Emergency doctors dispute McCain advisor's take on healthcare

The organization representing the nation's 26,000 emergency medicine doctors fired back today at a John McCain campaign advisor who said, in effect, that as long as there are emergency rooms, no one in American is really uninsured.

The advisor, John Goodman, president of the National Center for Policy Analysis in Dallas, told the Dallas Morning News on Wednesday that emergency rooms are a last resort for healthcare for anyone because, by law, emergency rooms can't turn away a patient in need of immediate care. "The next president of the United States should sign an executive order requiring the Census Bureau to cease and desist from describing any American -- even illegal aliens -- as uninsured," Goodman said.

If you've been to a hospital emergency room in recent years you probably know those folks don't have a lot of time on their hands. Here's what Dr. Linda Lawrence, president of the American College of Emergency Physicians, had to say about Goodman's remarks:

"Emergency physicians can and do perform miracles every day, but taking on the full-time medical care for 46 million uninsured Americans is one miracle even we cannot perform. Access to care in the emergency department is no substitute for the comprehensive healthcare reform policy that should be at the heart of the platform of any presidential campaign."

-- Shari Roan

Photo credit: Gary Friedman / Los Angeles Times

Comments

[James G. Knight MD in San Diego]

Of course Dr. Lawrence's statement is just a political play on words, and a rather foolish one to boot.
It's pretty clear that the 45 million uninsured are already getting much or even most of their medical care via emergency departments. While that certainly isn't the best nor the least expensive place to get non-urgent care, that's where they often go in addition to physician offices and clinics that care for patients paying cash (I offer a 50% discount to patients that pay cash)
Mr. Goodman is correct that under EMTALA, any person can go to an emergency room with an urgent illness or injury and receive care regardless of their ability to pay. And, you certainly don't have to have insurance to pay for inexpensive routine or preventive care in a clinic or a doctors office.
But insurance is essential to avoid financial ruin as a consequence of major illnesses or injuries.
The underlying misconception is that only people with health insurance receive health care in the US, and that is absolutely NOT TRUE, especially in the Emergency Department setting! In the ER, the truely ill or injured all get the same level of care from our ER system and the superb ER doctors and nurses staffing those departments, regardless of their ability to pay.
The trick is to educate people that being seen for a cold in a doctor's office, urgent care or clinic for $35 makes far more sense than going to an ER and running up a $600+ bill?
Having less costly major medical insurance to pay for rare but financially devastating illnesses or injuries give's one the security of knowing that a major medical problem won't bankrupt you and from a public policy perspective provides the funding necessary to sustain a healthy ER infrastructure for the benefit of all.

[Dan Schuly]

Dr. Knight,

Tell me, does your 50% off for cash payments extend to prescribed medications, expensive tests such as MRI's, CT scans, PET scans, blood work, referrals to specialists? No, it does not. Your solution seems an attempt to protect you the physician, and the emergency hospital rooms, but leaves those with the your suggested catastrophic insurance in a precarious position unless they should be so lucky as to have a major illness requiring more than the $10,000.00 deductible recommended by you. The honest answer is the solution offered by every single industrial country in the world, less the United States. That is, universal coverage.

[Jim Keany]

Right on Dr Lawrence! Why would any policy maker utter the ridiculous statement that no American should be considered un-insured. Clearly, Mr. Goodman does not understand the problem.

I love being an ER doc, mostly because of the uninsured. They are by far most appreciative. But they are also the most frustrating. I witness, first hand, the huge gap between the costly medications, testing, and specialist referral they require and what they can afford. As Dr Lawrence states, we can't do it all. Often all we can do is put a band aide on a major hemorrhage.

Great example… Ted Kennedy’s brain tumor is not an emergency. He is up and walking around. What happens when we do the emergency work on the uninsured mechanic from the local shop with the same diagnosis? I’m an ER doc. I can’t do surgery. I can’t provide radiation treatment. Even if I could write the prescription for the chemotherapy, who would pay for it? There was a time when I could call the local specialist and they would care for this guy out of the kindness of their heart. But shrinking reimbursement and overwhelming need of the uninsured have left most of these docs unable to stem the tide.

So what to do? Until we get a handle on how to best help patients and doctors utilize medical resources appropriately we are doomed for failure. I won’t even go on about the stock market profit from your healthcare dollar… attorney and plaintiff lottery tickets wins with multi-million dollar awards becoming commonplace… dollars lost on defensive medical practices… under-insurance as employers desperately control cost by providing lower coverage… dollars wasted as doctors hire intermediaries to fight for payment with dozens of insurance plans, each with their own contracts, forms, and filing requirements. Imagine filing tax returns every day in 20 different countries – that just about sums up medical billing.

Why do I bring this up in a forum about the uninsured? I truly believe that we could easily afford insurance for all at a fraction of what we currently spend if these issues are addressed.

[Angie]

First, $35 would be your COPAY. That is what you would pay before your INSURANCE kicks in, and they do not always pay 100% of the bill. You are often left with a balance to pay after insurance is applied. But we are talking about UNINSURED citizens here, so your comment is both irrelevant and incorrect.

Second, when I was last in an ER, I did not see anyone there just because they had a cold. It was broken bones, babies with high temperatures (sorry, they probably can't wait a month to get an appointment to see their physician), kids with bloody noses that would not stop, and many seniors with all kinds of health problems. Maybe you have come across a few-or even many- people in the ER that come because of a cold, but that is far from the majority. (also, I would have been in Urgent Care, but they don't keep them open 24/7)

You stated: "...the truely ill or injured all get the same level of care from our ER system...". FYI, there are many reports of discrimination in ERs.

You stated 'The underlying misconception is that only people with health insurance receive health care in the US, and that is absolutely NOT TRUE". I don't think this is a misconception. I think people know this. But they also know it is extremely expensive without insurance. And THAT is what we are talking about here.

Like you said, insurance is essential to avoid financial ruin as a consequence of major illnesses or injuries.
And like Dr. Lawrence said "Access to care in the emergency department is no substitute for the comprehensive healthcare reform policy that should be at the heart of the platform of any presidential campaign."

Germans keep health care costs down by paying their doctors a LOT less. The doctors are not in it for the money, but because they care about human lives. I am not suggesting we bring American doctors wages to that level of low, but I did find that solution interesting.

And there are many countries that have universal health care—and it works. People get EXCELLENT care. As a national community, everyone shares that expense. It humanitarian. Its loving. And dare I say, for my fellow Christians, its what Jesus would do. :)

McCain's health care policy simply is not good enough.

[chloe]

What both Mr. Goodman and Dr. Knight both failed to mention, is that the EMTALA mandated treatment that hospitals must render in the ER is almost always given by physicians who ARE NOT paid for this treatment. Although the government has programs that reimburse hospitals to some degree, the doctors who render the specialized treatment needed to save lives are not reimbursed. I can attest to this. Just last night my husband was called in at 3:am for an uninsured stabbing victim. He returned at 8:30 am, just enough time to get showered and changed for hospital rounds. He didn't know or care that this patient had no insurance and that he would never get paid, but how long do you think physicians can deliver this free care while at the same time eat the cuts in payment by medicare and health plans (not to mention the new "never events" no pay policy, but that's another subject). McCain is a disgrace for ignoring his duty to find a real fix to this problem and clamp down on the cheating profit pig insurance companies. The emergency room is the same as health insurance??? This is like saying that we no longer need to have the food stamp program because from now grocery store owners will be required to provide free merchandise to anyone who comes to the store hungry and without money in his wallet. It would be great if we could do that, but eventually not only the would grocery store owners lose their livelihoods, but so would all of the employees, suppliers, etc. My husband employs 17 staff members who depend on their jobs, medical insurance and other benefits to support their families. Think about this before you post replies about "rich doctors." The ER is NOT free and we all pay!

[Richard Walker]

A tongue-in-cheek blog posting by John Goodman is now being used to accuse him of not caring whether people have health insurance. Goodman and his colleagues at the National Center for Policy Analysis (NCPA) have been studying how to create universal health coverage for 25 years.

If you search the NCPA Web site with the words “insuring the uninsured,” you will come up with 174 documents that address just that one issue. The best article is “Solving the Problem of the Uninsured,” which appeared in the Thoracic Surgery Clinic Journal: http://cdhc.ncpa.org/learn/solving-the-problem-of-the-uninsured-john-c-goodman-june-2005-thoracic-surgery-clinics