I have severe asthma, and when my wheezing, gasping, slowly turning blue ass has to spend upwards of an hour waiting to be seen… there is a problem.  The last time I had to have someone support me into the back because I’d started greying out by the time they got to me.  Thankfully the new meds keep it more under control, unfortunately if I lose my insurance, those meds will be financially out of reach for me.

I am still waiting for one of the interviewers of the daily Republican liar to ask them if ER treatment is free? The repubs sure make it sound so and of course, we who use the ER all know different. And, quite frankly, I think that the debtor’s prison is quite ‘real’ in the sense that the bankruptcy code has been tightened, the cram-down on mortgages failed;  credit card rates are higher than what my ol’ local loan shark in Jersey City used to charge- in fact, the local bosses would have NEVER allowed such rates as it would be bad for everyone.; and student loans are still (save some rare instances) are still non dis-chargeable in bankruptcy. Of course, now the new law says if you owe the loan for 25 YEARS it can be erased; 25 years- over half of your adult working years. And do we even need to discuss how less and less is covered under insurance through huge deductibles and such?

No, the debtor’s prison is all too real and the repubs love it.

I can remember taking a friend to the emergency room.  She had insurance and a nasty bug bite, and was examined way before all the folks who looked feverish and could barely sitting up in their chairs—including children.

Surely you jest.  I thought those wait times only occurred in those commie countries because they “ration” their health care.

Blame it on my crazy Canuckian ways but it positively baffles me how anyone can look at the numbers of Americans dying, one of the lowest (the lowest?) life expectancy rates in “western” world along with one of the highest infant mortality rates and actually say “This system works.”

And what is the point of government if not to provide for it’s people?

Emergency rooms don’t do chemotherapy. I suspect they don’t do maintenance medication for cholesterol or blood pressure—patients go in for heart attack and stroke, whereas could they have afforded preventative medicine, there wouldn’t be an emergency. Again, HIV is best treated with drugs that prevent it from raging into AIDS. Not a treatment you get in the emergency room.

Not that it’s a strike against public health care, but we very much do have long lines at emergnency rooms in Canada. It’s often held up by conservatives as a reason to privatize healthcare.

Debtor’s prisons do functionally exists if you owe money to the state, whether that be a munipality, the IRS, or a psuedo-government agency like Sally Mae.

It would help if we could get more urgent care clinics for people who get non-emergent illnesses outside of business hours or while away from home, or for people who don’t (yet) have a primary care doctor.  It’s ridiculous that even people who have health insurance have to go to the emergency room if they come down with pneumonia on a Sunday or get sick while on vacation.

Amanda, it’s not a bug but a feature.  It is part of what’s behind “education reform” as practiced by R’s, “welfare reform” “tort reform” - to maintain a class of people so desparate and broken that they will do anything, take any job, no matter how humiliating, just to survive, and to blame themselves when they fail.

When I was an 18-yo fascist, I cast my first ever vote for Ronald Reagan.  I was sick to my stomach before I’d left the polling place.

The shame still haunts me.

Americans also have a libertarian attitude to health care, because the health media hypes many common chronic conditions as preventable (dismissing genetic effects or poverty). Of course they’re preventable—if you belong to the relatively leisured (or successful and hyper-organized) class able to find and cook healthy food and exercise fifteen hours a week, or to see psychotherapists instead of self-medicating. Health has become a privilege, not a right, and the wealthy look down upon the ill-health of the poor in much the way that the wealthy used to look down upon the crowded and unsanitary living conditions of the poor in the days of Orwell’s Wigan Pier.

At some point the tide may turn, given that everyone has parents and everyone’s parents become old, no matter what socioeconomic stratum they belong to. Of course, libertarians abandon their elderly parents on ice floes in the Arctic.

I can’t comment on ER’s, but I work for a cancer clinic that treats regardless of ability to pay and it’s the present system that does on occasion create a backlog.  Mostly it is because of non-compliant patients. These are patients that show up for their treatments when they want, if they want.  Quite a few of them have substance/psychiatric problems, many others just have fucked up priorities. Unfortunately our chief oncologists makes us keep them on the schedule way longer than we should and so they take up slots that could be occupied by people who would actually show up and complete their treatments.

Where real health care coverage for all helps me, is that other clinics would be forced to take up some of this burden. Also a lot of these low income non-compliant patients are usually stage 4 by the time they get to us, because they haven’t been to a doctor in a very long time(until their disease can no longer be ignored).  It also might help with some of the aggravating problems like the previously mentioned substance/psychiatric issues that cause them to skip treatments and linger on the schedule.

Noncompliant patients are a huge deal in general, but they’re also a social work problem.  It’s vastly cheaper to hire a social worker to walk folks who aren’t capable of taking care of themselves through care than it is to continue to treat them poorly.

Of course, given my experience in hospitals, the general cutbacks on anything that isn’t directly related to surgery might have something to do with this.  I can’t count the number of missed pain medications, blood clots allowed to create complications, etc.  Hospitals are where healthy people go to get sick and sick people go to die.

I spent almost $1500 this summer for a ER doctor to tell me to drink some water and go home.  This took almost 4 hours.  I got my blood pressure taken, and EKG, and I sat around.  This has also generated a surprising number of unitemized bills.

‘Just go to the emergency room’ is one of those statements that makes me so angry I feel sick to my stomach.

It’s a fair bet no one who says that has ever fetched up on the ground with a spiral fracture of the lower leg, weeping because it meant a trip to the ER, you simply flatly could not afford. I actually sat on the couch alternately apologizing to my partner for trashing our budget and artguing that we should wait and see if it was ‘really that bad’ after the swelling went down. (Four weeks on crutches, no weight bearing. Another 4 months on crutches before graduating to a cane. Several thousand dollars worth of loans from family and friends to cover the medical bills.)

Or had a shoulder injury so bad it re-dislocated 4 times over the next 3 years, like my partner. We knew from the doctor’s opinion of the original injury he needed surgery. We didn’t have insurance and could not afford his being off work on disability post-surgery. Again, thousands of dollars in medical bills. 

Or taken abusive phone calls from medical billing people who are unhappy with the delays and denials by the insurnace company when you finally DO have insurance. I finally told one of them ‘Sue me. But before you do, call the insurance company and tell them if you sue me I am going to sue them.’

This stuff is so infusive it’s become a cultural oddity in American media.  I’m thinking of an episode of It’s Always Sunny in Philadelphia where a character was trying to extract something himself (a tooth? can’t recall) because he couldn’t afford medical help.  The way it was cast as so mundane, so normal, was unsettling to me, a foreigner.  Sure there was a helping of grotesque delight in the scene, for humour’s end, but that inaccessibility of treatment is routine enough to make a sitcom out of it—an afterthought moment, in fact—seriously points to the fuckedupedness of your system.  Needless to say, it took me longer, probably, than the average American to figure out what the deal was—that is, why the hell he was putting himself through that when there were doctors down the street.  Then I clued in and realized it wasn’t as over-the-top stupid as I’d initially thought.  I imagine that scene plays very differently for Americans.

“One time after cutting my finger, I seemed to be the only person in the waiting room that was there for a reason other than pneumonia.”

Which is extra-great, because what people with communicable diseases and immune systems that have taken a beating always need is to sit for hours next to people with other communicable diseases.  I wonder how much people just not being able to afford flu shots or optional-but-recommended vaccines winds up costing the healthcare system overall every year.

“that inaccessibility of treatment is routine enough to make a sitcom out of it”

Keep in mind, It’s Always Sunny in Philadelphia is a sitcom where the running gag is that they’re all terrible, ridiculously dysfunctional people.

The Bush people didn’t want anything like debtor’s prison because that would imply a responsibility on the part of the creditor or the state to offer either possilby gainful employment or sustenance. So 20th-century.

That’s exactly the thing, Preying—when I stopped and remembered how US health care works, suddenly what looked like standard Sunny silly dysfunctionality wasn’t so silly even for that particular crew…

The right-wing answer, of course, is that all those sniffly children are illegal immigrants whose parents are sneaking them across the border for the wonderful US emergency room care.

I’ve known people who have sutured their own wounds at home with a sewing kit. When I worked at a pet store, I sold a lot of antibiotics designed for aquarium use to people for their own usage because they’d couldn’t afford anything else.  I know people who have passed on old, leftover medications to people who needed it.  Or guessed that they needed it since they couldn’t afford to go to the doctors to find out. 

These weren’t “ridiculously dysfunctional people”.  These were perfectly normal people - most of them blue collared working poor - who had no health insurance and were doing the best they could. 

Our system is fucked up.  Unless your head is firmly wedged up a very privileged ass, that should be glaringly obvious.

“That’s exactly the thing, Preying—when I stopped and remembered how US health care works, suddenly what looked like standard Sunny silly dysfunctionality wasn’t so silly even for that particular crew…”

I don’t think it’s the “I guess I’ll just have to pull my own tooth” thing that would have been meant to be the dysfunction so much as treating the necessity as a mundane or blase thing.  People get stuck scraping by with what they can swing—butterfly bandaids on a cut that should probably have gotten stitches, nyquil and crossed fingers with what might be pneumonia, etc.—often enough, but it’s usually a very oh-shit situation and the people stuck in it recognize that it isn’t right.

Honestly, I’m surprised there wasn’t more of a move during the Bush years to recreate debtors prisons, to add extra “motivation” for people that got stuck in a health care crisis to live their lives as obedient wage slaves.

Why bother?  The same effect had already been achieved by Bill Clinton’s signing of NAFTA into law (written in the legal language of a Treaty making it next to impoissible to recind, btw), w/ the implicit threat of the company moving to Mexico if the union refused to give up wage increases & benefits.

There are at least a few local public health systems that offer more than emergency care followed by a bill dodge. The Harris County TX Gold Card system does offer preventative medicine and extended treatment for chronic conditions. Ofvcourse of you’re a Gold Carder on the west side of town you will be driven past many ER’s to Ben Taub, be refused by Taub because it’s overcrowded, and taken to far away LBJ. You might die if the trip is during rush hour. Even so, Gold Card level of care would be a step up for many people.

Smartpatrol—those companies have all long since moved to China from Mexico.

Don’t use a melon baller.

It’s too bad you don’t have an urgent care clinic in your neighborhood (or maybe you do and it was closed) - my child recently stepped on glass and the urgent care MD was able to fish it out and make sure Jr. was clean and healing. Total bill was about $160, as I recollect.

Urgent care clinics are going to end up playing a major role in whatever our health care system ends up looking like; they make an adequate replacement for most GP services while being able to handle trauma cases that don’t require a full hospital, and they do it at a reasonable cost for basic procedures. Not to be a total UCC cheerleader, they’re hardly a panacea - just a useful option for many people.

keshmeshi: ridiculous that even people who have health insurance have to go to the emergency room if they come down with pneumonia on a Sunday or get sick while on vacation.

I’d say that is exactly what an emergency room is for: Something that happens when your usual doctor is unavailable (middle of the night, 1000 miles away,...) and cannot wait until you can see them.

The few times I’ve been to an emergency room [large university clinic in Germany] was when I or a friend had an accident in the small hours of morning or on a Sunday. Waiting time on Sunday was 15 minutes (there was a drunk with a bleeding head wound that had higher priority)—in the middle of a weekday night the doctors and nurses are usually happy when something not-serious distracts them from coffee and night time radio.

sara: At some point the tide may turn, given that everyone has parents and everyone’s parents become old, no matter what socioeconomic stratum they belong to.

But everyone’s (or nearly everyone’s) parents have always become old. If the parents are wealthy enough to pay their doctors, or determined enough to just die without seeing a doctor, the children need never notice.

Ranylt: This stuff is so infusive it’s become a cultural oddity in American media.

I noticed it in amateur fiction written by US Americans that is set in ... not the US, basically.

Punditus Maximus - I Know.  Ain’t Globalization grand?

Republicans actually think it’s a great idea to create a huge class of people that are stuck in bankruptcy.

Well, yes. I would think that was axiomatic.

The right-wing answer, of course, is that all those sniffly children are illegal immigrants whose parents are sneaking them across the border for the wonderful US emergency room care.

Heh.  One of the biggest drains on the Canadian Heath Care System are the sheer # of Yanks coming into our hospitals posing as Canadians to avail themselves to treatments they’d be denied by their HMOs back home.

Yet when I tune into US television, I often see the most offensive slanders re: our national health care system being given heavy rotation over the airwaves courtesy of paid spots from bottomfeeding astroturfing groups like PaitentsUnitedNow.com, bitching & moaning about how life-threatening delays are caused by decisions being made by Gov’t Beaurucrats.  As opposed to the US “system”, where lethal decisions are being made by Insurance Industry Beaurucrats, who decide that desparate & sick people are to be flat-out denied any treatment, despite having paid into their plans for years or even decades.

Before I forget, wasn’t there actual footage in circulation of someone literally falling over dead on an emergency room floor & lying there for several hours, w/ people stepping over them & the janitor cleaning around them?

I’d say that is exactly what an emergency room is for: Something that happens when your usual doctor is unavailable (middle of the night, 1000 miles away,...) and cannot wait until you can see them.

It is, however, wildly inefficient to not have a way to deal with people with different needs: 1) people who have “real” emergencies calling for immediate attention (heart attacks, etc.) 2) people who are seriously ill with things like pneumonia and 3) people who are very sick and can’t access a doctor during regular hours.  It is a problem that compounding the cost of medical care is the fact that a lot of people have to take time off work to see medical professionals during working hours.  Urgent care clinics can deal with #2 and #3 so that ERs aren’t juggling a higher volume of patients, slowing down care for everyone and not giving adequate care to emergencies while sick people get sicker sitting in a hospital.  Before our hospital opened an urgent care clinic where they ushered many patients I once waited over an hour to see a doctor with someone who had just had a grand mal seizure and had been brought to the ER in an ambulance.  As was said upthread our system is deadly to those without insurance and not efficient or rational for anyone.

And, Denelian, yes! Medical debt is horrendous and I wish there were more readily available sources of information for people.  I had an emergency room visit while I was uninsured and it plus the subsequent hospitalization left me over $10,000 in debt.  They will push people to borrow money, put it on credit cards, anything. because their collection options are somewhat limited.  I had a family member in the medical profession who told me to call their collections department and negotiate a reduced payment plan but at the time I was fully prepared to drop out of school to do anything to pay off the debt.

In short—fucking public option, please.

Before I forget, wasn’t there actual footage in circulation of someone literally falling over dead on an emergency room floor & lying there for several hours, w/ people stepping over them & the janitor cleaning around them?

There are at least two that I can think of offhand.

Yes, we do suck.

I have been analyzing and constructing a commentary for a huge multinational multicontinental research report.  One of the outcomes is “hospitalization” for respiratory and cardiovascular conditions.

One problem in aggregating the data was the different ways that emergency rooms are viewed and used in the US, Canada, and different areas of Europe.  Many of the situations that result in emergency room use in the US or in areas of Eastern Europe don’t apply to Canada and Western Europe where preventative care is widely accessible.  Furthermore, there is a push to treat and release people with respiratory conditions in the US, where they might be admitted if things got that bad in Europe or Canada becuase going to the ER means prevention failed (or, in Eastern Europe, because they more commonly hospitalize).

In short, the US tends to more people at hospitals, but these people often need stabilization only.  By contrast, people presenting at an ER in a country with better preventative care are in less easily treated shape.  The question is, why are we letting people slide and then treating them?  Why do you have to be in extremis to get services?  It is just another example of pennywise, pound foolishly wasteful spending.

Smartpatrol, the Royal Canadian Wingnut Relations love to complain - and rightfully so - about certain aspects of their health care system.  They do readily acknowledge, however, that when things go very bad quickly they are seen to IMMEDIATELY.

I can understand why farmers complain that musculoskellatal issues are not MRI’d and treated for years - even when there is a paper trail and an auto accident or farm accident involved.  That’s a legitimate quality of life and often an ability to work situation.  But conflating that into “life threatening delays” is total bullshit and the people who live there seem to know that, even when they are very conservative people.

I’d say that is exactly what an emergency room is for: Something that happens when your usual doctor is unavailable (middle of the night, 1000 miles away,...) and cannot wait until you can see them.

No, your emergency room should be for when you are having a stroke, or have been shot, or maybe even a broken arm, but not “ow I think maybe I might have broken my finger or maybe it’s just twisted but either way it’s friday night and I won’t be able to see a doctor until Monday at the earliest”, or “I’m running a fever of 101.3 and maybe I need antibiotics but I’m nowhere near my regular doctor.” These things are *urgent*, not *emergencies*. Hence, urgent care.

I have an emergency room horror story I like to tell to outline our need for better public health options:

I was pregnant, and while at work, at the end of the day, my face and arm went numb. I called my doctor, who said yes, pregnant women are at risk for stroke, go to the ER. So I went to the ER. I was triaged as urgent. And it was 6 pm when I got there. It was 2 am before an intern checked to see if I had blurred vision or could talk, 4 am when I saw a doctor, and the doctor said the CAT scan would have to wait for morning because there were no techs on duty.

When you are having a stroke, if you get clot-busting drugs within 3 hours you might be fully okay. Within 12 hours you could reduce the impact of the stroke. After 12 hours there is nothing they can do for you, all the damage is done.

I checked myself out of the hospital AMA at 4:30 am because what was the point? If I had had a stroke it was going to be way too late for them to help me by the time the techs got in at 8 am to give me a CAT scan.

So if I *had* had a stroke, pregnant woman with two existing kids who is currently the primary breadwinner *and* only driver for her household could have ended up disabled because no one bothered to get the correct drugs to her on time AT JOHNS HOPKINS, one of the best-rated hospitals in the United States. Because there were so many people there with chronic conditions that had become acute, due to their lack of health insurance, and so many people there who couldn’t pay, that the ER was both seriously understaffed and overbooked. It was a damn good thing it wasn’t a stroke, but I wouldn’t have been triaged as “urgent” if the triage nurse hadn’t thought there was a good chance it might have been.

Punditus- We do have a social worker. I think I’ve seen her twice in the two years I’ve been at this clinic. We can’t even get a much needed Patient Care Administrator(a $12/hour job), yet the hospital just bought 3 new helicopters and has paid various consultants-all from Booz Allen, the CEO’s former company-several million dollars.  It’s like Dick Cheney is running the place.