At long last, the Rs are supporting a public option -- the emergency room.

Welcome to the socialist coalition.

Dan

It seems to me that, in telling the uninsured (or woefully underinsured) they can drop into the emergency room, Republican leaders are promoting what is, in effect, an irresponsible public option: "No way of paying for your urgent health problem? Go to an emergency room and the hospital will absorb the costs."

"Last year, the conservative who shaped John McCain's health care policy said anyone with access to an emergency room effectively has insurance.........."

Yes, because nothing says "quality care" better than being dumped off on some curb still dressed in your hospital gown once your acute symptoms have stabilized. I'll have to get me some of that "effectively" insurance.

Oh, it's a great idea. Just a little spendy is all. Three weeks ago my son conked his head a little hard in a pickup football game. His trip to the ER to get his mild concussion checked out took only two hours and cost me $150 out of pocket. Not bad, thanks to our insurance that picked up the balance of the $9,200 or so on the bill. Thanks to him and his athletic endeavors we've hit our $1,500 deductible this year. Without insurance it would have been well into five figures.

What I would give for the media to actually cover what the Republicans say...

This guy is a PHYSICIAN?!

It is fucking disgraceful that anyone in the United States Congress should be so uninformed and/or dishonest as to argue that a) ERs are appropriate for anything but one-time actual emergencies, b) long-term care is available from ERs, c) people can go to the ER for free (not only must they pay; they must pay prices far higher than conventional doctor visits), and d) using the ERs like clinics doesn't drive the costs of healthcare up for all of us.

It is unbelievable that a Congressman who's also a doctor would stand there and spout this talking point. It is unconscionable. It is a violation of his professional ethics to blatantly lie like this.

I realize that the majority of healthcare professionals are caring, ethical people who understand the need for significant reform, but when I hear stuff like this from the seriously bad apples -- the perennially confused and chronically lying Mike K is another one -- it both sends me over the edge in rage and makes me wonder how people so corrupt can live with themselves.

They are literally enabling thousands of deaths every year with this talk.

awhile back, newt gingrich -- the future of the repugnant party -- suggested that the answer to caring for all the unwanted children in a world where abortion is illegal: orphanages...

emergency rooms are the same motif to a different question.

The motif is what is most essential to understand: it is a sociopath one, purely evil. we have monsters in government. monsters.

If there was justice in this world those assholes would be forced to witness as I did a friend of mine with no health insurance going to the emergency room to get the cancerous growth in his shoulder treated. I especially liked the part where he had to wait in agony while the gundhots and other trauma victims sailed by. Compassionate 'effin Conservatives

The hospital may absorb the cost of an uninsured patient showing up in the emergency department, but only after they send bill collectors and your credit goes in the toilet. In addition, using an ER like this makes it even more unlikely to get an individual policy due to pre-existing conditions or lemon dropping/recission.

In Miami the result of this hapless policy is that many hospitals have no emergency departments, it is too expensive and too dangerous (in the malpractice sense) to justify having EDs. So if there is a true emergent illness (a huge percentage of ER visits are either chronic or sub-acute illnesses) the ambulance may have to drive for a long part of the "golden hour" (that period of time in which the patient can be treated and live) putting the patient in danger.

So the snarky meme that "you die" is true of this Republican health policy.

Of course, Congress doesn't have to worry about that since they have emergency medical treatment available in the building.

The key angle here is actually campaign strategy. It's orientation more than strategy, really.

What it boils down to is that to get reelected, especially in lower-turnout midterm elections, what's critical is that incumbents turn out their most loyal partisans. For a GOP Congressman in Rep. Broun's part of Georgia, most of those have health insurance they are happy with already. Most of the people who don't, and who might face the "emergency room option," won't vote. Most of the minority who do vote will vote Democratic. Hardly any of them are likely to vote in a party primary against the incumbent; in districts dominated by one party or the other, incumbents are often more worried about primary challenges than general election races.

It isn't just the elected officials with this orientation. The whole infrastructure of the permanent campaign tends in this direction as well. There's no mystery about how to win elections in most districts; everyone who works in the permanent campaign industry knows what will work. It would take an unusually strong-willed Senator or Member of Congress to adopt a different strategy and win consistently.

I wish more opponents of health finance reform were pushed into this corner..."You can always go to the emergency room"...because it illustrates the fundamental dishonesty of their 'free market' argument.

Here's how it goes: many opponents of reform take the line that what we really need is a 'freer market' in health care. Mandates, regulation, subsidies...that's all 'socialism' and will make things worse. This sounds like a serious argument, on first gland. Many right-wingers dress it up in libertarian language. For example, months ago, Ramesh Ponnuru argued that health insurance should NOT be mandatory at all: it should be a rational choice, with people choosing to forgo it.

However, when pushed into the corner: what happens when an uninsured person gets sick, these same voices turn to the "emergency room" argument.

This reveals their dishonesty in serveral ways:
• They evidently are not the sort of people who go and wait in emergency rooms with the rest of us. I have good non-profit health care (Kaiser), but when I've had to go to the ER, not that sick, it has been a half-day affair with LOTS of waiting and frustration.
• Moreover, as the original post notes, ER's are a terribly inefficient way to deliver health care, and expensive, too.
• Finally, it shows that the 'free market' or 'libertarian' argument is bogus: Ponnuru was NOT willing to argue that the healthy young male without insurance who got in an accident should be allowed to bleed to death. (Perhaps ERs should set aside a no-treatment 'hospice room' for the uninsured?) Yet he argued that insurance should not be mandatory.
• Finally, some libertarian/free market types will respond that we should have a mandate for catastrophic care insurance, but not for what's on the table. But this, too, shows the fundamental dishonesty. To paraphrase GB Shaw, "We've established that you're actually in favor of mandatory insurance: now we're just haggling about the price!'

In short, anyone who argues against universal care and some kind of insurance mandate should be confronted with the 'bleed-to-death'scenario immediately. If they say yes, they have revealed that they truly are ruthless a**holes. If they back down and point to ERs or catastrophic care mandates, then one can happily agree that they ARE for 'socialism', and can we please move on to the debate about how to organize and pay for it?

That makes a nice pivot point - I've used it a couple of times in water cooler discussions.

"We're agreed that we have universal health care - anybody having a stroke gets taken care of in the emergency room. Wouldn't it be smarter and cheaper to set him up with some blood pressure meds before that happpens?"

You know, I could get behind a bill to fund public health via 'emergency room' visits: as others just noted, there is no reason we couldn't massively fund "emergency rooms" in hospitals and set them up with triage division at the door into regular old expensive emergency rooms on one side and broad-service but less expensive public health clinics with separate personnel and with options for either appointments or lengthy waiting times on the other side (hence ensuring that in practice people set up appointments so that the health professionals' time can be spent efficiently). Just buy every hospital a new wing next to the emergency rooms and publicly fund the new services, and bingo, single-payer health care, happy hospitals, and no insurance companies involved.

They are murderers.

Very nice post, PQuincy.

Zathras, I do understand how this works. I just can't divorce the moral component from the pragmatism. The stakes are too fucking high here -- 45,000 a year dead and millions more plunged into misery, despair and bankruptcy, here in the wealthiest country in the world.

I'll try to be calmer. This stuff sends me over the edge. I literally watched a dear, insuranceless friend die, holding his hand as the machines were disconnected, from an illness that could've been treated in the early stages. That picture, and the intense grief and anger that followed, will never leave me.

Try getting chemotherapy at an emergency room!

What the hell kind of Doctor is he,a dermatologist or something?He obviously has no idea at all the role ED's play in health care or how they function.A large busy safety net hospital,especially a level one trauma facility is so packed to the gills that the folks who have to use the ED as a clinic can be sitting for up to 12 or more hours.For an ongoing condition if someone isn't sick enough to be admitted the care they are going to get is cursory.ED's are not set up for diabetic teaching,mental health counseling etc.These Republicans are such dumbasses it hurts.

awhile back, newt gingrich -- the future of the repugnant party -- suggested that the answer to caring for all the unwanted children in a world where abortion is illegal: orphanages...

Well, orphanages worked out so great in Romania and Ireland that Newt just has to import their terrific programs to the US!

What I would give for the media to actually cover what the Republicans say...
Posted by: Go, Sestak! Or Hoeffel!

Here's an idea: Send a couple of undercover film students-dressed, say, as a hooker and her pimp-to ERs around the country. And post their vignettes on internet sites.

I betcha a new reality show would be a spin-off. . .

Are there no workhouses? Are the prisons all full? Humbug!

This is 100% right. The cost of emergency room visits for the uninsured are passed on to everyone through the inefficiencies of the for-profit healthcare system, which often cloaks itself in non-profit clothing. That's why a single baby diaper or a box of tissues can easily cost $50-75 in a hospital. Or Jimmy's son's bump on the head costs a grand total of $9,200. Most of us don't pay for it immediately out of our pockets, because our insurance pays it. But all of us end up paying through higher deductibles, premiums and copayments. Another dirty secret is that all of those uninsured emergency room visits that are the Republicans' BFFs are accounted for by hospitals in a pool called "uncompensated care." Individual hospitals tally millions in emergency room costs into this uncompensated care per year.

Then, the hospitals turn around and get reimbursed from their state governments for uncompensated care. So, actually, the Republicans are advocating for government-sponsored healthcare, albeit the most innefficient and costliest possible government-sponsored care: using the emergency room.

Advocating for this system also clogs up emergency rooms with people who should have been getting treated by a primary care physician to avoid the emergency room in the first place. When people aren't treated early for their illnesses, it leads to these types of unnecessary emergency room visits. But they can't access primary care doctors if they don't have insurance.

The stupid. It burns.

Beyond cost, this is incredibly stupid because it leads to an overcrowding of emergency rooms with people who are seeking care that they wouldn't otherwise be there to receive.

So, in other words, it's a choice between maybe waiting an extra week for hip replacement surgery or waiting an extra half and hour for a gaping head-wound or heart attack.

Republicans sure have bizarre priorities.

A supposed doctor and a member of the party of "fiscal responsibility" recommends everyone without insurance go to the emergency room?

I'm glad to read that Obama has decided not to bother dealing with the Repubs on this issue anymore. What a joke.

Though of course it is correct to say this is inefficient and dumps higher costs on the public, that criticism overlooks the more important practical truth, that it is harmful to the uninsured ER patient too.

The hospital will absorb the costs, eventually, but it is not like they don't try to collect from the patient first. They do-- and these efforts can be very damaging to the patient, destroying credit ratings, etc. It is definitely not the case that the hospital simply will say, "Oh, you have no insurance? No problem, this will be free!"

Someone should ask Broun if uninsured kids who get swine flu should be treated only when they get very sick and go to the Emergency Room. Ask him if he thinks that those kids should be going to school with his kids before they're sick enough to go to the Emergency Room.

Paying through higher taxes and premiums is one way that the insured are screwed by emergency rooms. Unnecessary exposure to contagious diseases is another.

You cannot appeal to these people through empathy, because they have none. Maybe you can appeal to their self-interest, or more accurately, their fear.

You're right Jake. Within a day after my one and only trip to the emergency room for a broken ankle, I got a call from the hosptial asking about payment. I also got a bill for the ambulance trip. I wasn't insured at the time.
And I'm guessing a lot of ER visits are much more expensive than mine was, although it seemed bad enough at the time.
The thing that I find truly stupid is the Repubs belief that telling everyone to go to the ER will somehow make the problem go away, instead of making things much, much worse--accelerating our economic decline due to healthcare costs.

No one goes hungry in America, they can just live off the land...

What a perfect example of the Rights' disconnect with reality.

It is amazing how these folk operate from their ego, the "I think it is, therefore, it is..." crowd.

A results of an overpriveldged life.

I think we're seeing too much in this from a policy perspective. Republicans don't seriously think relying on emergency rooms is effective or comprehensive, or entertain the fantasy that showing up at the ER is a good substitute for preventative care. The ER mention is just another moralistic/class war/racial dog whistle, really.

Getting the term "ER" out there to their constituents subconsciously reminds them of who would most benefit from health care reform. In the worldview of many, all these uninsured people hanging out at the ER are, by virtue of being uninsured, either (i) stupid or (ii) lazy, or both, and thus morally reprehensible for relying on "free" emergency room services as their primary means of receiving medical care. They also make it take longer for the good, hardworking, responsible, insured people who need a simple EKG because they woke up this morning with a little heartburn and need to know whether it was that Bordeaux and 16-oz. filet they had last night or if it's an actual episode. That obese woman with diabetes? Screw her, she would have seen that coming if she'd been on the ball enough to see a doctor years ago. I've got a tee time to make, dammit. I can't believe I have to wait because of her.

Also, when we conjure up a picture of an emergency room in our minds, other than accident victims, who are the visitors we imagine? You know it: The poor. Blacks. Hispanics.

I had to go to the ER a couple of weeks ago for what turned out to be a bad reaction to a prescription, but for all the world looked like a minor stroke. I have insurance but even now don't know what my total out-of-pocket will be. I do know that the total bill for the fiasco is going to easily run $6,000-$7,000 (and we never used an ambulance!). The ER itself was $2,500. CT scan, ultrasound, and MRI, etc. all ran -- I dunno -- $2,000 or somesuch. And then there are the fees from the doctors and lab.

If I'd lived in Canada or Europe or much of the Far East, I would have gotten virtually identical care and my out-of-pocket would have been far, far less ... and my annual insurance expense (be it from taxes or direct premiums) much less than here.

How can the Repubs say that this constitutes an intelligent system? All through this debate, I have been continuously flummoxed listening to the GOP's arguments. ERs are NOT anything like a real answer to universal coverage.

Like someone said above, wouldn't it be nice if the media comprehensively reported GOP claptrap for what it is?

I think mikeyes above mentioned an important point that never seems to get mentioned enough:

When you swing into the emergency room w/o insurance for your 'healthcare' it isn't as if you do not receive a bill. You get billed, and the hospital attempts to collect. You can fail to pay, and that makes it 'free'. But it remains on your credit report and affects your financial picture into the future.

I don't think the well-insured pundits covering this & politicians advocating this even realize that people receive a bill when they go to the emergency room. When they say 'emergency room care is free for patients', they are saying 'it is ok to skip out on bills & ruin your credit - that's an acceptable healthcare solution' for the individual. Do they advocate squatting as a way to solve the housing crisis?

So, yes the 'Emergency Room' canard is financially inefficient for society as a whole. But it is also not some magic cure-all for the financial health of the individual who is told to 'just go get free care at the ER'

xyz

there are only 2 possible outcomes to a trip to the ER for a mental health problem:
1. involuntary commitment to a psychiatric facility
2. referral for community mental health treatment

in short, if you don't need the first one, you should not go to the ER.

So the Republican plan for health care reform is to channel all health care through hospital emergency rooms. Okay.

Has Representative Broun introduced the Full Funding for Emergency Room Treatment Act yet? You know, the one that would cover all costs incurred by uninsured people in emergency rooms. You know, the one that would make it possible for hospitals to charge insured people for their actual care instead of having to charge enough to cover uninsured ER care?

No? He hasn't? Well, I didn't think so either.

Maybe they think going to the emergency room is like a stroll into their private, members only, Navy doctor staffed on-site clinic?

that might explain their retarded thinking.

many excellent comments here, especially cyb1851.

I don't understand why ERs are seen as any kind of a general palliative, since they are for emergencies. There are so many reasons to see a doctor over a period of months -- prenatal care, diabetes, cancer, asthma -- that it is a complete moral and intellectual failure not to see the problem for what it is.

This has been implicit in a couple of the prior comments, but you can only get treatment in an emergency room for an acute condition. "I have a lump I can't explain" is not an acute condition. "I am four months pregnant" is not an acute condition. The upshot is that in addition to the downsides of treating the ER as a backstop solution, the fact is that the ER is not available as a backstop in every case.

Perhaps the health care bill should just provide for really comprehensive "emergency" rooms at government expense. The republicans would be happy, cause everyone could get any treatment they want at the emergency room, and the dems would be happy because they would have a public option that would help everyone that walked in to a broad array of treatment.

I saw a recent news story about how First Responders i.e. Fireman and Paramedics are becoming the first line of health care in many locals. They responding to VERY large numbers of calls that are things like fever, breating problems and other illness that would be taken care of by a doctor if they could offord one or had insurance. So many people are using the First Responders as their ER and that too is paid for by taxes. Guess that is the kind of Public Option the Repigs want to see.

Also, when we conjure up a picture of an emergency room in our minds, other than accident victims, who are the visitors we imagine? You know it: The poor. Blacks. Hispanics.

Exactly. Blowing that dogwhistle is how Republicans conceal the fact that people with insurance are already paying for the uninsured, but in the most expensive and least efficient way possible.

I know people are probably sick of me talking about Deamonte Driver, but to me he's the perfect example of how we're currently running our healthcare system. Because his mother couldn't afford $80 to take him to the dentist, taxpayers will now be paying $250,000 for the hospital's futile attempts to save his life.

Two hundred and fifty thousand dollars versus eighty dollars. And Republicans try to claim they're the ones who understand economics? They don't even understand the difference between $250,000 and $80.

Alkalai, the uninsured don't regularly see a physician for checkups or even when they have mild to medium-level health concerns. It costs too much, and they know it. What happens then? The problems fester and go untreated until the emergency room is the only place they can go. Then we all end up paying the higher and unfair price -- yes, including the uninsured who face collections efforts by hospitals. That is grossly unfair, because the hospitals end up getting compensated by the government anyway for uncompensated care.

This is one big root of the problem. It is ruining people's financial lives, and it is costing us all a lot more money than is necessary. It is why we need coverage so that anyone can a doctor when they have a health concern. No more emergency room nonsense!

We don't need to wait until problems become emergencies.

Talk about rationing care. Does this moron think that someone with depression will get seen by a doctor at any point in the near future at an ER? Let's see, heart attack, sucking chest wound, severed limb, shortness of breath.....or someone coming in for depression to be treated by physicians that get to provide about 10 minutes of care to those on the verge of literally dying!

Alternatively, if the ER counts as "universal coverage" according to their own words, how soon will the call be to shut down all emergency rooms because they are socialized medicine and do nothing more than redistribute the wealth of the taxpayers to those that can't afford or have no access to medical insurance?

I agree with shortstop: I am livid with anger over what passes for discussion over healthcare. What sociopathic, sadistic cretons advocate for Emergency Room healthcare? All the arguments above clearly expose the insanity of the ED argument. What is the business plan of hospitals that provide EDs to the public? I'd love to see how they are funded and what their investors think of this plan.

I have almost lost patience with this whole discussion. Thank God, and I mean that, I have a deeper faith and trust in a Higher Power, and know that this physical life is not the whole experience of Life.

I am committed to Oneness through Justice and Transformation
peace,
st john

I am livid with anger over what passes for discussion over healthcare. What sociopathic, sadistic cretons advocate for Emergency Room healthcare?

Actually the Republican rank and file is made up of many decent people who are gullible to the lies they hear. They can't believe that people go without health care, so they are willing to believe that "free" health care is readily available. Never mind that ER care is not free and consists of emergency stabilization (and admission for delivery of women in active labor) rather than chronic care.

I just wish a Dem Congresscritter would have the balls to demand that anybody in Congress who voted against a Public Option would thereby renounce their Public Health Care privileges, for them and their dependents, (as our taxes are paying for it,) and would have to, in any medical emergency, go to an ER, (not the one in the Capitol,) and use the Private Insurance which they will have contracted on the next day this amendment passed. Why should those jerks have a benefit unavailable to the rest of the population? Why do they get socialised medecine for them and we the People cannot?
Maybe the Obama strategy is to let them run at the mouth until he can deliver a decisive "riposte", (I hope...) but I'm tired of listening to that vomit of lies and untruth flowing from their anal(oh so sorry, I meant buccal),orifices,
as they are both so dirty it's quite difficult to see a difference.

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