Little Red Ribbon-Hood: January 2008: Archives

January 15, 2008

More On That Alleged Best Health Care In The World genre: Little Red Ribbon-Hood

The Waiting Room

Those opposed to an overhaul of the U.S. health care system frequently tout it as the best health care in the world. However, while there are many positive aspects to our health care system, more and more deficiencies have begun to emerge and receive the attention they warrant. Following last weeks report that the U.S. ranks last in the number of preventable deaths, the time one has to wait before receiving emergency care continues to increase...leaving those in need of prompt attention at risk.

TUESDAY, Jan. 15 (HealthDay News) -- The last thing you want to hear in the emergency room when you've got crushing chest pain or can't breathe is that you have to wait before you can get treatment.

Unfortunately, in too many instances, that's exactly what's happening. In fact, new research found that waiting times in emergency rooms have increased by 36 percent for all patients, to an average of 30 minutes per patient. And the sickest sometimes have to wait the longest: As many as one-quarter of all heart attack patients had to wait 50 minutes or longer before seeing a doctor.

Study author Dr. Andrew Wilper, a fellow in general internal medicine at Harvard Medical School and an internist with the Cambridge Health Alliance, reports in the Jan. 15 online issue of Health Affairs that the increasing wait times are the result of a "perfect storm" that has occurred as emergency room visits are on the rise while many ERs are closing their doors.

These expanding wait time compounds the plight of those who lack health insurance and rely upon indigent emergency room care for their health care. Not only are preventable and treatable illnesses being ignored until they become medical emergencies; those arriving in the emergency room with them are at greater risk since they are having to wait longer periods of time to see a physician and receive the attention they need. Is it any wonder that the number of preventable deaths in the United States is on the rise?

"The real problem is that patients are backing up in the ER. If a patient is still in the ER six or even 12 hours later, it means that room, that nurse and that equipment just aren't available for the next patient that comes in the door," explained Dr. Art Kellermann, a spokesman for the American College of Emergency Physicians.

Kellermann said a good analogy to this situation would be if controllers at a busy airport started parking planes on the runways. "We'd think they'd lost their minds, but that's what hospital administrations are doing with ERs," said Kellermann. "We've taken the most time-critical portal of care and allowed it to become gridlocked."

For the current study, Wilper and his colleagues reviewed data from 1997 through 2004 and included 92,173 adult ER visits. Of those visits, almost 18,000 were thought to need immediate attention at the time of initial evaluation, and 987 had a diagnosed heart attack.

Not surprisingly, the wait to see an ER physician also increased during that time. In 1997, the average wait was 22 minutes. By 2004, the average wait was up to 30 minutes -- a 4.1 percent increase in wait time each year.

For heart attack patients, even a few minutes of delay in treatment can literally mean the difference between life and death. Yet, the average wait time for a heart attack patient increased from eight minutes to 20 minutes over the study period -- a 150 percent increase.

The study also found that blacks, Hispanics and women had to wait longer for care. Whites waited an average of 24 minutes, while blacks had to wait an average of 31 minutes and Hispanics had to wait 33 minutes on average. Wilper said it's possible that blacks and Hispanics might be more likely to visit hospitals that have longer wait times in general.

He said there needs to be an expansion of insurance coverage, modified management of inpatient and elective surgeries because so many ER beds have been lost, and an expansion of primary care that might help ease the overflow at the emergency room.

"This is an issue that cuts across insurance status," said Kellermann, who pointed out that even people with insurance are left waiting in ERs, because there just isn't enough space or enough resources.

The report also notes that several hundred emergency rooms have closed their doors. I suspect that the decline in hospitals offering emergency care adds to the problem and likely reflects the disincentive for hospitals to provide such care since it often involves patients who lack insurance or any real means to pay for the services rendered.

As the number of uninsured Americans increases, the problem will only exacerbate...a fact that ought to be recognized by all Americans since it also has and will impact the care provided to those who are insured. Reciting the president's meme that everyone in America has access to health care may be an accurate statement; but it is also an inarticulate assessment. As the number of uninsured expands, a tipping point is inevitable and those inclined to ignore as much are simply burying their heads in the sand.

Those who emphasize the waiting times for health care in other countries as a reason to oppose some form of universal health care seek to portray those delays as a justification for the U.S. market driven system. Unfortunately, that rationale only succeeds so long as 47 million uninsured Americans fail to receive preventative care and treatment for chronic illnesses and diseases. If those countries providing health care to all were able to ignore the routine health care needs of nearly 20% of their citizens, I suspect their wait times would decrease.

If America wants to assert its prowess in providing timely and top-notch health care, it must soon address the needs of the 47 million Americans who are being ignored. Our challenge shouldn't be to match the health care provided by other nations; it ought to be to actually provide the best health care in the world...to all Americans...when they need it.

To do otherwise is an exercise in self-deception that will continue to be evidenced in additional negative reports. Wouldn't the verifiable pride that comes with a can-do attitude be preferable to false pride that results from a "don't look, don't see" mentality? Even worse, how can the deaths that result from foolish pride be anything but inexcusable?

Tagged as: Dr. Andrew Wilper, Dr. Art Kellermann, Emergency Room Care, Harvard Medical School, Health Care, Health Insurance, Indigent Care, Poverty, Preventative Medicine, Uninsured, Universal Health Care, Wellness

Daniel DiRito | January 15, 2008 | 11:15 AM | link | Comments (1)
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January 8, 2008

How About That Best Health Care In The World? genre: Little Red Ribbon-Hood & Six Degrees of Speculation

Ham & Cheese

During this election cycle we've often heard politicians argue that the United States has the best health care system in the world. Unfortunately, there are problems with how this assertion should be measured and a new report suggests that U.S. politicians have ignored one very important factor. Specifically, for the 47 million people who lack health insurance, the results can be deadly despite the following inane comment from George Bush at a recent speech in Cleveland:

I mean, people have access to health care in America. After all, you just go to an emergency room.

In the report released by "Researchers Ellen Nolte and Martin McKee of the London School of Hygiene and Tropical Medicine", the evidence suggests that the United States ranks dead last in terms of preventable deaths...a statistic that fully refutes the wisdom of the president's observation. Basic logic should tells us that treating conditions in an emergency setting is inferior to routine care and monitoring...which rarely happens for those individuals who lack health insurance.

France, Japan and Australia rated best and the United States worst in new rankings focusing on preventable deaths due to treatable conditions in 19 leading industrialized nations, researchers said on Tuesday.

If the U.S. health care system performed as well as those of those top three countries, there would be 101,000 fewer deaths in the United States per year, according to researchers writing in the journal Health Affairs.

Nolte said the large number of Americans who lack any type of health insurance -- about 47 million people in a country of about 300 million, according to U.S. government estimates -- probably was a key factor in the poor showing of the United States compared to other industrialized nations in the study.

"I wouldn't say it (the last-place ranking) is a condemnation, because I think health care in the U.S. is pretty good if you have access. But if you don't, I think that's the main problem, isn't it?" Nolte said in a telephone interview.

All the countries made progress in reducing preventable deaths from these earlier rankings, the researchers said. These types of deaths dropped by an average of 16 percent for the nations in the study, but the U.S. decline was only 4 percent.

"It is startling to see the U.S. falling even farther behind on this crucial indicator of health system performance," Commonwealth Fund Senior Vice President Cathy Schoen said.

"The fact that other countries are reducing these preventable deaths more rapidly, yet spending far less, indicates that policy, goals and efforts to improve health systems make a difference," Schoen added in a statement.

As one can see, this report clearly points out just how absurd it is for the President to make the above statement. Yes, everyone knows that the uninsured can go to the emergency room...if they're having an urgent medical event such as a heart attack, kidney failure, diabetic coma, and so on...but they're not going to be provided with long term care in the form of heart medication, blood pressure medication, or insulin The care that is needed to treat long term medical conditions and chronic diseases and to avert or reduce these emergency room events as well as the increased risk of death is not available to many of the uninsured.

The bottom line is that the prevailing problem being ignored by the President and the 2008 GOP presidential candidates is the cost of health insurance and the inability of many, if not most of the 47 million uninsured, to afford it.

The topic was discussed in the recent ABC New Hampshire Republican debate. The following are a few relevant excerpts that clearly demonstrate the insufficiency of the GOP's proposals to correct this urgent and expanding problem.

MR. ROMNEY: Charlie, it -- that doesn't mean it shouldn't be improved. And I think -- I think that the notion of people buying their own private health insurance is a very good one, so long as a lot of them do it. Only 17 million Americans right now buy their own health insurance. If 50 million Americans were buying their own health insurance -- because it would be just as tax-advantageous to do it that way -- and we had a health savings account, people -- economists believe there'd be a 30 (percent) to 50 percent reduction in the cost of health insurance, and quality would come up.

MR. GIBSON: You all have proposed free market, consumer- purchased insurance, and you all talk about giving tax deductions for buying insurance. Let me do a little math. The average family employer-provided insurance, when the companies buy it, its $13,000 a family.

Now, you've talked about a 15 (thousand) to 20,000-dollar deduction, right, for people buying their own insurance? If you take a median-income family of $62,000 in this country, you've just saved them $3,000 on their taxes. That doesn't come close to buying an insurance policy.

MR. GIULIANI: Charlie, a health savings account actually helps to accomplish what the governor is talking about. If somebody can put aside -- and the plans that we've been talking about include a health savings account -- you'd have a -- you'd have an exemption up to 15,000 (dollars). If you could find a policy for 11,000 (dollars), you could have a $4,000 health savings account. You would be able to buy some of your health care and your prevention yourself. It gives you an incentive over a lifetime to deal with wellness.

None of these comments address the fundamental problem. The fact is that the vast majority of the uninsured don't have the income to buy health insurance even if they wanted to do so.

Let's look at some of the GOP candidate’s specific statements. Mitt Romney seems to suggest that the problem will resolve if we can simply get more individuals to buy private health insurance. Excuse me, but there are millions of Americans who can't even afford to pay their portion of an employer sponsored insurance plan. Just how are those individuals going to be able to afford even more expensive individual policies?

Rudy Giuliani's plan isn't any better. Note Charlie Gibson's explanation whereby the government offers a tax incentive for individuals or families to purchase private insurance. However, to do so, a family needs to be able to afford at a minimum of $13,000.00 (the amount they currently pay for employer sponsored insurance) in order to receive a $,3000.00 tax break. If you haven't the ability to pay for the insurance, the tax break is meaningless. Therefore the Giuliani plan only works for those who can already afford health insurance. It sounds nice to talk about a 15 to 20 thousand dollar exemption, but it isn't going to help those with low incomes who already pay minimal taxes.

When Giuliani goes on to laud the benefits of an HSA, he is once again insulting our intelligence. If most of the people who lack health care had the ability to set aside $4,000.00 in an HSA...or under their mattress...wouldn't they already be doing so? Further, the assumption that people aren't mindful of their own wellness is laughable. If you can't put food on the table for your family, you sure as hell don't put $4,000.00 in an HSA account for wellness care.

Frankly, the bulk of the GOP rhetoric on health care is little more than smoke and mirrors intended to feign concern without ever having to fund care. I would relate it to one of my favorite expressions told to me by an old friend, "I'd have a ham and cheese sandwich...if I had any ham or cheese." By and large, the same logic holds for the plight of the uninsured.

In fairness, both John McCain and Mike Huckabee argued that the lack of wellness and preventative care are largely responsible for the skyrocketing costs of health care. Their statements are a sensible equivalent to the oft heard expression, "you can pay me now or pay me later"...except for one critical omission. The "pay me now" portion of the equation is the lion's share of unfunded health care costs...costs which are only currently covered by health insurance...the health insurance that millions can't afford...and that the GOP has little desire to fund.

Since the health care industry isn't absorbing these costs (and doesn't want to), they have absolutely no motivation to offer to subsidize this type of care. At the same time, it’s abundantly evident that the GOP opposes the government stepping in to cover these costs. The truth of the matter is that the health care industry and the GOP both accept that it's cheaper (and more profitable) to continue only requiring the health care industry to provide indigent emergency care. In the end, that essentially leaves few people advocating for the needs of the uninsured...and more people in the morgue.

It's been more than seven year since George Bush sold the American public on the notion of "compassionate conservatism". Let's hope that the election of a Democrat in 2008 will be the first step towards seeing it demonstrated.

Tagged as: Charlie Gibson, Compassionate Conservatism, George Bush, GOP, Health Care, Health Insurance, Indigent Care, John McCain, Mike Huckabee, Mitt Romney, New Hampshire Republican Debate, Poverty, Preventative Medicine, Rudy Giuliani, Uninsured, Wellness

Daniel DiRito | January 8, 2008 | 9:25 AM | link | Comments (4)
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