Rationing in the ER

Interesting post at Democratic Underground. A man brought his mother to the ER with chest pain, and pitched a fit when they tried to send her home. More tests showed she had an aneurism.

What really gets hot is the comments section, with other people telling horror stories of their own, including a doctor who says that women do not get taken seriously.

My mother-in-law brought her son to the ER with abdominal pain and was told to take him home and give him some aspirin. She refused to leave, and it turned out he had appendicitis. She saved his life in the 1960’s by standing up to white doctors in a Southern hospital and telling them that she was his mother and she knew her son was having an emergency.

Every so often some appalling story of callous indifference in the ER hits the press. Though you find bad people in every profession and workplace, I don’t think it’s just individuals. Economic rationing depends on volume, and you have to move the patients through the same as customers in a fast-food restaurant. No matter how many non-discrimination notices they put up– everyone knows who has what insurance. Too much time spent on the care of the underinsured will not get you promoted.

We have to some day have some tough, reality-based discussions about finite resources and make decisions on how much of our national wealth to spend on health care. There are many other urgent needs.

But don’t think that there’s not rationing going on now. Don’t think that showing up with chest pain and a famous name is the same as showing up with only your pain and your need. Democratic Underground has opened up a forum for stories about the gaps in our emergency system.

Free Market Can’t Do This

I was making my home visits and spent some time talking to a nice woman who lives on disability. She told me that she used to work at a strenuous low-wage job. Now she is in a wheelchair, because one of her knees was destroyed by MRSA and cannot be repaired. What should have been routine surgery became a year-long ordeal when infection set in, and she lost the use of one leg.

Methicillin Resistant Staph Aureus is the bane of surgeons and the plague of nursing homes. Oceans of disinfectant and mountains of gloves and gowns can’t eliminate it. But Norway has succeeded in beating back the resistant superbugs. From Americablog…

Twenty-five years ago, Norwegians were also losing their lives to this bacteria. But Norway’s public health system fought back with an aggressive program that made it the most infection-free country in the world. A key part of that program was cutting back severely on the use of antibiotics.

Now, you economists out there will note the words, ‘public health system’ and also the implication that patients would not be able to shop around for a doctor who hands out antibiotics like candy.

How contrary to a free-market system, where choice rules and rationing is unacceptable, at least to the people with money. In a market system you will darn well get your antibiotic when you demand it, and no government bureaucrat will get between you and the doctor you bought.

Too bad we can’t get nature to go with our program. She keeps cranking out germs faster than we can crank out cures.

What’s called for is some measure of wisdom, some measure of unselfishness and looking at the population as a whole. You may not believe in evolution, but the germs keep on evolving. Antibiotics used wisely are lifesaving. Used selfishly and carelessly they lose effectiveness and leave us outsmarted by bacteria once again.

How to Play God

Fascinating post on Daily Kos today, about real doctors who played god and decided who was to have a chance at staying alive.

It was the 1960’s, kidney dialysis was just being developed, and there were not enough machines to go around. Who would they treat, and how did they choose?

In nursing school we had an exercise where we had to discuss a case of 3 patients and 1 heart. Who would get the transplant? There was no right answer, the exercise was intended to get us to define the questions.

Do not doubt that Americans are dying every day, needlessly, because insurance lobbies and politicians have decided to ration care. Kidney dialysis is common today because the government stepped in to make this lifesaving treatment available to ordinary Americans.

We could reduce the number of Americans who need dialysis if we made the choice to ensure that everyone has access to primary and preventive care.

Rationing Health Care

I’d love to just steal David Leonhardt’s excellent analysis in the New York Times today, ‘Limits in a System That’s Sick’ and paste the whole thing here. It’s hard to pick and choose when the whole essay is full of new perspectives.

Leonhardt points out the obvious–we are already rationing health care, and not in a fair or sensible way. Everyone who has to deal with the system, as a worker or a patient, knows that some people are getting meds and tests that they don’t even need, for profit and liability reasons– and others are suffering for lack of basic, effective, preventive health care that is proven to work.

But not all the costs are seen in the hospital—

There are three main ways that the health care system already imposes rationing on us. The first is the most counterintuitive, because it doesn’t involve denying medical care. It involves denying just about everything else.

The rapid rise in medical costs has put many employers in a tough spot. They have had to pay much higher insurance premiums, which have increased their labor costs. To make up for these increases, many have given meager pay raises.

Anyone who works for a small business knows how true this is. Leonhardt compares the US with other countries and explains why Americans pay more for less. A chart in the article shows survival rates in several countries. If you are diagnosed with breast cancer, stay here. If you need a kidney transplant, better go to Canada. I think I know why.

We are good at catastrophic care–doing the surgery. We are not good at the basic preventive care that your transplant patient will need for all the years of his life. If we could put the money where it will do the most good, we could have the best of high tech, and keep the need for it to a minimum.