We have a lot of people in need of medical care in the US. Almost all of that need is real. Many people have chronic illness that can be managed and when done so properly they remain productive members of society. Some of this need in the ER comes simply from our societal demand for convenience. We want what we want right now (i.e. fast food and ATM's!). Honestly, some comes from people who perceive some imaginary need when really they just need to suffer through the flu or a cough and quit running to someone to be fixed for every little thing. We can argue about who truly has need and who does not, but it will not stop the flow of people into my ER anytime soon so let's just assume there are a large number of people who will continue to stream in. As a society we either need to cough up some more money or start making some hard moral choices about who will receive medical care and who will not.
We all want the moral superiority of saying, "We believe ALL people deserve education, healthcare, etc...." - but when it comes time to put the money where our mouth is no one is willing to offer up the public funding. What does that say? It means we are lying. We DON'T believe all people deserve these things because were unwilling to put out money where our mouth is. That is fine with me... but if that is going to be the approach we take - lower taxes and less public funding - we all better toughen up and have the backbone to tell the truth!!
The truth is that we will have to learn to be okay with the fact that people are literally going to start dying in the streets or grow up uneducated creating social classes of have's and have not's. If you can't morally be okay with a homeless crazy person dying behind a restaurant or with an uneducated laborer that provides your cheap food every day ending up crippled from the ramifications of their diabetes then you have to help pay for their care - because they can't. That is the truth. The good news is that the problem is not simply money, it is where we choose to spend it. Money for public assistance in primary care clinics and mental health clinics is CHEAP compared to the costs of these patients after they enter the doors to my ER - which is currently the only Federally mandated place we have to spend money!
I have one patient in particular I would like to point out. She is in her very early twenties, "socially marginalized" as I like to put it. She is a diabetic on insulin and for various reasons she is not getting the oversight and social support she will evidently require to maintain her health. Every 3-6 weeks I see her in my ER in "DKA" (look it up, bad ramification of not taking your insulin). Most of the time she ends up getting admitted to our ICU and has about a 3-4 day hospital stay until she is stable and is sent home. She does this EVERY FEW WEEKS. Do you have any idea what a level 1 or level 2 ER visit costs? What an ICU bed, nursing support, MD's and lab tests cost for every day? I will easily bet she alone costs our hospital a million dollars a year. The video above is a short segment on one part of a larger problem facing our country. I thought it was well done and spurred these thoughts this morning... Please take the time to see what it is about.