Gotta have some skin in the healthcare game
When I talk about healthcare, I have some skin in the game-and I mean more than the parts that hang out of the hospital gown during exams.
No I mean I’ve been paying my own healthcare for 19 years because I’m self-employed. I might have become one of those 70 million uninsured but healthy 18 to 34 year olds but I rapidly had two children after starting my own business and with babies you just don’t get the uninsured option.
In almost two decades I have been through HMO’s, HSA’s, private plans, minimal plans and plans that cost close to $800 per month. I can tell you, as a self-payer, that no matter where you start your plan, it will increase by 20% in six months and by 30% on the renewal date. So to keep it reasonable, you have to keep moving.
Luckily, we’re all healthy. My two sons are athletes and I work out several times a week. Unfortunately, being healthy has no impact on health insurance premiums. I’m with Blue Cross now and despite the fact that I have very low body fat and am on or underweight for my age, I pay as much for my policy as a woman who is diabetic and 100 pounds overweight. I have called and complained many times but the health care system just isn’t set up to reward healthy people.
It’s not really set up for those without insurance, either. I’ve been reading a lot about how low income people use the ER as their primary source of care, but I don’t see how. I’ve spent a lot of time in the ER-both of my sons play football and rugby and I have two aging parents. I am there so much I know some of the staff by name. But about 18 months ago the mother of one of the other boys on the football team called me about her son. She is not from this country-though she is here legally. He had had a concussion during practice a week earlier and had been okayed but he was now beginning to slur his words and his arm was losing strength. She had called the large, urban teaching hospital where he’d been airlifted after the concussion-but they told her she couldn’t bring him in because she didn’t have insurance.
I didn’t doubt this because I had sat in the ER two years earlier for a broken bone and watched a woman with a broken leg be turned away because she didn’t have insurance. She couldn’t even drive home because it was her right leg. She just sat in the wheelchair and cried.
The football mom called me on a Monday evening-I remember this because he had first exhibited these symptoms on a Friday at a school event. I am familiar with stroke symptoms because my dad has had them and it sounded as if this 18 year old boy was having a stroke. I asked her to meet me at my local hospital. Long story short, I bullshitted my way past admissions and got him into the ER and in front of a doctor. He was in fact having a stroke, but he was treated and today he is fine. But it still scares me to think that his mom had held off taking him in-and in fact had been refused admission at another hospital-because she had no insurance.
I believe health care is a fundamental right for all citizens. We don’t need to deliver the $800/month plan for everyone, but we do need to guarantee ER access and annual or semi-annual preventive and well-care visits. Like income tax, people should pay towards the plan, even in a graduated fashion. And we need to incentivize good health-not penalize it.
The problem with the debate in D.C. this week is that most of the debaters have never lived without insurance. I doubt most of them have ever spent any real time in an ER, watching people be turned away. They need to spend a weekend there to fully understand what’s needed.
Then maybe they too will have some skin in the game.
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Nora, you nailed it in the last two graphs.
Nora, both hospitals you referred to are breaking the law.
The federal “patient-dumping” statute, passed in 1986 requires any hospital emergency room that accepts medicare (pretty hard to find one that does not) cannot turn any patient away with an emergency situation. A just broken bone is an emergency situation. A reaction that indicates that a concussion may be a more severe brain injury is absolutely an emergency. The federal statute provides that every human is entitled to screening, emergency care and appropriate transfers. A hospital must provide “stabilizing care” for a patient with an emergency medical condition. The hospital must screen for the emergency and provide the care without inquiring about your ability to pay.
An emergency room can turn you away or transfer you to another facility once your condition is stable. Neither of the instances you reference would be deemed “stable”.
This is just the emergency room obligation required by federal law. Many states provide for additional obligations on emergency room care.
Not only are the hospital(s) you reference breaking the law, they are also stupid. If the football player who began showing signs of brain injury some days after initial treatment and the emergency room turns him away, they open themselves up to one whopper of a malpractice lawsuit should something bad happen to the young man. Same with the broken bone case, although a lesser offense.
Something is wrong with the picture you are painting. It is a rare thing for a hospital emergency room to violate the federal patient dumping law. For you to experience two such examples is very strange indeed.
When I questioned the hospital for turning away the woman with the broken leg, they told me that broken legs for adults did not constitute an emergency and they did not set bones in the ER for adults. They clairifed that if the patient had been a child (like my son), they would have set the bone. But most bones for adults are now set in the Ortho office–and for that you need insurance.
The second incident, with the football player, also happened. They told the mother they would not admit her son since they had no insurance.
Maybe I’ve just been in the ER too much, but both incidents were true.
In response to another comment. See in context »Nora- I don’t doubt for a minute that the stories are true. But both hospitals did break the law. There is no legal distinction between the broken bone of a child versus a broken bone of an adult. The emergency room is not permitted to make that distinction. The more I’ve looked into it after reading your post, I see that the violation happens more than I had thought. If it’s close in time, you should definitely report them because it just isn’t right- particularly the instance where they turned away someone with a head injury.
In response to another comment. See in context »