ER WAITS: ANOTHER COUNTRY HEARD FROM

Single-payer advocates cite recent wait time increases in U.S. emergency rooms as yet another reason to embrace government-run health care. Like most of their arguments, this one ignores some very inconvenient facts. It does not explain, for example, why Britain and Canada have serious wait time issues despite their government-controlled systems.

The reality, of course, is that countries with socialized medicine tend to have far longer ER wait times than we have in the U.S. This reality has been confirmed, once again, by the travails of Norwegian ER patients. As Aftenposten reports, Norway’s state-owned hospitals are unable to provide decent service:

State health officials are sounding the sirens themselves over a state of emergency in Norwegian hospitals’ emergency rooms, where patients face lengthy delays, inexperienced doctors and often chaotic organization.

And, like all government-run health care systems, Norwegian health care produces a bumper crop of horror stories, including the following:

In one case, a patient suspected of suffering a stroke was kept waiting six hours and 10 minutes before being treated. In another case, a patient who drifted in and out of consciousness didn’t get treatment for nearly four hours.

These are government-owned hospitals, mind you. No profit motive eating at the the soul of the system. No evil capitalists syphoning off precious resources to pay for fat Cuban cigars. Just plain, old-fashioned bureaucratic ineptitude and inefficiency.

So, I’ll ask the question again: Why should we in the United States base our health care reform project on a model that consistently produces poor results? Doesn’t it make more sense to try something new, like free-market reform? 

Comments 33

  1. Marc Brown wrote:

    There are hundreds of horror stories about American ERs, David. To pick one, just go to LA’s skid row and witness the poor discharged with gowns still on.

    ‘Shockingly, Olvera’s situation was only one of at least 50 reported cases in the past 12 months in which sick, confused, and homeless patients were driven by ambulance following discharge and dumped somewhere in the 50-block area of downtown Los Angeles called Skid Row.’

    http://www.newsinferno.com/archives/2414

    Posted 26 Feb 2008 at 7:13 am
  2. Catron wrote:

    You haven’t addressed the point of the post, Marc. To wit: Why should we trade our system for state-run systems that perform no better?

    Posted 26 Feb 2008 at 7:20 am
  3. drmatt wrote:

    Who said anything about trading? In my experience America is the leader in innovative ways to attack old problems, we have the ability, intelect and know how to take the best from each system and create something to be modeled all over the world. Because the one thing in common would be that it was govt run? there is no way to build a system that doesn’t have something in common with another system, so we can sit around and point at the falacies of any system and say “that is why we shouldn’t do it that way” that sounds like a good idea, lets do that.

    Posted 26 Feb 2008 at 7:57 am
  4. Stuart Browning wrote:

    We should also point out that due to EMTALA, many of our ERs have been effectively socialized.

    Advocates of statist intervention never fail to portray the failure of government as an indictment of the free market.

    Posted 26 Feb 2008 at 8:02 am
  5. smartdoc wrote:

    The skid row hospitals in the US with bad ERs are already socialized medicine (Medicare and Medicaid provide essentially 100% of actual payments). Why expand this nightmare to everyone?

    Posted 26 Feb 2008 at 8:30 am
  6. Marc Brown wrote:

    No hospital in Western Europe is throwing homeless people out on the street like LA does – we do much better than that.

    Posted 26 Feb 2008 at 8:55 am
  7. drmatt wrote:

    Good point smart doc, without medicare and medicaid those people would have to be dumped in the ocean or a nearby landfill.

    Posted 26 Feb 2008 at 9:19 am
  8. Rich wrote:

    The elephant in the room, in the US presently, at least in my neck of the woods, is financial failure of community hospitals.

    As more and more of the elective surgeries are performed in outpatient centers, and as CMS tightens it’s belt on payments for inpatient services, hospitals struggle and fail.

    One hospital closes, and the neighboring ERs are suddently overburdened by the additional volume of patients, and end up admitting increasing numbers of low-reimbursement (loss-leader) patients, further stressing their financial well-being, ultimately resulting in their closing, and an exponential increase in stress on the remaining neighboring hospitals, and so on.

    This is currently happening in New Jersey. The rate of hospital closure in New Jersey is increasing. Two nearby community hospitals closed within the past year, and another one announced that it will close this summer. A third has announced that there is speculation about selling the facility off, to function as a nursing home.

    Why is this happening? Are they all run inefficiently, seeking too-large payments for all of their employees and executives, running exorbitant programs and offering world-class golden-touch service for all of their patients? Or are they saddled with economic burdens and unfunded mandates (a la EMTALA), compounded by an inability to effectively compete in the market to provide services for which they are better reimbursed (because of a government-imposed slanted playing field)?

    Nothing, other than government regulation and legislative mandate, is restricting the activities of these entities.

    Posted 26 Feb 2008 at 9:39 am
  9. Marc Brown wrote:

    Clearly the only way to solve your ER crisis is public funding. I agree – hospitals shouldn’t have to treat people for nothing, but nothing is what a lot of people have. It is cheeky of David to try and suggest that say Noway’s ER is in in crisis, and not America’s – as the LA Times reports:

    http://www.latimes.com/news/local/la-me-emergency9feb09,1,5278651.story?ctrack=1&cset=true

    “Overcrowding in our emergency departments is a national crisis,” said Dr. Linda Lawrence, president of the American College of Emergency Physicians, an advocacy group based in Washington D.C. “We no longer have the capacity to serve as the safety net for society.”

    The group surveyed 1,000 emergency care physicians in September and found that one in five knew of a patient who had died because of having to wait too long for care, Lawrence said.

    A review of 90,000 emergency room visits nationwide from 1997 to 2004 found that one in four heart attack patients waited almost an hour after arriving in a hospital emergency room before receiving care.

    The National Institute of Medicine, an arm of the National Academies of Science, warned in a 2006 report that hospital-based emergency care was at a breaking point because of increasing demand and dwindling numbers of both emergency rooms and hospital beds.

    Posted 26 Feb 2008 at 10:26 am
  10. drmatt wrote:

    unfunded mandates, cost of liability, fee for service system, unfair reimbursement schedules, cost of medical school, rising cost of pharmaceuticals, for profit health insurance, unreimbursed overhead produced by both govt and private insurance. Let’s face it there is “NO ONE CAUSE” of the failure, anyone who believes otherwise has a great view of trees but is missing that big bunch of trees, undergowth, etc called……..um……….um………..oh yeah, forest.

    Posted 26 Feb 2008 at 10:30 am
  11. Marc Brown wrote:

    ‘without medicare and medicaid those people would have to be dumped in the ocean or a nearby landfill.’

    Tsk tsk, Drmatt, where are your green credentials? Much better if we recycle them as compost for rich people’s gardens.

    Posted 26 Feb 2008 at 10:35 am
  12. Stuart Browning wrote:

    “rich people’s gardens”?

    It’s this kind of comment that confirms my belief that this debate is only secondarily about “health care” for the advocates of an increased role for government.

    Posted 26 Feb 2008 at 11:28 am
  13. Marc Brown wrote:

    “It’s this kind of comment that confirms my belief that this debate is only secondarily about “health care? for the advocates of an increased role for government.”

    I think Stuart you’ve had sense of humour bypass surgery coupled with a satirical spleen removal.

    Posted 26 Feb 2008 at 12:14 pm
  14. Stuart Browning wrote:

    … and I didn’t even need languish on a long waiting list to get it!

    Posted 26 Feb 2008 at 12:25 pm
  15. Marc Brown wrote:

    Ah, there’s the irony of overtreatment for the privileged in America today.

    Posted 26 Feb 2008 at 12:37 pm
  16. drmatt wrote:

    Stuart, you didnt languish for your surgeries because you have resources and good insurance, my laughectomy is on a six month waiting list until I can raise enough funds to show the hospital I am serious about paying for it. I could go to the ER I suppose but they wont see it as a true emergency, plus the wait is very long.

    Posted 26 Feb 2008 at 1:03 pm
  17. Stuart Browning wrote:

    Marc – In a free society, each of us can decide what is or is not “over-treatment”.

    When government bureaucrats take this upon themselves we see things like breast cancer patients being denied Avastin or an elderly man needing to wait a year for a hearing aid as was chronicled in the New York Times last week.

    Quite frankly, these decisions should be made by an individual. Other people’s lives are not yours – or anyone else’s – property.

    Posted 26 Feb 2008 at 1:08 pm
  18. Rich wrote:

    “Clearly the only way to solve your ER crisis is public funding.”

    What? I hope you did not get that from what I wrote. Public funding and the rules, regulations, and mandates that went along with it got us into this mess in the first place.

    Hospitals used to collect a little more from those with means than their actual costs, and were able to provide care for those who could not pay (or without insurance, etc). No longer, as the hospitals are reimbursed less than cost for those who are insured, and the platying field is tilted against them in favor of ambulatory surgical centers (in an effort to reduce costs to, you guessed it, public funding sources), removing the last hope for hospitals to have at least one profitable activity.

    It’s been a long time since we were free form government control, but we’ve have 40+ years of a government controlled and regulated system, which has failed miserably. Why is it so clear that increasing the domain of a system that has produced the reports you cited is a viable answer?

    Posted 26 Feb 2008 at 1:38 pm
  19. drmatt wrote:

    Stuart, there is no decision to be made if the services you need to; survive, maintain health, or continue to be a productive member of society are too costly. Economic barriers are as real as armed guards keeping you from obtaining such things. There is no choice, that is an illusion conjured up by free market morons who think that putting medicine in the hands of profit driven big business is a good idea.

    Posted 26 Feb 2008 at 2:11 pm
  20. drmatt wrote:

    C’mon Rich, what you have is 40 + years of free market with ever increasing intervention/regulation by the gov’t to patch the holes that free market wasnt addressing, I reiterate; COBRA- stop dumping poor people on poorer hospitals, EMTALA- do not withold treatment due to inability to pay, Medicare- cover the older/sick population that the “free market” didn’t want to cover, Medicaid- cover the poor people that free market wont even consider covering, HIPPA- allow people to continue thier insurance after they lose thier job (this particular one was an ingenious way to weed out the very sick, if you get very sick you lose your job and the free market could just dump you), Critical access- to open hospitals where they were needed but otherwise not profitable. Please Rich, educate me on where Govt intervention was not to fill the overwhelming gaps left by your beloved free market

    Posted 26 Feb 2008 at 2:16 pm
  21. Matt Horn wrote:

    “I think Stuart you’ve had sense of humour bypass surgery coupled with a satirical spleen removal.”

    Geez Marc, I think I made the same observation about you last week. Maybe not so metaphoricaly.

    Stuart:
    “this debate is only secondarily about “health care? for the advocates of an increased role for government”

    Are you sure you’re not a carpenter?

    You hit the nail right on the head.

    Posted 26 Feb 2008 at 3:39 pm
  22. drmatt wrote:

    cmon matt, you don’t strike me as a conspiracy theorist? I could give a crap less about providing the GOVT with a greater role, in anycase, in this country we “are” the govt, do you remember “we the people”, a govt for the people, by the people?? Personally, I only see the increased role of govt here because it is the only way to remove profit as a major motive, we all know money is power and power corrupts, I dont know about you, I can handle my car companies, computer companies and stolk brokers being corrupt but I have to draw the line at my medical care.

    Posted 26 Feb 2008 at 3:58 pm
  23. Marc Brown wrote:

    ‘Quite frankly, these decisions should be made by an individual.’

    Yes, if you want to pay for a treatment, then of course you can, if you can find a doctor to provide it (when are you scheduling that lobotomy?).

    But if you can’t pay the facts are:

    1 – Your private insurance companies have many more exclusions than public systems in western Europe

    2 – The FDA has narrowly approved Avastin for advanced breast cancer despite the fact that it has no survival benefit and its severe side effects will negate the short tumour free progression period for many (and some will die from the drug). The National Breast Cancer Coalition is against the approval for this reason, and the vast expense will no doubt mean many insurance companies will still not fund it.

    Posted 26 Feb 2008 at 4:20 pm
  24. Marc Brown wrote:

    ‘What? I hope you did not get that from what I wrote. Public funding and the rules, regulations, and mandates that went along with it got us into this mess in the first place.’

    Of course not – but what I’d like you address is:

    1 – The US spends about twice as much per head on healthcare as nations in western Europe – agreed?

    2 – If the hospitals are still going broke, is the answer to increase payments, and if so where will the money come from?

    3 – If you don’t want to spend any more money, are there costs you can take out of the system and what are they?

    Posted 26 Feb 2008 at 4:25 pm
  25. Rich wrote:

    DrMatt – Which of the programs that you mention have worked? Which have produced the outcome for which they were designed? The Gov’t has a poor track record in this regard.

    EMTALA- Hospitals are closing because they cannot afford to keep the ER open.
    Medicare – right…. can you say Donut Hole.
    Critical access – the critical access hospital in my area is the one that is on the block for sale.
    HIPAA – bad in concept, worse in implementation.

    Marc – The answer is not as simple as increasing the money. What needs to happen is to incentivize pepople to utilize resources in a productive way. The market does this naturally. Gov’t intervention, like EMTALA (good intentioned, but too sweeping) puts unnatural forces to work. Causes the exhaustion of resources. A simple matter like a sore throat that might not be costly to treat in an appropriate setting is expensive to treat in an ER. Reallocate those dollars, treat 5 sore throats for the price of one.

    Perhaps we spend twice as much because of this perverted system. For what it takes to treat an innapropriate patient in the ER, I can provide care for 10 such patients in my office. But there is no disincentive to keep people from using the ER inappropriately. So how about some of the money coming from more approriate use of resources. The right incentives (rather than force – that is forcibly removing money from the peoples collective wallet)
    I believe I answered all three of your questions, though briefly.

    But what do I know, anyway. I am just a “free market moron.”

    Posted 26 Feb 2008 at 5:55 pm
  26. Nurse K wrote:

    Catron—your major commenters need to start a bitch-and-moan message board somewhere on GoogleGroups or something.

    Just a bunch of people shouting at each other, not necessarily sticking to any particular subject matter. Yawn.
    —–
    Here’s what I learned about Norwegian health care when I was there:

    If you are stuck on a mountain village somewhere (of which there are many) and ask for a helicopter ambulance to come take you to the hospital for your breathing difficulty or whatever, they are allowed to say “sorry, you’re too old for the helicopter, find your own way down the mountain”. Doesn’t matter if there is no way to get down the mountain; if you’re too old, you’re F’d.

    Also, non-emergency (eg immediately life-threatening) consultations with people like neurosurgeons/orthopods are nearly unheard of. Wait times of years are common.

    Dental is not covered there, so people take the ferry to Sweden to get their teeth cleaned because it’s cheaper. Same with buying meat and beer, incidentally…people take the ferry and buy 10 or 20 cases of beer in the duty-free store on the ferry, get off the ferry, buy meat in Sweden, and come back. Speeding tickets are $1500 US.

    Posted 26 Feb 2008 at 7:42 pm
  27. Catron wrote:

    “Just a bunch of people shouting at each other …”

    I thought it was a pretty good dust-up, and it kept me amused during an otherwise tedious day of number crunching.

    “… if you’re too old, you’re F’d … non-emergency consultations … are nearly unheard of. Wait times of years are common … Dental is not covered there …”

    Geez, K, I wish we had a system like that here.

    Posted 26 Feb 2008 at 10:10 pm
  28. Marc Brown wrote:

    Rich,

    ‘The answer is not as simple as increasing the money. What needs to happen is to incentivize pepople to utilize resources in a productive way. ‘

    Yes, but where exactly is _money_ not being used productively? What money exactly and how can it be better spent?

    ‘A simple matter like a sore throat that might not be costly to treat in an appropriate setting is expensive to treat in an ER. Reallocate those dollars, treat 5 sore throats for the price of one.’

    What dollars, and who does the reallocating?

    ‘Perhaps we spend twice as much because of this perverted system. For what it takes to provide care for 10 such patients in my office. But there is no disincentive to keep people from using the ER inappropriately.’

    How would you incentivise people to come to your office and how would they pay you?

    ‘I believe I answered all three of your questions, though briefly.’

    Sorry – you’ve not even started.

    Posted 27 Feb 2008 at 4:21 am
  29. smartdoc wrote:

    Nurse K:

    Just to corroborate your comments, I saw a Norwegian woman in consultation recently. He family had flown her to the US for treatment. She had waited many months for a covered consultation, and her Norwegian consultant allegedly dismissed her after 5 minutes. The family and the woman were desparate.

    But hey, it was “free.”

    Posted 27 Feb 2008 at 6:34 am
  30. drmatt wrote:

    Rich, I know it is shocking but I agree with you, the GOVT patchwork programs suck, by the way I never said they worked, but you didnt answer the question, these arose in response to what “free market” doesn’t take care of!!! the free market is a great idea for cars and computers etc, etc, etc, it is a bad idea for medicine, yes the market self regulates but here is the rub, tell me what complicated moderately expensive product in the free market is within the financial reach of all? NONE!!! “the market” will be a specific set of people who can afford it, by it’s very nature a significant number of people will not get health care, and guess what will happen, after public outcry the govt will step in and we will have what we have now.
    David, I agree, not only is it amusing it is educational, I am neither narrow or closed minded I have learned from you, matt and rich quite a bit, thanks

    Posted 27 Feb 2008 at 7:03 am
  31. drmatt wrote:

    Rich, I also agree with you on the ER access, it cost way more for simple stuff, due to emtala people go thier for the “simple stuff” clogging the ER so when people with true emergencies come they end up waiting. I think PCP shortages, and poor reimbursement contribute to this, if a PCP needs to keep a full schedule to maintain a particular income then many acute cases end up in the ER. Let’s not forget liability, wouldnt’ be nice in the ER if you could walk into the waiting room and say, “your not an emergency go home, your not an emergency go home” and so on. It is going to be a boring day if we keep agreeing like this!!!!

    Posted 27 Feb 2008 at 7:25 am
  32. Nurse K wrote:

    She had waited many months for a covered consultation, and her Norwegian consultant allegedly dismissed her after 5 minutes.

    My friend’s grandma in Norway had trigeminal neuralgia and the meds weren’t doing much for her pain, so her doctor recommended neurosurgery to sever the nerve sending painful signals to her face, etc. She waited 5 years to be seen since trigeminal neuralgia won’t KILL you (although it is called ‘the suicide disease’ because many people kill themselves to put an end to the pain) but is severely painful, and when she finally got to be seen, the doctor said, “Hi, you are 85, and I don’t operate on any 85-year-olds for things like this. Sorry.”

    Posted 27 Feb 2008 at 9:45 am
  33. Will Jolly wrote:

    I would remind Marc Brown and drmatt that this country did have a largely free market healthcare system at one time, and it was much better than what we have now. There were more charity hospitals, doctors would make house calls, and, most importantly, medical care in general was much less expensive.
    Drmatt, why is the free-market so bad for medicine when it worked so much better than our current healthcare system?

    Posted 15 Apr 2008 at 10:04 am

Post a Comment

Your email is never published nor shared. Required fields are marked *