOVE the opportunity to show Obama around a modern day ER...like mine for example...trauma center, largest in the state..filled with drunks, herion OD's, cocaine induced chest pains, and "abdominal pain's"... women wanting a free pregnancy test..god forbid they actually ARE knocked up, then then demand an ultrasound..complete with print out pics of the little bundle of joy (that is screwed from the start) so they can show the baby's daddy, friends etc...introduce him to our drug seekers...the people who wait 5 hours for a free rx for motrin and a work note (those who actually LOOK for a job) for a week because they have a hangnail...OHH..and lets not forget the oh so special way, every-single-one that walks in... on already FREE government housing, foodstamps, and FREE HEALTHCARE...with a GUCCI or COACH bag, BLING to boot, Juicy Couture pants, Prada shoes and lastly, 40 dollar a week fake nails with the most hideous designs (that cost $3bucks a nail EXTRA)...DEMANDING THEY be seen for their nail scratch of an injury BEFORE the 80 year old having a heart attack!! Ladies and gentelmen...your tax dollars hard at work..now and probably forever if this ridiculous healthcare plan goes through. Mr Obama..pick a date and time..I would love to give you the royal tour of REAL healthcare occuring even BEFORE you plan to set this country off and under and bankrupt.
When your show "Empowered Patient" airs we would like the nurse "Sarah" who you describe in your book to be your first guest.You seem like you have a great friendship with "sarah" after your hospital scare so there should no problem getting in touch with her.We have information that the hospital incident that you claim to have happened is blown out of proportion.We would like the opportunity to be on your program and have sent you emails.A good journalist gives both sides of the story and lets the viewer decide who is correct. There was a medical reason and a good one why the hospital was going to do a spinal tap on Shir and we would like to explain the reason on a world wide network like CNN.We think it is the fair thing to do and we are very glad that Shir is a healthy happy child.
signed
guess who?
Medicine is NOT an exact science. What is right for one patient may not be right for another.Medical professionals are also human too so we make mistakes just like all humans do. Your "medical scare" was not one of those mistakes and the way you talk and write about it makes certain people involved SICK.....The truly sad thing is no one wants to do a painful procedure on a neonate...
I am an ER physician and I have to agree that it does seem that we are seeing more and more patients in the emergency room that would best be served by the primary care physicians. It would also cost less to everyone involved.
That being said, I do not see any change in the current situation. I do think that it may worsen with the new Obamacare.
I will say, thank you all for my job security.
This is a typical CNN piece, all opinion and no fact. There have been dozens of studies on ER costs and who is driving up the utilization. In reality, it is the insured using the ER at alarming rates, not the uninsured. The comment above regarding homeless, etc hanging out in the ER is accurate, but they are not seeking treatment. All of these studies can be easily searched using google. The most comprehensive study used to figure out why their health insurance mandate caused ER activity to double. Look it up and at least have an educated opinion on the issue.....although I know that is too much to ask for the typical CNN Opinion.
As a former ER nurse and now an QA auditor for medicaid one of the most infuriating trends that my colleages and i come across is the amount of funds that go to non-american citizens who come from their country of origin specifically to utilize our healthcare system for FREE ! It's called EMERGENCY MEDICAID. It happens everyday in every ER in the nation. Hundreds of millions of dollars are spent on people who NEVER pay into a system but are able to utilize it! I wish and pray that this issue is taken up by the media! Why is this possible? Why can't my brother who has been uninsured because of unemployment get EMERGENCY MEDICAID ? He's paid into the system his whole life. You know why? He owns something! This Goverment program is the most ridiculous,wasteful,unfair and mismanage program there is and there is nothing being done about it! Our Audits are meaningless
can you outline the alternative, I mean really go into a meaningful list of alternatives, and lobby for that change with your fellow colleagues? I know I have heard of the problems you listed, but have your professional organizations lobbied for changes?
To tell off a former ER nurse and an QA auditor – "but have your professional organizations lobbied for changes?"
is like telling a witness to a child abuse case off – "Has your city government done anything about it, has it lobbied for changes?"
Would an alternative to the ER be possible. Would it be possible to have a separate 24 hour clinic with a leased space within each hospital for the minor medical conditions? Would it be possible for that clinic to be subsidized by a non-profit foundation? Could this be staffed with volunteer doctors and nurses (more doctors and nurses asked to be there during some of the tougher times of the year or for emergency disease outbreaks of things like the flu)? Would it possible that the clinic is stocked, in part, by medication or medical equipment that would other wise be tossed by the area hospitals? (For example, Project Cure receives medical equipment and medicine that for various reasons cannot be use and are sent to clinics and foreign hospitals around the world on an as needed basis)?
It seems that part of the problem is that there is no place to go for those with medical difficulties, so the ER is the default.
We do have clinics out here in the Denver area that advertise themselves as an alternative to your doctor's office hours, that are open 24 hrs, and that do not do the work of emergency rooms. I'm not sure if they turn away those who cannot pay.
ED use will not improve with universal healthcare coverage. In the military, where all Soldiers and dependents have primary care physician, inappropriate ED utilization is common. The same complaints of access to care and lack of knowledge of the medical system are the reasons given for ED utilization behavior.
FOR ILLEGALS YES IT IS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Well what do you know, the secret is finally out!
our emergency room will continue to be abused by individuals who have no desire to help themselves, having worked in ERs it is amazing to see the number of patients who are brought in by EMS for no other reason then they are drunk and have no place to go, or the jail doesnt feel they are medically stable enough to be there, yet when a true patient with chest pain or other life treatening injuries presents we are taxed for rooms and staff to care for true emergencies, as we are full with drunks psych patients, dental pain and others who would be better served with education and access to a primary care doctor.
This has been and will remain the situation until the nation's focus shifts to preventative care and Heathy Lifestyle choices.
Largely it's not what you eat that determines your health status – it's what you don't eat. Live With Intention, DrBillToth.com/blog
it's the american way to eat as much bad food as people want and then to expect the government to pay for it. i love hearing how people point to other countries such as those in europe to suggest socialized health care works there. yet in those countries obesity is a fraction of what it is here in the states.
I actually think he looks more like the first guy, but I agree it would be ilcfdfuit at best to use that video as proof, but it may be one element of the case assuming there are a bunch of other things they have against him.EIther way, the tatoo'd guy has some explaining to do. Either he stole it, or his friend stole it, or he purchased it from the person who stole it. Either way it's a lead.Either way, the tatoo'd guy is a serious lead. Either he is the thief, knows the thief or pur
You know, instead of looking to have the government give you something, why not earn your keep. You could join the Reserves and work for them one weekend a month and have your entire family covered for a under $200 a month.
why do that when they could get handouts without leaving the sofa?
You know, I DID that. I served for seven years. The Army wrecked my knee, sent me to a doctor who messed it up even more, and I finally got out on medical. I rehabbed my OWN knee without insurance until I finally found a good civilian job that gaveme access to medical care. I thought about going back into the Reserves because I wanted to do something for my country, but then, through no fault of my own, I developed a debilitating auto-immune condition. The Army wouldn't take me back now, even though the condition is under control and I'm highly trained (I have been both enlisted and a commissioned officer).
So stop acting like you know all the answers, Miss High-and-Mighty. Not everyone is physically capable of being in the military. I WAS, but I'm not anymore. It's not always as simple as you'd like to believe it is.
If a person really wants healthcare, that person will get it in the US thru health insurance or visit to ER if uninsured. All Obamacare will do is put a burden on primary care which will lengthen the waiting time for all and for ones who can't wait (including ones who could have afforded insurance before Obamacare) will go to the ER..... which is no different than what is happening right now AS THE AUTHOR STATES AS WELL
US doesn't need universal care, it needs efficient care that is affordable by all.... BIG DIFFERENCE
ER's are not free. People keep saying that it is. It isn't. Even if you are seen because you are unable to pay at the counter or through health insurance, they sure as hell bill you the expenses. If you don't pay you get a big hit on your credit and you'll have debt collectors after you, same as anything else. So please stop claiming that the ERs are free or that other people are paying for your care. They're not.
When people who don't want to work or don't want to pay for insurance lie about their resources to get a Medicaid card, it is free.
(I am not referring to those who genuinely are unable to work and truly need Medicaid.)
Folks are missing the point. Cost, ethics, and the roots of America all are at play here.
Here is how it works today. Those who cannot afford health insurance (or do not qualify [i.e. illegal]) use the ER for primary care mostly, even those on Medicaid. Taxpayers float the bill in the end.
The proposed plan is a requirement for health insurance for all. This will not only add to the pool of insured, a pool that is statistically more ill than the rest of the population, it also inserts a layer of necessary work, both government and insurance resources. For the government, this work is around enforcement of the law, “get your insurance” notifications and programs, etc. The insurance companies will need to rework many of their programs, likely adhere to stricter and more confusing regulations, and deal with a segment of the population that will find it difficult to pay premiums.
Now what happens when the insured pool changes in this fashion? Rates go up. OK, fine, we all get that. Are we really shifting the financial burden in a way that makes sense?
None of this makes healthcare COST less. It is a game of cost three card Monte. Not only that, we have increased the burden on both the government AND the insurance company.
Ethically, it would be great to say that we can provide quality healthcare to everyone. Arguments that “the pursuit of happiness” includes good roads, a good electrical grid, K-12 education have been made and won. What about Healthcare?
America is the most innovative country in the world. Over the past 100 years, it has created the most used new drugs and new medical technology. Why? The efforts vs. reward policies that have been set in motion by our founders were revolutionary. Government need only provide the framework to keep us safe and let us grow. It was these very principles that prompted Tomas Jefferson to write, “Government big enough to supply everything you need is big enough to take everything you have ... The course of history shows that as a government grows, liberty decreases.”
We have been given a healthcare reform bill that was passed under suspect tactics by folks that do not understand how business and medicine interact. Bush was right when he said “they can go to the ER” but he never explained it well enough (story of his tenure).
Here is the key. It works now. Everyone has access to healthcare. Taxes cover those who don’t have health insurance for whatever reason. So…. What is the solution? Add more government, which has been proven time and time again to be less efficient than business to cost-effectively handle healthcare transactions AND push everyone’s rates through the roof by absorbing the riskier insured pool. This combined with reimbursing less for Medicare/Medicaid, which will drive less primary care doctors to accept these patients, which will drive more to emergency care for primary care.
I call this the perfect storm of stupidity, and we have just begun to see its effects.
Solutions:
1) The healthcare system in America today is not broken. Those who tell you this are trying to scare you and then use you for political gain. Folks who try to bash America’s healthcare often tout statistics that are not applied apples to apples. Birthing statistics are gathered with different metrics in other countries. Dig a little deeper before you post. For chronic disease, there are better programs in some other countries, I agree. Remember, the USA is great in areas where people can make the most money (acute/urgent care, elective surgery, etc).
2) Healthcare costs will rise each year. This is a fact. There are more elderly people and inflation is reality. Because they are rising is not necessarily a huge problem that requires a rework of the system.
3) One out of every four 1st graders in America are here illegally or the children of illegals. Fixing the immigration issue will help healthcare tremendously. Vote some folks in that can put aside politics and get it done right.
4) Creative ways to funnel folks to the right type of care have not been tried in earnest. This is the type of “framework” that government and government-sponsored groups need to provide.
Great post and points....A couple of things grind at me..The way the health care reform was passed and shoved down our throats on x-mas eve.Obama said in his campaign he would be a "transparent President" and "C-span cameras would be allowed in" Honestly I have read the bill twice and we won't know how good the bill is until in goes into full effect.Jimmy Carter who never says bad things about anybody blasted Ted Kennedy recently saying he did not want healthcare reform unless it was HIS.We will know when the bill goes into effect who WROTE this bill.
The media always presents cases that are not the "norm" For instance the college kid who dropped out of college for a year and was involved in an auto accident.His mother was complaining because they have a 10k bill.When the bill goes into effect there WILL STILL be hard bad luck cases out there.There has to be a time when personal responsibility kicks in or the government will go bankrupt just like individuals.
I will adjust with whatever Washington D.C. throws at me.....what is next? everyone gets a free college education and a free 3 bedroom house?
If your Statistic is accurate or even close to being accurate it will not help the emergency room...............
The statistic that 1 in 4 first graders are here illegally???? That means that they are off the books...That means they do not pay taxes......That means they will not be affected by amendment 17 or health care reform........I think that is high and NO AMNESTY ......Colbert is NOT funny and he is wrong
Whoever wrote this has obviously never had UTI. If there is no Urgent Care facility open, you have to go to the ER for a UTI. You need antibiotics ASAP. We should open up our drugs like they do in Latin America. No prescription is needed there for most drugs. You can go to the drugstore and get the antibiotices that the dr would have prescribed...but, no dr visited required.
We have to be careful with antibiotics, due to the rise in antibiotic-resistant bacteria. Do you not know anyone suffering from reoccurring MRSA?
Zyvox for all!!!! hahahahahahahhahahahahahahahahahahaha
I think you are going to have to explain methicillin-resistant-staph-aureous to the dope!.....LOOK MOM....No google/wikipedia
hahahahahahahahahahahahahaha
Inizialmente tutti osannavano The Conduit perch gli aoturi mostravano di avere l'intenzione di spremere fino in fondo le potenzialit grafiche della console : per la maggior parte degli utenti questo bastava a giustificarne l'acquisto, il gameplay, la trama e l'originalit non sono discussi nemmeno lontanamente in alcuno dei commenti qui elencati, il che equivale a dire "Purch non sfiguri graficamente, lo compro".Poi nel corso dei mesi, grazie ai vari trailer si iniziato a delineare un magior spessore della struttura narrativa, nonch del gameplay, il che un bene ma non comunque fondamentale: "The Conduit" sar un immenso successo commerciale su scala planetaria a prescindere in quanto non esiste un possibile rivale a contendersi i soldi dell'utenza (Metroid Prime 3 ha gi un anno e mezzo sul groppone e gli appassionati lo hanno gi finito in tutte le salse), inoltre il 2009 si sta rivelando avaro di sorprese Insomma, faccio il tifo per High Voltage nella speranza che non deluda le nostre aspettative ma, siamo sinceri, in un contesto normale in cui i giochi di qualit non si facciano desiderare, probabilmente non lo avremmo desiderato a tal punto
On your special can you please have the hospital and/or the nurse/pa/doctor speak or give them an opportunity to speak who missed a subarachnoid hematoma on a child?A child gets hit in the head with a baseball and the doctor does not suspect a subarachnoid hematoma? or order the appropriate test? Journalism presents both sides of the story.If it is true it sounds like bad medicine......
"Providing health insurance for all its people is an obvious basic tenet of civilized society."
Where did you see this? Who are you to make this claim?
I don’t own a home, so I think providing a home for all is an obvious basic tenet of civilized society, or maybe providing a nice vacation to Europe…
How about pay for what you consume. Anything provided by the State, healthcare, food stamps, low income housing is not a “right” but a gift. Be grateful and say thank you to those who buy it for you…
How about pay for what you consume.<---EXACTLY.....................
I am 22 and weigh 325 pounds ....I am going to get liposuction,gastric by-pass and a boob job!.....Thanks Obama!
my healthcare rights are fertility...........I am going to have more KIDS!!!! Watch my new show KATE PLUS 80......Thanks Obama!
It is my healthcare RIGHT to hair PLUGS so I can pick-up young chicks.....Work? what is that? Thanks OBAMA!
It is an AMERICAN right that every single american has a personal doctor,nurse,pharmacist,personal trainer, and personal chef...24 hours a day ...7 days a week...hahahahahahahahaha
I forgot--.IT IS FREE!!!!!!!! or at least it would appear to be.......taxes,taxes taxes
The irony is that many of these patients do in fact have health insurance. It is the primary care doctors who tell patients to go to the emergency room for anything that happens outside of the doctor's hours or can't wait a week a so for an appointment. I've experienced situations with my husband where he goes to the doctor's office and the doctor sends him to the emergency room, then the emergency room physician tells him he should have gone to the doctor's office. Doctors need to take responsibility for their patients and stop trying to pawn the patients off on someone else.
Clinics often can't afford to stay open 24 hours – which is what is needed to remove some responsibility from ERs. We also have to start valuing primary care doctors and prevention. 1/3 of the people going to ERs have no health insurance, which means they definitely aren't going to a clinic, and which means they are waiting until the health problem becomes unbearable to visit the ER. This is dangerous AND expensive.
Health insurance only works when there are enough people putting into the fund to pay for the times people are sick. It also works a lot better if people can receive preventative care easily. This isn't happening now, but hopefully with the new health care bill it will. If almost everyone is putting in, the money will be there to cover everyone without major problems. This also means societal changes, more leniency for sick days, or half days so people CAN get treated. Things like that.
Everyone interested in good non-partisan research on health in America should check out healthaffairs. org ... funded by the Robert Wood Johnson Foundation.
The problem with the healthcare reform isn't that Republicans or conservatives don't want people to have access to healthcare (obviously, although it's often portrayed otherwise for political purposes), it's how to pay for it. Have all the opinion pieces you want from doctor's, health advocates, and social workers, our problem is MONEY!! I would love every hungry American to eat steak every night for dinner, but we can't afford for everyone to have it all. Healthcare is no different.
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I understand why the law states patients have to be seen regardless of ability to pay, but do they have to be given perks for free? How about no more pain meds, photos of baby ultrasound, pregnancy tests, etc. without paying for them first? That would be reasonable and perhaps make abuse of the system less attractive.
I've got great healthcare, but choose to not have a PCP. I utilize clinics or non-ER "urgent care" facilities. They're open at hours when I need them, the standard of care is sufficient, and they're motivated to get a quick, correct diagnosis. I've yet to meet a PCP able to offer these three elements. On the other hand, my wife has a PCP & OB-GYN and our kids have a pediatrician. What is appropriate for one is not appropriate for all.
sembra ke le kritike siano state utroscttive x konamida questi screen sembra k si possa angolare finalmente il tiro!!!!!!!quello k aveva rovinato questo fantastico gioco era proprio quelloarrivavi davanti al portiere e muovendo il nunchuk segnavi1 p troppo facile x ki dopo 1 azione spettacolare ,grazi eai controlli wii ,invece di tirare nel 7 segna il portere cn 1 tiro rasoterraSPERIAMO BENE tsu78 28 Settembre 2008 alle 6:52 #20 puntipi che le critiche in generale,credo abbiano pagato molto i sondaggi che ha fatto konami sui vari siti (ad uno ho anche partecipato),comunque la grafica migliorata,speriamo abbiano registrato anche effetti secondari come gli spalti dello stadio e sopratutto abbiano messo l editor di squadre e giocatori(che importante per la longevit del prodotto),comunque quest anno sar un bella lotta fifa-pes.ci me vado a ved vale rossi v :p orlando9164 28 Settembre 2008 alle 19:33 #30 puntibene: non solo miglioramento del tiro a quanto sembra, ma anche delle gestione difensiva che ora sembra davvero interessante e della grafica che mi pare molot ma molto pi nitida e definita Murak 28 Settembre 2008 alle 21:46 #40 puntisbaglio o la grafica non da ps2? Tails92 28 Settembre 2008 alle 22:37 #50 puntiesattamente, allora non sembra solo a me nettamente migliorata SIETE SICURI KE SN SCREEN X LA VERS WII???????SKERZO X FORTUNA KE NN FANNO PORTING DA FIFA 2007 X PS2 CM EA ADESSO VADO DA QUELLI DELLA KONAMI E LI BACIO LA FRONTE .. metaforicamente parlando ovviamente
With the pending and just put into effect Health Care policies it is more important than ever to empower ourselves and take control of our own health and the health of our families. Check out this fantastic blog for simple health tips that are easy to use in our busy lives: http://blog.mydiscoverhealth.com/
Are your health tips guaranteed? Where do you practice? What is your name and license number? Is it true that "your blog" is based on entertainment? I am not sure I want to mix entertainment with health! so do have clowns on staff too?.......or is backed by a real medical practice?
Health care insurance is not the same as health care. Also, I don't believe that forced human servitude should be part of the "ethical priorities" of a nation.
Kaiser Roll said:
I can't believe Obama wants to provide health care to poor people. the poor should just go get their own healthcare where ever they get their food and shelter, be it at the city garbage can or sewer. I don't understand why everyone in America can't all have a high-paying job at the same time so we can all be millionaires and have private doctors? wake up America, the poor can all go get $100K jobs tomorrow and be eating gold by wednesday if they would just do it. Yours truly, Republican common sense
Honestly, people like KaiserRoll are the reason the US is in trouble. What a peice of trash!!!!
That being said, some people DO use the ER inappropriately. It's a fact and GOD BLESS those Drs, Nurses and Technicians that work in them.
I've been SERIOUSLY ill 3 times in the last 3 years and spent over a month in the hospital in that time. That being said, twice, my route to the ER (and admittance to the hospital) was after calling my PCP... going there urgently, and then going to the ER. EACH TIME they were expecting me, and once they even had a team of Drs. waiting to jump right in to treat me, and great compassionate doctors, nurses and support staff (This is at Roosevelt Hospital in NYC... a very old very good hospital!). Yes, I have insurance (not great, but I have it). I've never gone to an ER without being admitted overnight at least.
Some people are NOT so lucky to have insurance, but people seriously and repeatedly abusing the ER (so called GOMERS... GET OUTTA MY EMERGENCY ROOM) should face criminal consequences (the same as abusing 911).
That being said, ER's that negligently DON'T treat seriously ill people and let them die should also face criminal charges.
There are RIGHT ways and WRONG ways to use EVERY resourse.
I thought it was pretty obvious what Kaiser said was a joke. He's pretty clearly either mocking republicans or is too stupid to trouble yourself with. Caaalm down.
WHAT????Oh my GOD!!!ER doctors are killing Gomers???? Please join me with Elizabeth Cohen on very very very special OPrah Show with George Clooney.Noah Wylie,Anothany Edwards to discuss this ER .....EMERGENCY SHOW today on OPRAH!
I thought it was the cough suppresant DXM that was killing the Gomers........I have to buy that darn book......so I too can become empowered!
If you don't have insurance, is it even possible to get a PCP who will take you on as a patient these days? Many won't even take new patients regardless of the type of insurance you have. Mine isn't currently accepting new patients. When the baby boomers were growing up, state and federal governments greatly increased the number of future teachers attending four-year colleges. In many cases, college tuition was waived if the teacher agreed to spend a couple years teaching in the public schools. Now, we have fewer medical school students than in the 1980's, despite the fact that half of America's college students would probably go to medical school if they could get in. And where's the government, AMA, etc? The biggest foolishness was to expand the system without fixing it. Big Pharma, etc. will become more and more powerful as we funnel an ever increasing percentage of GDP into their pockets and real reform will become less and less possible until the economy collapses under the weight of not being competitive with the rest of the world!
DEBT=SLAVERY......Oh My God!!! Breaking News......D-E-B-T=SLAVERY! Oh mY gOd!!!
CNN no longer is a news network.........It is one big giant INFOMERCIAL.....Following Faux and MSNBC ...CNN held out to the very end ........I think I just saw gAY pORN with ALLI(Mr Egghead)and that dude from Showbiz Tonight...I am calling the FCC!!!!
Alli you were just playing yourself in Wall Street 2.......Get over yourself Egghead!
CNN ----–>R.I.P. .....................1980-2010
Don't forget to buy my PASTA BOAT!!!! and if you call right away I will throw in a Slap Chop for free!!! Just pay for shipping and handling!
Slavery? hmmmmmmmmmm
I think it is called work....and paying off bills.......You can't take the money ,house,car or DEBT with you when you die!..
Where are you going with this CNN?
I think it is conspiracy that Alli is not nominated for an academy award for his role in Wall Street 2!
xyz.....OH MY GOD....Not my Blackberry!
WOW! What an educational interview!!!!Is he one of CNN's heroes of the year?
David ZinZenko!
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Fell asleep on that last riveting interview........FUNNY..............
Great more distractions!!!!.........and buy a sport coat that fits-> JACKass
I was held hostage for 6 long draining YEARS but those painful years were a PICNIC compared to the interview with RIck Sanchez.......................WHat a DOUCHE!
"But most of this is attributed to patients who do not have primary care doctors, usually because they don’t have insurance."
This is a common assumption, but it ignores the fact that we do not have enough primary care doctors. The recent reforms focused on payment mechanisms and failed to truly reform actual health care delivery. Did you know the average family doctor who mostly provides cognitive services is reimbursed 52% of the average salary of a manual procedure based specialist? The skewed reimbursements are set by the American Medical Association and Medicare (CMS). At present, the US has < 30% of our doctors working in primary care; efficiency studies show we need 50+% of our doctors in primary care to provide the proper cost-effective balance that maximizes health (see Barbara Starfield – Hopkins).
I'm not an expert on this issue, but I heard that there is some kind of association of doctors who control how many people are accepted to medical schools each year. They try to keep the numbers small so the demand for doctors is inflated. Any truth to that rumor?
It is starting like many of us thought it would.....Christian scientists push for spiritual care to be in the government health care reform.....How about the Bishop... Eddie Long......look at all that Bling bling and a Bentley.......
CNN-----> R.I.P.......Shitzer/Parker....guess what my ratings will be....0.1?
I am from New York She is from South Carolina...It is an Odd Couple.....hahahahahah..ROTFL..lol
Does any one want some tips on how to pick up escorts and hookers with government dollars?
Call me 1-800-Spi-tzer!!!!!
Hey you still owe me $$$$$$$ from last time...Come on Mr. Toad!
woo-hoo...More KIDS!!! Stop the Foreclosure of my home...THANKS OBAMAcare!!!!!!!!!!!
Nursing Bra for SALE at my Garage Sale..........I need 10k!!!! ....THANKS OBAMAcare
Eat this not that....--------->SHUT THE F#CK UP.........
Grocery Shopping is so Difficult on Wednesday Night!
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Come on....Really?
George Blanda and Gloria Stuart tragic deaths could be the result of AMERICA:Healthcare Gone Wrong......We must have health care NOW!!!!!!!!!!!! It is an AMERICAN right..........George and Gloria AMERICA's poor health care let you down!!!!!!
more healthcare reform coverage on cnn.com
WHAT????? Oh my GOD!!!!! 2 more tragic deaths from america's troubled healthcare system.....
On a very special OPRAH with Elizabeth Cohen we will examine if George and Gloria were empowered patients.
If they bought and read Empowered Patient could it have saved George and Gloria?
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