Sunday, November 15, 2009

An Unplanned Trip to the Emergency Room

To say that it was a headache would be an understatement. It was a headache from hell. It was a headache that made self-decapitation seem a reasonable alternative.

It was Wednesday, Veterans Day. It was a day off from work for me. The headache came shortly after my wife left for work. It came on suddenly, with full force, closing my left eye. I could not lie down. I could not do anything but pace around the flat howling.

It was difficult, but eventually I called my wife for help. She called neighbors.

One of our neighbors is a retired nurse. She did not take a very long look before she decided that I had to go to the emergency room.

It was fortunate for me that neither she nor her husband is concerned about how litigious this country is rumored to have become. They took me to emergency in their car when they discovered I had no health insurance to cover an ambulance ride. Such generosity is rare and foolish and wonderful. I thank God for my neighbors.

At the emergency room I was asked numerous questions as I writhed in pain. The hospital staff and I each attempted to do our separate parts with aplomb. I cannot complain about my treatment because I was out of my mind.

Blood was taken for tests. A CT scan was run. Nothing came from these or the doctor's examination. The pain was subsiding somewhat, but I was still sick. The doctor prescribed a spinal tap. He was frank about the pain. He was uncomfortably explicit about what the procedure entailed. It sounded terrifyingly medieval.

My head was in pain. I was asked to make a decision. It took time. I have no health insurance. I am spending money and I have no idea how much I am spending. I suspect it is money I do not have. I am sure it is money that was not in the budget. Who budgets for the emergency room?

There was a good chance the spinal tap would show nothing. If the spinal tap revealed anything, it would be something deadly.

I decided for the spinal tap.

The procedure was every bit as uncomfortable as promised. I will take three colonoscopies over one spinal tap any day.

The results: nothing. From the blood tests, the CT scan, the examination, and the spinal tap, nothing to indicate the cause of my sudden extreme headache.

I was sent home with prescriptions for three pain medicines to deal with the headache that might come as a side effect of the spinal tap. I doubt you have to read that last sentence twice to catch the irony. The headache I came to the emergency room with still lingered, less severe, for the next four days. I lost two days of work at a job for which there is no "paid time off."

Now there is nothing very special about my experience. There are people who suffer migraines and cluster headaches frequently. I have never been diagnosed as having either. This little episode, however, does illustrate several facts that undercut the Republican and conservative critique of universal health care.

Health care does not fit in the marketplace.

In my pain I was not offered different emergency rooms with different features. There was no choice of different CT scans with greater or lesser resolutions, or a spinal tap at the base of the spine or the base of the neck. Frankly, those sorts of choices were completely irrelevant. I wanted the pain to stop.

Neither did the services suggested come with a price up front. It was simply take the blood test, the CT scan, and the spinal tap, or leave it. The bill comes later. The doctor gave no indication that he even knew what a spinal tap costs.

Marketplace ideology does not work beneficial health care. A visit to the emergency room is not a trip to the grocery store and conservative critics of universal health care are, at best, fools for not recognizing this.

I was not going to write about this until I read conservative Milwaukee Journal Sentinel columnist Patrick McIlheran today.

Among the many falsehoods the Mr. McIlheran packed into his column was that "of course, the government now ensures the poor and the old get care. It even pays for the not-really-poor via programs like BadgerCare."

This is one of the many assertions conservatives make without support of facts – that the needy are being taken care of, even the not so needy. No need to fix what is not broken.

Well, the call came on Friday the 13th. The hospital wanted to confirm that I have no insurance and screen me concerning my financial situation to see if I qualify for assistance. I do not qualify for any assistance. I will be getting a bill in four figures from the hospital. And a bill from the radiologist and another from the doctor. I am not poor, and Mr. McIlheran is purposely vague about what he terms "the not-really-poor," but there is no Badger Care for me.

This brings to mind another myth about our current system of health care that conservatives like to assert. It is said that hospitals must provide emergency care, even to the uninsured. In addition, it is said that when the uninsured do not pay, that loss of income is simply averaged over the bills of insured paying patients. The uninsured get a free ride.

I am sure that hospitals lose income treating the poor and uninsured. I am sure that they have found some way to recover that loss from the people who do pay.

The poor and uninsured are billed, however. They are expected to pay. After several billing notices, their accounts are handed over to collection agencies. The collection agencies use all available means to recover the cost. There is no free ride for the poor and uninsured in our current system.

I have never been to an emergency room as a patient before and I hope never to make another visit. If this country had the universal health care that is popular in so many other developed countries, preventative care might have discovered and addressed whatever brought on this headache so that there would have been no emergency room visit.

As it is, I have a debt in four figures and an inconclusive diagnosis.


John said...

Mr. Hill, you say you're not poor, but what is your income level? What is your occupation? Why dont you at least have a high deductible plan which can be had for modest premiums? If you want sympathy/understanding you have to give a little more information than just I shouldnt have to pay because its expensive.

Michael James Hill said...

Dear John,

You miss the point. I do not want your sympathy. There is nothing in what I wrote which suggests that I should not have to pay.

The point is that heath care is one area where the market principles of a capitalist system does not serve patients. It serves shareholders.

Read the earlier posts.

Jimmy 45 said...

Why don't we prevent grocery stores from making a profit? What about car dealers and bus companies? Are we not all dependent on those companies for our food and transportation? Are they not looking out for their shareholders? Why is it such a bad thing to make a profit? You would prefer the government take and redistribute someone's money to someone else who either refuses to pay for care or simply claims they do not have the means to pay? Get real.

Michael James Hill said...

Dear Jimmy,

There are a multitude of differences between buying groceries, taking the bus to work, and hundreds of other mundane economic activities and health care.

I think you and I can agree that when it comes to food, clothing, housing, transportation, the capitalist system of a free market works just fine. (Although I would add, you still need a democratic government to bust up trusts, prevent monopolies, and generally keep the market honest.)

Health care is different, even as retirement is different. These are areas where we lose our power to choose.

These are areas also, where the profit motive works against the client/customer.

The automobile company makes money by selling as many vehicles as it can to many different customers.

The for-profit health insurance company makes money by selling its services to those who will not use its services. Hence it denies coverage to older citizens (pre-existent conditions are many among those who have existed for some time) and takes the premiums of younger clients who will most likely not have a reason to cash in on medical care.

Capitalism is demonstratively the best economic system to provide the highest standard of living to the most people. However, it is a human invention and like any human invention it has its limitations.

It does not provide humane health care. It does not provide for the elderly.

Read some of the early posts.

Jimmy45 said...

The government can provide a more efficient vehicle to provide healthcare? I would not put my life in any democrats hands. All they know how to do is waste money. While I will agree the system needs work, blowing it up is not the proper way of proceeding. People need to understand that healthcare is not free and there is a cost. Staying healthy and physically fit should be a goal. Giving people free doctor visits will only increase costs because the demand will significantly outstrip demand.

Michael James Hill said...

Jimmy, you are being a bit thick.

The economic policies of George W. Bush prove that Democrats do not have a lock on wasting money.

There is no position which advocates that we put our lives in the hands of either the Republicans or Democrats.

No one is proposing that health care be free. The issue is whether or not there is a better way to pay for health care. Most industrialized countries have found a better way.

As for "staying healthy and physically fit" I am all for it. The only problem is this little thing called mortality. If you have not heard about it, you will.

Mary B. said...

Such a bad thing to make a profit? You would prefer the government take and redistribute someone's money to someone else who either refuses to pay for care or simply claims they do not have the means to pay.

O'Young said...

While healthcare systems in some parts of the country do make profits based on their patients and what they can charge, those same states have major issues in terms of patient illness (complications, comorbidities, delayed treatment etc. etc.) in large part because many many patients wait too long to seek assistance.

In WI, as in a number of states (MN included), healthcare systems are not-for-profit - they don't have shareholders to pay, they do have plant, property and equipment that they need to maintain and update due, in large part, to patient expectations; any and all "profit" is directed back into the healthcare system.

As one commentator stated, patients truly need to understand the costs associated with provision of care, but sharing that level of information with the public is challenging - many factors influence how a hospital or health system structures its pricing - severity of patients, labor costs, etc., etc. - these all play a part in the hospitals' base rates and how this is applied in the ratio of cost to charges.

A huge component, surprise, surprise, is the cost of labor, and health insurance factors in to this, oh and most healthcare systems are self insured. It is a complex and headache-inducing challenge.

While other industrialized countries provide socialized healthcare, it isn't cheap and the public still ends up paying for it in terms of money, access, availability of services, and massive gate-keeping.

This is the headache I live daily in helping hospitals provide cost effective, efficient, safe care.