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 13^th. 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.

Doctor's Charges

We were expecting a bill from our doctor. What we received on 1 April 2009 was much worse. It was a letter.

Dear Valued Patient, it began. The adjective was the first false note. Just what made me a "valued" patient? What kind of letter uses the salutation to pay a compliment? How much is this going to cost me?

As you know I love practicing medicine and enjoy being your physician, the letter continued.

Actually, I did not know either of these things.

A little over a decade ago, we chose Dr. Arthur King to be our physician because he was within walking distance of our home. This became particularly important in recent years when we gave up having a car.

I have not seen him in over a year. As I am without health insurance, there is little point. The lab work for a decent physical is more than I can afford.

We procured a high-deductible policy for my wife recently. It was for a diagnostic examination for a condition that could prove serious – but thankfully so far has not been – that we expected a bill.

Therefore, we cannot claim the close relationship that our doctor seemed to think we had. His office staff has been cordial and understanding. He has been professional and never prescribed snake oil. Nevertheless, the last sentence of his overly flattering first paragraph sent a chill.

Unfortunately, the current system does not allow me to provide your care in the way I know you deserve.

Then came the pitch. He was going embark on a new method of medical practice "that enables the patient-physician relationship to be a true partnership." The services under this "new" system were described in bulleted short phrases.

Opposite "Higher quality care experience" was "Total care coordination with specialists and other providers," "Test result consultation," "Post-specialist visit explanations," and "Assistance with insurance filings."

The verbiage was pretty, but the first three points simply describe standard operating procedure when a general practitioner makes a referral to a specialist. The last is how a doctor gets his money.

Opposite "Incredible access at your convenience" was the truly incredible claim of "24/7 access to me via cell phone, email, or office phone." Notice that this is not access to "service," but to Dr. King himself. The FAQ sheet, which accompanied this letter, was equally unambiguous on this point, offering "Direct access to your physician any time of the day or night."

Only God is accessible 24/7. Mere mortals do not have this power. Leaving aside the fact that even doctors must eat, sleep, and take days off, there is the conflict of dealing with a patient in the examining room when the cell phone goes off. "More about your colonoscopy later, Fred, I have to take this call."

There was one new item that followed "Incredible access" – "House calls as needed" (italics in original). There was no statement about who would determine the need or how need would be determined, making this an empty though enticing promise.

All the puffery and empty promises of this letter came down to this. Dr. King claims to have 4,000 patients. Under the new ModernMed practice he can have no more than 500. Of those 500 patients, the first 300 to sign up will be offered the introductory monthly rate of $75 a month. The unfortunate remaining 200 patients will be charged the normal rate of $125 a month. Given the terms offered, everyone will be paying $125 or more a month in the years to come just to be a patient of Dr. King.

That is right, friends, this retainer fee does not cover office visits or tests or anything else. It is a simple retainer fee, promoted with pompous and incredible claims. There is nothing offered under this new system that is not either standard operating procedure of a good general practitioner or available elsewhere for less or nothing.

The advantage is all with the doctor. He dumps 3500 patients. He dumps some who have come to him regularly for any number of reasons. He dumps some who come only under the compulsion of dire illness. He keeps only those who can pay for the privilege to call him their doctor. He receives over a half million dollars annually under the introductory rate, three-quarters of a million in the next year, and undoubtedly, a million and more in the years to come, in addition to any fees charged for the actual practice of medicine.

At $125 a month, his patients will pay an annual $1500 in addition to their health insurance premiums, deductibles, and office visit co-pays. They will receive for this sum nothing beyond what is expected of the general practice of medicine.

What is being promoted here is "a new revolutionary model of medical practice." What we have is medical extortion.