American Healthcare System

Uh huh, and when they tell you that you must pay the $5,000 for the CT up front when it is suspected that you're bleeding into your brain and you've lost sight in half your left eye... you're just gonna run right out and wikipedia that info, hire a lawyer and what.... sue their pants off??? Oh wait! That's the problem, right, those pesky lawsuit happy patients!   Puhlease. 

 

I have to wonder.  If this great healthcare system we've got here in the good ole' US of A really is a "help first, ask questions later" system, why would there be a need for a law such as EMTALA?  Do all these great hospitals really need to be told, "don't dump your patients"?  Even the GAO can't get good figures on how often EMTALA is violated because it only knows when it's reported.  How many illegal aliens turned away are going to go to "The Man" to complain about violations?  They don't even report when they're victims of crime.  How many disadvantaged people turned away are aware there's a law or how to file a complaint about a violation?   

As you can see from EMTALA, you cannot be asked to pay for care upfront, including CT's, which are deemed by the treating doctor as needed.  If a hospital breaks this they will loose their medicare/medicaid funding which is a HUGE portion of their income or in the very least have a HUGE fine.  In addition to the hospital liability in your example, the physician would loose their licence.  Se we aren't stupid, even if someone was evil and cared more about their pocketbook then people, one would not risk loosing their licence which would end their career.  So yes, you cry EMTALA and you are heard.  Hospitals can cry EMTALA on each other too because if someone is turned away and ends up in your ED, you are now footing the bill that another hospital should have.  So you can report a hospital if you feel they did something inappropriate.  I find your argument about the need for EMTALA strange, that's like saying "why would a country need laws that murder is illegal?".  Seriously come on, IMO a very poor argument which proves nothing about anything.  We also have a law that child porn is illegal and that you can't rape someone.   Does that mean that these were pervasive problems in a majority of people?  Yeah duh of course not, it means that there are bad people who do need the law, and the same is true with EMTALA, there are bad people, but they are not the majority or norm.  I have treated thousands of patients in hospitals all over southern california, as well as boston and chicago in my training.  I have never, not ONCE seen a patient with an acute care need turned away (this is done routinely in other countries).  If you actually look at the literature, they have compared the actual number of EMTALA vilations to the number of emergency room visits and found it is an insignificant risk.  You have no proof that it's a pervasive problem, in fact there is proof of the exact opposite.  You are trying to prove a point that isn't proveable.  We don't have a problem with people being turned away who are in need of acute care in this country.  We have a problem with people's access to preventative care and a need for insurance/malpractice reform, as well as some other things which we have talked about previously.  Not perfect, but definately not what you are making it out to be.

 A requirement to provide medical care and laws regarding rape, murder and child porn are very different things.  Neither your nor I can provide reliable, proven statistics regarding EMTALA if even the GAO cannot.

    "The overall impact of EMTALA is difficult to measure, however, because there are no data on the incidence of patient dumping before its enactment, and the only measure of current incidence—the number of confirmed violations—is imprecise. "

Any evidence you or I have to give, as a provider or a patient, is anecdotal, which I have stated again and again, mine is, as a patient who HAS been turned away, who HAS been asked for money prior to receiving service and who HAS had to declare bankruptcy because of things like $100 pajama sets and $5 kotex pads.  And we were INSURED!

For every statistic I can cherry pick showing a profit, you can show one recording a loss.  For every patient I can show who lost their life savings or maybe just their life due to life threatening illness and a refusal of care, you can show one who had an amazing outcome.  But in the greatest nation in the land, I don't think children's parents should have to hold bake sales to raise money to save their child's life.  "Treat first, ask questions later"? Not from where I'm standing.

Done.
 

 

Actually they can, but you would be more successful in finding them if you looked more recently then 2001 as there is quite a bit more data which has been accumulated since then and many more papers have been published evaluating EMTALA violations ;)  It is true the actual incidence is never going to be known, but the incidence of cases vs ED visits now/year is.  The point that you are missing still is that parent's will never have bakesales to safe a child's life, they may have bakesales to pay the bills after we save their lives.  That is the issue which needs reform.  You haven't cherry picked or shown anything, the one artilce you posted didn't show what you thought it did.  It's clear that regardless of what anyone says, what anyone writes you have decided how things are.  What you said earlier about "your experience" not coloring the whole is not true, you clearly have. 

Hmmm, this is timely.  Tonight's Frontline:

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

 

I think the real problem with the US healthcare is that insured people are going bankrupt in order to pay their medical expenses.  I haven't heard so much about uninsured people, but I can only imagine.  I was talking to a friend of mine who is minimumally insured and she won't go to the dr's for anything because she is afraid of her insurance dropping her.

agilebasenji

I think the real problem with the US healthcare is that insured people are going bankrupt in order to pay their medical expenses.  I haven't heard so much about uninsured people, but I can only imagine.  I was talking to a friend of mine who is minimumally insured and she won't go to the dr's for anything because she is afraid of her insurance dropping her.

 

I agree.  I think this thread is very general in scope and thus different people are bringing up different issues.  I agree with everything Ottoluv has said and always appreciate her input on medical issues. However, receiving treatment and paying for it are two very different animals!  I know that as an American I can get into a hospital in time and receive appropriate care, but I have little confidence I won't be paying for the next decade, even though I am insured and supposedly receive some of the best benefits of employers in our class.  My family has always had insurance through my dad's employers and yet my mom had to cash in our life insurance policy to finally pay off what we owed for my brother's broken arm, which did not even require surgery.  It took almost ten years to pay it off, and I believe my mom called the hospital's accounting people and just settled, since it was costing them more to manage what she owed them than she was paying each month.  There were several years my mom canceled our dentist appointments b/c we were paying off bills for my sister needing her appendix out.  We/I have no complaints about the actual care received during medical emergencies.  I've never had a bad experience with any of my Dr's and they've helped solve my problems.

I don't know enough about the costs involved in medicine to even have an opinion on how much dr's make and how much certain procedures truly cost, but I DO know that insurance companies have tried to rip off almost every single person I know (see the story I posted earlier about my friend with the kidney disease).  They make you jump through a dozen hoops just to receive what is part of the normal plan.  It pisses me off b/c like someone mentioned earlier, people like my grandpa are of the generation where they get a bill and they pay it, no questions asked.  They aren't used to having to make 3 phone calls and hassle people to do their job.