Editore"s Note
Tilting at Windmills

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July 11, 2007
By: Kevin Drum

EMERGENCY ROOMS....A reader emails to draw my attention to this quote from George Bush, highlighted in Dan Froomkin's column today:

"The immediate goal is to make sure there are more people on private insurance plans. I mean, people have access to health care in America," he said. "After all, you just go to an emergency room."

Did somebody actually write that line for him? Was it ad libbed? I mean, WTF? Does Bush really believe that emergency rooms are a great way of providing medical care for poor people?

And as long as we're on the subject, it's worth noting that emergency rooms have only been required to treat all patients regardless of ability to pay since the 1986 passage of the EMTALA Act. The Reagan and Bush Sr. administrations, unsurprisingly, did little to enforce it. Bill Clinton tried to step up enforcement in 1994, but in 2003, after Bush Jr. became president, he approved new rules that loosened EMTALA regulations. And of course Republicans routinely complain about EMTALA to this day, calling it a "hidden tax" on the insured and railing against the fact that it doesn't allow hospitals to dump illegal immigrants with heart attacks in the gutter. Long story short, the GOP is not exactly a stronghold of support for emergency room care for the poor. Bush might want to keep that in mind.

Kevin Drum 3:09 PM Permalink | Trackbacks | Comments (105)

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Comments

Bush Jr. on health care in emergency rooms is tantamount to Bush Sr. on laser bar code scanners in supermarket checkout lines. As bluebloods, both are so separated from the realities of the masses (i.e. the rest of us) that they really have no clue.

Posted by: AC on July 11, 2007 at 3:13 PM | PERMALINK

> Did somebody actually write that line for
> him? Was it ad libbed? I mean, WTF? Does Bush
> really believe that emergency rooms are a great
> way of providing medical care for poor people?

That "there is plenty of free health care in emergency rooms" line has been tested, pushed, and refined continually here and at Ezra Klein's in every single health care discussion for the last year. Now it just "happens" to pop out of George W. Bush's mouth.

But there is no organized Radical Right counterblogging effort. No way - that would be a conspiracy and we know that those never happen.

Cranky

Posted by: Cranky Observer on July 11, 2007 at 3:14 PM | PERMALINK

I want to compliment you, Kevin, on the amount of attention you're devoting to this most pressing of issues, health care reform. Good job; please keep it up.

Posted by: shortstop on July 11, 2007 at 3:15 PM | PERMALINK

Yes, shortstop, but I think Kevin really needs to make a separate discussion on how fat Michael Moore is.

Posted by: osama_been_forgotten on July 11, 2007 at 3:22 PM | PERMALINK

Not to mention that still doesn't help the cost. Just because you can't pay now doesn't mean the hospital can't charge you - and if anyone looks at their bills they'll know emergency care isn't cheap. Then they'll just garnish the poor SOB's wages until they get their due if they won't/can't cough it up right away.

Posted by: Patrick on July 11, 2007 at 3:25 PM | PERMALINK

It reminded me of Reagan's line about unemployment, how there really couldn't be so much unemployment, 'cuz all you have to do is read the want ads.

I'm paraphrasing.

As Molly Ivins once said, too many years, too many limousines.

Posted by: merciless on July 11, 2007 at 3:25 PM | PERMALINK

Under EMTALA, the hospital just has to make sure the patient is screened and "stabilized." For a patient with serious leg fracture, this means putting a splint on and sending them back out.

Posted by: Jose Padilla on July 11, 2007 at 3:27 PM | PERMALINK

I once had a coworker who had emigrated from Czechoslovakia, via Sweden before the fall of the Soviet Bloc, who said the very same thing as W. Bush. Was he an infiltrator?

Posted by: Brojo on July 11, 2007 at 3:29 PM | PERMALINK

KD: Bush might want to keep that in mind.

Read the last two words of that sentence again. No, this isn't the usage patrol, this is the what? patrol.

Posted by: thersites on July 11, 2007 at 3:30 PM | PERMALINK

Where have you been Kevin? Bush's ER quote is the standard way for conservatives to explain that everybody in the USA has access to health care. My former boss, a FOX news junkie, used to say it and he is a healthcare administrator!

Posted by: Big Red on July 11, 2007 at 3:30 PM | PERMALINK

Kevin,

There you go again bringing up facts. As you know the repubs could care less about facts. Until the press holds them to the facts as much as they are concerned with fact checking the likes of Michael Moore nothing will change.

Posted by: Lew on July 11, 2007 at 3:31 PM | PERMALINK

I know that in the past, Rush Limbaugh has made the emergency room claim to mock the idea that Americans lack health care. So it's a common point made by right-wing millionaires.

Posted by: Jim E. on July 11, 2007 at 3:33 PM | PERMALINK

These are clearly people who haven't been to an emergency room in a middle-class area. I have Kaiser health insurance and went to the emergency room with my infant son after he took a hard fall. I was worried about a concussion and thought at a Kaiser hospital we could at least get a quick basic checkup. went there at 10 p.m. left at 3 am after deciding that no concussion symptoms were evident. Got no medical attention whatsoever. there were others their with clearly worse problems -bleeding, broken limbs, etc., with longer wait times. emergency rooms don't work even if you have health insurance.

Posted by: CalDem on July 11, 2007 at 3:33 PM | PERMALINK

Yes, everyone can go to the emergency room, often that is the only care available to them, and that's one big reason health care is so expensive in the United States. If people were ensured, they'd go to their doctor, a whole lot cheaper.

Posted by: David in NY on July 11, 2007 at 3:38 PM | PERMALINK

This comment will probably get deleted or edited without notice as many others have, but:

And of course Republicans routinely complain about ENTALA to this day, calling it a "hidden tax" on the insured and railing against the fact that it doesn't allow hospitals to dump illegal immigrants with heart attacks in the gutter.

Actually, I'm sure many Republicans don't mind such a subsidy to those who employ IllegalAliens. And, neither to many Dems. If Kevin Drum wants to take pressure off emergency rooms, perhaps he should stop his increasingly desperate attempts to support IllegalImmigration.

Posted by: The Annoying LonewackoDotCom on July 11, 2007 at 3:41 PM | PERMALINK

Has anyone asked Bush the price of a gallon of milk lately?

One trip to the ER, where everything costs 10x an ordinary doctor's visit, will eat up all the money you were trying to save so that you could afford ordinary low-risk health insurance. But that doesn't matter, because you won't be able to get it once your trip to the ER proves you have a pre-existing condition.

So then all you can get is the high-risk priced insurance, which costs 2x or 3x regular insurance, and so all the money you were saving up and lost to the ER wouldn't be enough anyways.

Catch-22.

Posted by: Kathryn in Sunnyvale on July 11, 2007 at 3:41 PM | PERMALINK

I second CalDem - I accidentally got a nasty gash in my arm from some broken glass two years ago. It was deep enough that it clearly needed stitches. I am self employed and pay for my own insurance, so was fully covered. At the closest ER the wait was around 10 hours to be seen, the second ER we went to they told us the wait was 8 hours. Third ER was only 4 hours, so that was where I got my stitches and my insurer paid $1200 for the treatment.

Posted by: arteclectic on July 11, 2007 at 3:45 PM | PERMALINK

I second the point that this is a frequently used talking point.

The Fox News junkies in my extended family trot this one out every time health care comes up. And there's no reasoning with them about the added cost, inadequacy, ineffeciency, etc. because then the conversation immediately devolves into them ranting about immigration. Seriously bizarre.

Posted by: es on July 11, 2007 at 3:51 PM | PERMALINK

of course entala is a "hidden tax" on the insured. it's also one worth paying.

what jose padilla said. the law only requires hospitals to stabilize a patient before dumping him or her. that does not mean full treatment.

what david in ny said. getting primary care in an er is hugely inefficient.

also in south florida, it's not unheard of for an er patient to wait as long as 24 hours to get treated especially in winter. a lot of snow birds don't have a primary care doc here, so when they get sick, under their insurance, they have little choice but to go to the nearest er for treatment. anyone who thinks going to an er is a great alternative for those who don't have insurance don't know what they're talking about.

Posted by: mudwall jackson on July 11, 2007 at 3:53 PM | PERMALINK

The Annoying LonewackoDotCom on July 11, 2007 at 3:41 PM:

Help me out here. I read this blog fairly regularly, and am trying to remember Kevin's "increasingly desperate attempts to support IllegalImmigration"

Do you even read the blog, or are you just automatically regurgitating straw-man talking points?

Posted by: thersites on July 11, 2007 at 3:56 PM | PERMALINK

"The immediate goal is to make sure there are more people on private insurance plans. I mean, people have access to health care in America," he said. "After all, you just go to an emergency room."

I guess if there's a nail in your head or if the short fuse on a cherry bomb just blew your fingers off, you'd make a routine appointment to get care while your extremities bleed and your flesh rots away? The POTUS is correct--if you have a problem, health related, then GO to the Emergency Room.

Obviously, he did not mean to say that that is the preferred method of treatment for routine problems. It is, in fact, the best way to ensure you don't die when your neighbor forgets to hold the ladder you're standing on and you fall into a nasty nest of power lines. I think this game of "gotcha!" has all but played out. Liberals want to reverse the last two elections and they seize on every misquote or mistake that the POTUS makes.

Earth to liberals--if you take incentives out of health care and socialize it, the doctors will have no incentive to take care of you. The best and the brightest will leave the profession and you'll be stuck with second-rate medical care.

Posted by: Norman Rogers on July 11, 2007 at 3:58 PM | PERMALINK

Actually, just Googled, and in North Carolina, the average cost of an emergency room visit is $1029. That's a damn expensive way to see the doctor. Too bad nobody will ask Bush how much he thinks an ER visit costs, as against a visit ot a doctor.

Posted by: David in NY on July 11, 2007 at 3:58 PM | PERMALINK

Isn;t the acronym for the law EMTALA.

Posted by: Bradley Manton on July 11, 2007 at 3:59 PM | PERMALINK

Tom Tomorrow's comic on health care is brilliant.

Posted by: ROTFLMLiberalAO on July 11, 2007 at 4:06 PM | PERMALINK

Let them eat cake.

The rich and poor alike are free to sleep under bridges.

And so on.

Posted by: CKR on July 11, 2007 at 4:09 PM | PERMALINK

Maybe this is a Republican plan to thin the herd. A 12 hour stay at the ER is a fast way to catch pnuemonia.

Posted by: astrid on July 11, 2007 at 4:09 PM | PERMALINK

Earth to liberals--if you take incentives out of health care and socialize it, the doctors will have no incentive to take care of you.
Norman Rogers

So Norman, it was just an freakish accident when, a while ago, my wife got treated in France for a medication-related allergic reaction for about $40 (in current dollars) the same afternoon, right? That doc was lovely and seemed perfectly willing to provide us the care, but he must have been an aberration or something? You are really deluded. Go to another country with an open mind (probably impossible) and see.

I guess it's better to go to an emergency room in America and pay over $1000, though, right Norman? Like the President says.

And Norman. There's less to Econ 101 than meets the eye.

Posted by: Davi d in NY on July 11, 2007 at 4:13 PM | PERMALINK

Isn't the acronym for the law EMTALA.

Yes. It stands for Emergency Medical Treatment and Active Labor Act. And while it is better than nothing, not by a whole hell of a lot.

Posted by: Blue Girl, Red State (aka G.C.) on July 11, 2007 at 4:16 PM | PERMALINK

Kevin,

I take no side in this fight, but do you have a source for your claims about the various administrations' enforcement of ENATLA?

Posted by: Shelby on July 11, 2007 at 4:24 PM | PERMALINK

seize on every misquote or mistake that the POTUS makes

that's a whole lot of seizin', Norm.

(to everything there is a seizin')

Posted by: thersites on July 11, 2007 at 4:30 PM | PERMALINK

Another anaecdote.

While on vacation in French Polynesia (Tahiti) (ie. third-world shithole?) - I got some horse dander in my eye, and it swelled up like a baseball. We went to a doctor (who spoke English pretty well). He gave me a steroid injection, I was out of there in 15 minutes, with my eye all better by dinner time, and the total bill was $5.

While on vacation in Florida, I got some cat-dander in my eye, with a similar reaction. ER Doctor (did not speak English well at all) ($100 ER visit copay) sent me to a pharmacy with an antibiotic eyedrop prescription (despite me telling him exactly what was wrong and exactly how to treat it), which cost a $40 copay, did not address my symptoms at all, and ruined my vacation; including excruciating pain on the flight home from the air depressurization on my swollen and sore eye.

Posted by: osama_been_forgotten on July 11, 2007 at 4:32 PM | PERMALINK
Norman Rogers at 3:58 PMObviously, he did not mean to say that that is the preferred method of treatment for routine problems.
However, that's what he said. Perhaps you should talk to him. Get that language problem fixed. Check if there is some ER that specializes in it.
Norman Rogers at 3:58 PM...if you take incentives out of health care and socialize it, the doctors will have no incentive to take care of you....
Only if they want to get paid. You're lamer than usual lately. Perhaps you've out of gas Posted by: Mike on July 11, 2007 at 4:34 PM | PERMALINK
[blah blah blah] IllegalAliens [blah blah blah] IllegalImmigration.

I see TLB has changed his handle here, but still not learned how to separate or capitalize (or, rather, appropriately refrain fromp capitalizing) English words.

Posted by: cmdicely on July 11, 2007 at 4:38 PM | PERMALINK

All those malingerers should use the Norman-Rogers-tested-and-approved method of health care: defeat your illness through sheer will power. Snivelers.

Posted by: Everett Volk on July 11, 2007 at 4:45 PM | PERMALINK

To be fair, I've seen the same guy go by a number of variations of "the lone wacko," and it's the name of his blog. Yes, he looks like an utter moron, but he's more harmless than most trolls.

Posted by: Cyrus on July 11, 2007 at 4:46 PM | PERMALINK

"You only have 24 hours to live. 22 now. Sorry about the wait."

Posted by: Dr. Hibbert on July 11, 2007 at 4:47 PM | PERMALINK

(to everything there is a seizin')

Comment of the thread!

Posted by: Blue Girl, Red State (aka G.C.) on July 11, 2007 at 4:54 PM | PERMALINK

Dealing with the potential closure of inner-city hospitals as a result of bankruptcy, the first step was to close the emergency rooms. Most cost, least return.

Of course hospitals, particularly in inner-cities, write-off millions in free care. It's hard to garnish wages when they don't have a job, Patrick.

The feds help out too by no longer reimbursing for all the interns at teaching hospitals, reimbursement increases lag cost increases which makes the hospitals look to take it out either in scheduling changes or lay-offs (or both). The cost equation will be the trickiest part. Which hospitals should be closed? Philadelphia, for example has 7x the number of beds for population density. Who gets to decide which to eliminate?

Posted by: TJM on July 11, 2007 at 4:56 PM | PERMALINK

Heh.

Irony: Joe Lieberman introducing a BIPARTISAN bill.
http://lieberman.senate.gov/newsroom/release.cfm?id=278654
(get the joke? It's bipartisan, because he pretends to be in one party, while shilling for the other).

The bill, of course, is more saber rattling at Iran. . .

Posted by: osama_been_forgotten on July 11, 2007 at 4:58 PM | PERMALINK

Norman, that post was weak. Weak. I want to hear how you had to go to the emergency room when you cut your arms after you sideswiped a cabbie in your Lexus SUV and had to drive to the emergency room at high speed to make sure the cabby didn't get your license plate, bribed the parking attendant to hide your car and then, realizing their was a wait at the ER, slipped the triage nurse a $100 bill and promised your Doc a choice tee time at your country club if he would treat you right away.

We have Al if we want moronic moralistic lectures and defenses of the president.

Posted by: Tyro on July 11, 2007 at 5:01 PM | PERMALINK

I work in an inner-city ER. EMTALA (Anti-dumping law) has it's good and bad points. The hospital I work at is a university teaching hospital, run by the state so we aren't as profit-driven as a private hospital. We were the hospital that uninsured patients were sent to. The law is great for preventing other hospitals from inappropriately sending unwanted patients to us. It does,though, add to the problem of ER over-crowding. In the past if a person came in complaining of something that wasn't emergent and/or needed a specialist, we could refer them to the appropriate place. Now we can't. The patient has to sign-in, wait, be evaluated, then get the referral. They, or their insurance carrier pays for this visit. There's probably more of these visits than "illegal aliens" even though our hospital is close to a Mexican neighborhood.
We also are pretty bad at preventitive medicine--no cholesterol tests, no mammograms.

Posted by: Aquarius on July 11, 2007 at 5:05 PM | PERMALINK

THM: Why the decider of course.

Osama: Man you sure seem to like getting your dander up!

Posted by: optical weenie on July 11, 2007 at 5:05 PM | PERMALINK

"The immediate goal is to make sure there are more people on private insurance plans. I mean, people have access to health care in America," he said. "After all, you just go to an emergency room."

Good luck getting treated for cancer at the emergency room.

Posted by: Stefan on July 11, 2007 at 5:11 PM | PERMALINK

Aquarius: How many of your non-emergent cases do you think come from people who have medical coverage, but can't get to a doctor (who doesn't have off-hours coverage or who is in another city, etc.) for treatment. I'm sure that, particularly when our kids were young, we did this on late night ear-infections, bad sore throats on vacation, and so on.

I note this result Kevin cited in a post below:
"[S]ome 26% of U.S. adults in one survey went to an emergency room in the past two years because they couldn't get in to see their regular doctor, a significantly higher rate than in other countries." I wonder if this is not so much because appointments aren't available as because doctors don't have off-hours coverage.

Posted by: David in NY on July 11, 2007 at 5:16 PM | PERMALINK

The problem with EMTALA, it seems to me, is that its the backwards, highest-cost, least-effective way of providing "universal access", since it provides universal access only to the most time critical and expensive component of the delivery system and thereby encourages overstressing that component of the system for everyone, and encourages people who don't need actually need what that component provides to attempt to use it since they don't have reliable access elsewhere.

(Which, really, has always seemed to be a good place to build a selling point for a comprehensive universal healthcare system—reducing the ER burden by offloading work to more appropriate venues.)

Posted by: cmdicely on July 11, 2007 at 5:18 PM | PERMALINK

And Norman. There's less to Econ 101 than meets the eye.
This is a grievious slander against Econ 101.

What Norman claims is that a doctor has an incentive to treat you if he has to bill an insurance company, but no incentive at all if he has to bill a state agency.

I´m no fan of Econ 101 but I´ll eat my hat if somone cane point to me a curriculum that makes such an obviously absurd claim.

Posted by: eric on July 11, 2007 at 5:24 PM | PERMALINK

Back in the seventies, me and the hubbie had our fair share of fun: swinging, drugs, sex toys - you name it, the Rogers dabbled in it.

One muggy August night, our neighbor came over with some 40s and a bag of Maui Wowie that would choke a buzzard.

After a couple of swigs and bong hits, the three of us were feeling pretty frisky, which led to some naught menage-a-trois experimentation.

I'm a lot of woman, but even I can't handle two at once. The Mr. and the neighbor got to arguing and the Better Half ended up with a bong to the head, leaving a couple of nasty gashes doused with rancid bong water.

A quick trip to the local emergency room got everything sorted out. The Mr. was stitched up, good as new, all for a tidy little sum that left us with enough cash to enjoy a 3AM trip to IHOP.

Don't let anyone tell you that we need to fix the system we have now.

Posted by: Norman's Mom on July 11, 2007 at 5:27 PM | PERMALINK

To whoever is attempting to do the funny--please leave the comedy to the professionals, sir. You are stinking up the gym.

What Norman claims is that a doctor has an incentive to treat you if he has to bill an insurance company, but no incentive at all if he has to bill a state agency.

A hilarious slip of the tongue? An indication of the madness that will ensue if we put the government in charge of health care? A Freudian slip of the highest order?

Yes, the "State" will take care of you. The "State" will be there to mop your brow and escort you throughout life, from cradle to the grave.

Incentives are the basis for capitalism. If you have no incentive to make a profit, what good works will follow? The answer is--none. Eliminate incentives and what will follow is the socialization of medicine and quality care will decline precipitously. If a doctor has no incentive at all, what will that doctor do?

He or she will FIND a way to maximize their profits by going into specialty procedures and disciplines, like cosmetic surgery. That will crowd out family practitioners.

Fool with the marketplace all you want liberals--that direction leads to ruin and Depression.

Posted by: Norman Rogers on July 11, 2007 at 5:38 PM | PERMALINK

"Do you even read the blog, or are you just automatically regurgitating straw-man talking points?"

He does both, but he reads the blog through the same monomaniacal filter that he uses for everything he does. It's interesting to watch someone so clearly obsessed with, and unhinged by, a single issue.

Posted by: PaulB on July 11, 2007 at 5:38 PM | PERMALINK

Yow! Norman "The QWERTY of Fury" Rogers has entered the ring, and the liberals are quaking!

Posted by: Everett Volk on July 11, 2007 at 5:44 PM | PERMALINK

It's interesting to watch someone so clearly obsessed with, and unhinged by, a single issue.

Bwah hah hah hah hah hah hah!

Now that's comedy, dear. Pay attention, amateurs!

Posted by: Norman Rogers on July 11, 2007 at 5:44 PM | PERMALINK

Under Norman's furious onslaught of hyperbole, generalization and rank lies, the bearded hippies of the Washington Monthly comments section are forced into a rhetorical corner!

Bashed and bloody, reduced to a quaking puddle of patchouli-scented jello, the peaceniks and communists are forced to accept that only rich people should have health care, because poor people are lazy!

Posted by: Everett Volk on July 11, 2007 at 5:48 PM | PERMALINK

thersites: I commented on CalPundit back in 2002, and I've been reading and commenting here since our host moved here. Me and Kevin have even exchanged a couple email messages! However, lately I seem to have become "annoying", with several of my comments deleted or edited without notice (perhaps this one will join that list). As for Drum's desperate tone, he used to act simply befuddled and out of his depth when discussing such matters, but lately he seems to have cranked up the name-calling. As for me being "obsessed", I'd frankly rather be RidingMyBike, but if I blog, it's because I also feel the need to shine a light in dark corners and spread the truth to those who will listen.

Posted by: The Annoying LonewackoDotCom on July 11, 2007 at 5:49 PM | PERMALINK

Norman,
What's my INCENTIVE for not breaking into your house and whacking you in the head with a sledgehammer while you sleep?

Are you going to PAY me?

Or do you rely on the evil communist state to protect you from murderers, rapists, thugs, con men, white-collar criminals, and terrorists?

Posted by: osama_been_forgotten on July 11, 2007 at 5:51 PM | PERMALINK

if I blog, it's because I also feel the need to shine a light in dark corners and spread the truth to those who will listen.

Funny, there was this guy talking about an international conspiracy between the Templars and the FreeMason who told me the exact same thing!

Posted by: Tyro on July 11, 2007 at 5:52 PM | PERMALINK

if I blog, it's because I also feel the need to shine a light in dark corners and spread the truth to those who will listen.

Funny, there was this guy talking about an international conspiracy between the Templars and the FreeMason who told me the exact same thing!

Posted by: Tyro on July 11, 2007 at 5:54 PM | PERMALINK

o-b-f,

You won't sneak into Normie's house and beat him senseless for one reason, and one reason only:

He tore that bastard down so the machete-weilding, psycho-pathic accountants of the IRS have nothing to attack with chain saws next time they come to search for overdue library books.

Posted by: Everett Volk on July 11, 2007 at 5:58 PM | PERMALINK

We quaking libs must also assent to the self-evident truth that doctors can only be motivated by money. How wishfully juvenile we have been to suspect an MD of being driven by a desire to alleviate suffering.

Surely when huge incomes are denied doctors the "best and the brightest" will instead become hedge fund managers.

Posted by: chance on July 11, 2007 at 6:00 PM | PERMALINK

chance,

Don't forget to admit that ensuring that American workers have proper healthcare is certain to drive the entire nation into a deep Depression, both psychic and fiscal. I mean, there's nothing like good health to make workers unproductive.

Posted by: Everett Volk on July 11, 2007 at 6:04 PM | PERMALINK

And just to be clear, I use the word "workers" in place of "citizens" because human capital is just another input (and should be treated as such).

Posted by: Everett Volk on July 11, 2007 at 6:07 PM | PERMALINK

Everett in addition to being witty you have a good memory as well. Keep up the goods work.

Posted by: Gandalf on July 11, 2007 at 6:15 PM | PERMALINK

I'd frankly rather be RidingMyBike, but if I blog, it's because...

I'd rather be WalkingInTheWoodsShootingAtBearsWihtMyBigAssGunsThatEvenNormanFears but instead, I sit here waiting for links to Kevin's "increasingly desperate attempts to support IllegalImmigration."

Posted by: thersites on July 11, 2007 at 6:27 PM | PERMALINK

I have been waiting over six years to get a festering malignant boil removed from the face of democracy in America.

Posted by: ER on July 11, 2007 at 7:06 PM | PERMALINK

So, socialists whould federalize the emergency rooms in America and be done with it. This frees up tons of money for state mandates in other areas of health care.

Posted by: Matt on July 11, 2007 at 7:06 PM | PERMALINK

when huge incomes are denied doctors the "best and the brightest" will instead become hedge fund managers...

...or fast food franchisers or bloggers.

Posted by: Brojo on July 11, 2007 at 7:23 PM | PERMALINK

Ah, Kevin.

Bush was right Kevin. But of course, Bush has insights into the real world, whereas you keep yourself holed up and insulated in your little bedroom all day typing away on your ivory keyboard.

Anyone - ANYONE- in this country who needs immediate medical care of an urgent nature can be admitted to an emergency room. No one will be left to die. When I walk down the street, I don't pass by rotting corpses or people gasping there last breathes. Of course, you wouldn't know this because you never venture outside. You perfer to remain in your little liberal dreamworld, imagining hordes of dying poor people who can't get admitted to hospitals - a liberal's dream.

Posted by: egbert on July 11, 2007 at 7:36 PM | PERMALINK

Sorry Egbert, your full of shit.

As usual.

Posted by: MEG on July 11, 2007 at 7:52 PM | PERMALINK

Fool with the marketplace all you want liberals--that direction leads to ruin and Depression.

Proof that the redoubtable Rogers lives in a time-reversed alternate universe. The New Deal caused the Great Depression.

Boggles the mind.

Posted by: sara on July 11, 2007 at 7:53 PM | PERMALINK

Proof that the redoubtable Rogers lives in a time-reversed alternate universe. The New Deal caused the Great Depression.
Posted by: sara on July 11, 2007 at 7:53 PM | PERMALINK

well, the Invisible Hand does not necessarily have to obey the laws of space and time now, does He? (nor, apparently the laws of economics - if there ever was such a thing. . .)

Posted by: osama_been_forgotten on July 11, 2007 at 8:00 PM | PERMALINK

Apparently, socialized medicine is only fit for our veterans (the VA) and our elderly (Medicare). No one else.

Posted by: The Conservative Deflator on July 11, 2007 at 8:22 PM | PERMALINK

Eggface: I don't pass by rotting corpses or people gasping there last breathes.

Apparently, Eggy does pass by spelling and grammar checkers.

Posted by: bigcat on July 11, 2007 at 8:29 PM | PERMALINK

Sorry, a bit off topic,

Apollo, did you hear about Florida State Rep Bob Allen of Merritt Island frogged marched from a local park restroom Wednesday afternoon.

Mr. Allen is a Republican state rep in Brevard County Florida. He was caught during surveillance in a Titusville Florida public park, cracking down on prostitution.

The undercover agent that Bob propositioned was a male.


Posted by: MEG on July 11, 2007 at 8:29 PM | PERMALINK

Mormon Rogers: "Earth to liberals--if you take incentives out of health care and socialize it, the doctors will have no incentive to take care of you. The best and the brightest will leave the profession and you'll be stuck with second-rate medical care."

That was so feeble, you probably weren't even awake when you "wrote" it. By the way, there are bno incentives in the present system, only disincentives, as "Sicko" makes clear to anyone with eyes and ears and -- what was that other thing? -- oh yeah: a human heart.

Anyway, the notion that doctors need a material reason to look after you goes against the philosophy of the entire profession. Not that you Emergency Roomers give a shit about that.

Posted by: Kenji on July 11, 2007 at 8:34 PM | PERMALINK

Here in Tokyo the few times I've been to the ER I've been in and out within the hour. Usually a nominal fee equivalent to twenty or thirty dollars.

Can usually see my doctor on the day, a specialist within the week.

My insurance payments are about $1200 a year.

Posted by: snicker-snack on July 11, 2007 at 9:01 PM | PERMALINK

Wingers..I am an EX Emergency room Tech..now a Veterinarian: ER's are only a place to go when you ARE sick...they offer no preventive care. IF you are bleeding from the rectum you can go there...you cannot go there to get the colonoscopy that would have prevented the cancer to reaching the bleeding ( you are dead) state. YOU cannot go to the ER for routine blood work, you can go to find the reason you collapsed is your blood sugar is 625. You cannot go to an ER for a stress test..you can go for a coronary.
I hope I have made my point here.

Posted by: Richard on July 11, 2007 at 9:03 PM | PERMALINK

"I hope I have made my point here."

Yeah, some point. The fact is YoU CAN RECEIVE MEDICAL CARE FROM AN ER!!!! It's not like someone will turn you away if your poor and in the middle of kardiac arrest.

We all know you're not going to go to an ER for a physical. Duh. And I don't think anyone would be stupid enough to try that stunt.

Liberal Emergency Room techs are still liberals.

Posted by: egbert on July 11, 2007 at 9:33 PM | PERMALINK

Who's the guy on crack upthread who said "no one will leave you to die in the emergency room?"

You're sh*tting me, right?

http://www.msnbc.msn.com/id/19251478/

Posted by: The Hedonistic Pleasureseeker on July 11, 2007 at 9:34 PM | PERMALINK

"Business Week, no great fan of a national healthcare system, reported in late June that "as several surveys and numerous anecdotes show, waiting times in the U.S. are often as bad or worse as those in other industrialized nations -- despite the fact that the U.S. spends considerably more per capita on health care than any other country."

http://news.yahoo.com/s/huffpost/20070711/cm_huffpost/055749

Posted by: The Hedonistic Pleasureseeker on July 11, 2007 at 9:41 PM | PERMALINK

Why is it ok for some people to have to make health care decisions based on how deep they are willing to go into debt?

How can anyone not understand how wrong this is?

Posted by: alleydog on July 11, 2007 at 10:16 PM | PERMALINK

I guess if there's a nail in your head or if the short fuse on a cherry bomb just blew your fingers off, you'd make a routine appointment to get care while your extremities bleed and your flesh rots away? The POTUS is correct--if you have a problem, health related, then GO to the Emergency Room.

Because, of course, diabetes, cancer, and heart disease are not health related problems. Only accidents are real health problems.

He or she will FIND a way to maximize their profits by going into specialty procedures and disciplines, like cosmetic surgery. That will crowd out family practitioners.

Um, you are aware that the United States already has fewer family and/or general practitioners per capita than any other industrialized country, right? It's a huge problem in both urban and rural areas.

So if we get universal health care we'll somehow change the market that's already making doctors choose high-paying specialties and make ... even more of them choose high-paying specialties than they already are?

I'm getting the feeling that you don't actually know how the market works.

Posted by: Mnemosyne on July 11, 2007 at 10:19 PM | PERMALINK

Problem: We have an over-expensive medical system that leaves tens of millions without care and wastes the money of those who have access on corporate administrative expenses (such as finding ways to keep from paying for care), extraordinary executive payments, etc.

Wingnut solution: Do nothing. 'cause people can go to the emergency room once they've got terminal cancer, severe trauma, or the like.

Criticism of wignut solution: It fails to address both 1) the lack of access to care by millions with less than emergent medical needs (which thus causes them to have poor health and require more expensive treatment later and gives no care at all for chronic illnesses like asthma, cancer, cardiac problems, joint degeneration, opthalmological problems that will lead to blindness, etc., etc., etc.) and 2) the problem of the expense of our system. It fails to recognize that other countries provide better care than we do for less expense (and somehow does this even though theoretically according to wingnut Econ 101, that's impossible). And thus, it makes no sense at all.

Posted by: David in NY on July 11, 2007 at 10:21 PM | PERMALINK

David, considering that Norman and Egbert are both perfectly fine with a hospital dumping a paraplegic man with a colostomy bag on Skid Row because, hey, he got his emergency care, it does make sense. After all, the man was one of those horrible brown people with a Spanish name, so he was already treated better than he deserved. Right, guys?

Posted by: Mnemosyne on July 11, 2007 at 10:29 PM | PERMALINK

The buzz around DC is that Dick Cheney used the services of the DC Madam while CEO of Halliburton!

More to come….

Posted by: The Conservative Deflator on July 11, 2007 at 10:32 PM | PERMALINK

This time as a link:

Dick Cheney used the services of the DC Madam while CEO of Halliburton .

Posted by: The Conservative Deflator on July 11, 2007 at 10:37 PM | PERMALINK

egburp: "But of course, Bush has insights into the real world, whereas you keep yourself holed up and insulated in your little bedroom all day typing away on your ivory keyboard."

And where exactly does that put you in the foodchain, pantywaste?

Posted by: Kenji on July 11, 2007 at 10:41 PM | PERMALINK

pantywaste

Clever misspelling!

Posted by: shortstop on July 11, 2007 at 10:43 PM | PERMALINK

(And was a more incredible waste of panties ever born -- or borne?)

Posted by: Kenji on July 11, 2007 at 10:43 PM | PERMALINK

The buzz around DC is that Dick Cheney used the services of the DC Madam while CEO of Halliburton

I think I just threw up a little.

Posted by: ckelly on July 11, 2007 at 11:00 PM | PERMALINK

Bush derangement syndrome again. Bush did not say emergency rooms were "a great way of providing health care to poor people." He said they provided access to health care.

I realize using emergency rooms for poor people is not the best approach in many cases. But dems always get away with arguing 43 million are "without health care" when they are really "without health insurance." Health care for poor persons is provided and paid for by those of us fortunate enough to have jobs and health insurance and paying taxes.

Posted by: brian on July 11, 2007 at 11:07 PM | PERMALINK
....in this country who needs immediate medical care of an urgent nature can be admitted to an emergency room. No one will be left to die. When I walk down the street, I don't pass by rotting corpses.... eggbutt at 7:36 PM
Patient dies in ER. Bodies found skid rows all across America.

Stick to the good side of town.

Posted by: Mike on July 11, 2007 at 11:25 PM | PERMALINK

Egbert and his ilk show the usual conservative lack of common sense and knowledge. Face it, going to the emergency room only stabilizes an acute serious medical condition. Do peoople die since they do not receive actual medical care to treat or manage the underlying medical condition? The answer is yes.

1. A patient has high blood pressure and cholesteral. He/she goes to an emergency room for chest pains and is stabilized. Lacking health insurance but not qualifying for medicaid, the individual can not afford perscriptions for drugs to control these conditions. Eventually, the person has a heart attack and dies.

2. A patient has diabetes thereby increasing chances of stroke or heart attack. May be the person will not die. Instead, the person ends up in the emergency room and has a limb amputated. They get the person back out and guess what, still no treatment for the underlying problem.

Why conservatives can not see the waste of this system is beyond me. People without adequate health care will either eventually die or end up needing vastly more expensive treatment when the ultimate crisis occurs. Yet they cannot understand that other countries do indeed provide more comprehensive and cheaper care than does the United States. The costs of the current system increases the cost of goods sold, creates significant financial hardship for families and businesses (those undpaid debts when someone suffering large medical costs goes into bankruptcy) and lost productivity of those in the labor force missing more days than necessary due to poor health.

Posted by: JMOHR on July 11, 2007 at 11:36 PM | PERMALINK

Um, mike...
I agree with your sentiments but the Colliers article you cite is from 1949. Geez, don't make to too easy for the trolls...

Posted by: thersites on July 11, 2007 at 11:38 PM | PERMALINK

Norman,

I'm glad you plan to take care of yourself.

Nobody else will want to.

XOXOXOXOX

Posted by: david in norcal on July 12, 2007 at 12:21 AM | PERMALINK

Has anyone asked Bush the price of a gallon of milk lately?

Can anyone explain to me why milk, which is a renewable resource created by subsidized "farmers", costs more than gasoline, which is neither?

Posted by: craigie on July 12, 2007 at 1:15 AM | PERMALINK

I once went to an emergency room at a small Catholic-run hospital in my small-to-mid-size city because I was worried about a spill on some ice that made my shoulder hurt. They ended up telling me it was just "soft-tissue" damage. Anyway, I had no medical insurance, and I brought $150.00 or whatever with me to pay the bill for seeing them. Anyway, the point is, before I saw the doctor and before I settled up out front, some officious office manager or "liaison" came up to me and basically berated me and raked me over the coals about bothering them, and why didn't I have a primary-care physician, and why didn't I seek a primary-care physician, and even if you say you're moving in a few months why do you think you're not going to just be bothering us more in the future?! And why do you think you're not preventing us from treating all of the desperate life-and-death cases that come through here?! And just how do you think you're going to be paying for this?!

I pointed out that in my town there pretty much are no life-and-death bullet-shot, etc., cases that go through that dead-quiet emergency room, that there certainly were no such cases in the emergency room at that time, and that if there were such a case they would obviously be treating that case first and not me. I also told the woman that she obviously cared more about money than caring for patients, and that she should feel deeply, deeply ashamed of herself.

Around that time, I also went to a dermatologist's office about a mole. Beforehand, I turned in the patient paperwork, and the secretary asked what insurance I had. I said I didn't have insurance. The secretary looked SCANDALIZED and DISGUSTED as if I was a schizophrenic beggar in urine-soaked rags who'd started to masturbate in front of her. "Well, just how do you think you're going to pay for this?" I pointed out that I'd brought $150.00 with me and I didn't think it would be a problem. She clearly was still annoyed that one of the riff-raff had darkened their doors.

This was all in the early 1990s, and I'm sure it's all still the same way today.

I could go on and on about the greed and swindles of doctors and hospitals. Doctors paid salaries by hospitals who then hit up patients for an additional $150.00-$300.00 just for breathing in the direction of their x-ray for 30 seconds. ...Supposedly non-profit hospitals that make patients jump through hoops to get themselves declared state residents and eligible for medical charity before they'll cut a $5,900 bill for 2 days at the hospital down to $3,700. ...Etc., etc.

What a bunch of pigs.

Posted by: Anon on July 12, 2007 at 1:46 AM | PERMALINK

When I compare this to Germany (where I live), I find the German system much better, though it is currently in need of an overhaul to maintain the high quality of care and yet remain affordable in the future.

For example, there are very little trips to the emergency room, and instead people are encouraged to consult their own doctor first. The doctors (even the rural ones) often form rotations amongst themselves to handle such late-night calls. Here's an example of what such a situation entails:

Say I acquire a medical condition that can't wait. I decide it's not dire enough an emergency to require an ambulance, so I call my doctor's number, and am routed to the mobile number of the local doctor that is "on call". He listens to my description of symptoms, and then decides whether to send an ambulance, make a house call or to have me come to his office. I then meet the doctor, and he performs a cursory examination to determine if I need hospitalisation or can be treated with medication. In case ER care isn't needed, I still will be asked to visit my regular doctor during normal hours for a more thorough examination, or given a prescription to see a specialist. All of this is covered by my insurance.

The system isn't perfect, by any means. Doctors in Germany complain about all the paperwork they are required to fill out, and the demographic shifts mean that the current system cannot be maintained as an employee-financed system, but it is still better off than what the US has.

Posted by: Saint Fnordius on July 12, 2007 at 6:29 AM | PERMALINK

I'm a volunteer EMT in a somewhat poor county just outside of DC. One of the other problems with the poor using the ER as their first stop medical care is the poor also don't have money to take taxis or have cars. So they call ambulances. We have no right to refuse transport so while I'm taking someone to the ER for a cold or because they ran out of their psych medicine, I'm not there to get to the heart attack victim or the automobile accident quickly. So the next nearest ambulance comes and that leaves two areas no longer covered. It's a real snowball effect. Especially when we then have to wait at the hospital for 1+ hours just to drop off our patients. So, people with legitimate problems and plenty of health insurance don't get the emergency care they expect, because everyone "has access to health care". It's truly sickening and I wonder how many people die or are disabled every year as a byproduct of this.

Posted by: Kelley on July 12, 2007 at 8:10 AM | PERMALINK

Bush sums up in a few lies so much that is wrong with our "system". Access to an ER is not healthcare, and would be the worst possible way to provide healthcare.

And make no mistake, this mess is the fault of our "leaders". Even today the AMA is ruled by disgusting creatures that even younger doctors can't stand.

The trolls like to talk about the "market" in healthcare, but of course there is no free market in healthcare. Once you have awarded monopolies to doctors, drug companies, "regulated" insurance companies and hospitals, you need to create a balancing force for the good of society or you will be, as we are, ruled by greedy cretins.

That said, there is something else we can do to end this rule of fools, and that is to starve the military-industrial complex. The military and the employees of the war industries all have their health insurance, paid for by us, and they see no reason to change. In return for our lavish income tax payments to keep the war machine going, we get neither good citizens nor security.

Think about the people you know who are happy with the way things are, and what they do, or did, for a living. That's a big part of the problem.

Posted by: serial catowner on July 12, 2007 at 9:23 AM | PERMALINK

"We have no right to refuse transport so while I'm taking someone to the ER for a cold or because they ran out of their psych medicine, I'm not there to get to the heart attack victim or the automobile accident quickly."
Posted by: Kelley on July 12, 2007 at 8:10 AM
---
"Say I acquire a medical condition that can't wait. I decide it's not dire enough an emergency to require an ambulance, so I call my doctor's number, and am routed to the mobile number of the local doctor that is "on call". He listens to my description of symptoms, and then decides whether to send an ambulance, make a house call or to have me come to his office."
Posted by: Saint Fnordius on July 12, 2007 at 6:29 AM
---

It looks like something like the German system would solve the sort of problem you allude to..

Posted by: Doc at the Radar Station on July 12, 2007 at 11:09 AM | PERMALINK

Not having a nationally or regionally coordinated system, and not having guaranteed benefits, prevents the German solution to that problem.

Unfortunately, the dead enders like Norman and egbert (and many Republicans) have this faith that the incoherence of the market is better than rational organization. Not so in this case.

Posted by: David in NY on July 12, 2007 at 11:59 AM | PERMALINK

I realize using emergency rooms for poor people is not the best approach in many cases. But dems always get away with arguing 43 million are "without health care" when they are really "without health insurance." Health care for poor persons is provided and paid for by those of us fortunate enough to have jobs and health insurance and paying taxes.

brian's point is the kind of dead-ender idiocy to which I'm referring, above. People who don't have health insurance, and who aren't independently wealthy, don't have access to "health care" in any real sense, they have only access to "emergency care," a very, very different thing, and one that is (and ought to be) rarely necessary. Real access to health care requires ability to get preventive care, care for chronic illnesses, availability of elective surgery for painful and disabling conditions, evaluation of non-emergent conditions, and so on and so on. Without these there is no access to "health care."

So brian, think about it. Suppose you've got this funny-looking mole on your head, and you don't have much money and you don't have any insurance, and it might be melanoma and you might need repeated biopsies and chemotherapy or radiation therapy. Are you seriously saying you have "access to health care?" Because that's the situation of the 43 million people whom you are disregarding.

In short, brian, when we say those people are without access to "health care" we are absolutely right, notwithstanding the availability of an emergency room for a small set of conditions.

Posted by: David in NY on July 12, 2007 at 12:12 PM | PERMALINK

In Canada, with government-controlled health care, I hear you have to schedule an emergency room visit six months in advance.

Posted by: Qwerty on July 12, 2007 at 12:53 PM | PERMALINK

The issue is whether it is moral to allow capitalism and profiteering in medicine.

I believe it is immoral and anti-Christian.

Pretty simple really.

Of course we could get into a discussion over whether the US spends 25 or 27 times as much per patient as Cuba does on healthcare instead of focusing on how the insurance companies, doctors and pharmacy industry are raping us all.

Enjoy.

Posted by: timtimes on July 12, 2007 at 12:58 PM | PERMALINK

My brothers' girlfriend went to an emergency room. They checked her into the hospital, but then insisted she leave, still too dizzy to stand, with the phone number of a neurologist she was to call.

She left numerous messages on the machine of the neurologist --- none of her phone calls were returned.

She died a couple months later.

Posted by: catherineD on July 12, 2007 at 3:51 PM | PERMALINK


Emergency Room! Answer to Health Care! This remark could only be made by someone who has a personal physician following him around 24/7 and has NEVER paid for medical coverage! Emergency Room - tell that to the DEAD woman, in California, who DIED on the emergency room floor (on tape) vomiting blood, as a janitor cleaned up around her - and staff ignored her. Be it the Administration or Congress (who recently voted AGAINST permitting drugs from Canada/Japan - made by same U.S. companies) for citizens paying 4-5 times the REST of the world. Why care? They (Washington politicians) have a choice of five different health plans (full dental - eye - prescriptions), FREE out patient care at Walter Reed/National Institute of Health - a FULLY staffed clinic/ambulance on call, while in session and best of ALL - taxpayers (who can't afford medical care) pick up 72% of premium costs! Some animals are LOTS more equal than others - When those killed in war are cavalirly referred to as 'collateral damage' and citizens as 'acceptable risks or human resources' - well, I rest my case. OH, but there are hearings on the diabolical treatment of dog fights (not that I object) but still NOTHING on deaths of citizens due to lack of medical care!!! JM

Posted by: Jude Moriarty on July 20, 2007 at 7:19 AM | PERMALINK




 

 

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