As I have pointed out many times, a good deal of BS appears in the “news” media relating to health care. Few articles, however, reach the level of irresponsibility achieved yesterday in Slate:
Imagine you run a hospital. There are two competing sources for inpatient beds. The first source is patients who come in through direct and transfer admissions. They are more likely to come with private insurance and need procedural care, both of which maximize profits. The second source is E.R. patients, who are more likely to be uninsured or have pittance-paying Medicaid and less likely to need high-margin procedures. Do the math: If you fill your hospital with the direct and transfer admissions and maroon the E.R. patients for long periods, you make more money.
The authors of this disgraceful piece of agitprop would have their readers believe that the people who run hospitals deliberately allow people to languish in their ERs for financial gain. The suggestion is not merely slanderous. It is absurd on its face.
I have worked in hospital finance (at institutions large and small) for more than two decades and have never met an administrator or finance person (not one) to whom such an idea would even occur. Where I have worked, suggesting such a policy would get you fired.
Moreover, the clinical staff would have to be complicit in (or, at the very least, aware of) the implementation of such a program, and I have never worked with a physician or nurse (not one) who would countenance anything like the authors describe.
Think about it. Can anyone imagine Shadowfax, Gruntdoc, Scalpel, Nurse K, et al, putting up with this kind of behavior from the people who run the hospitals in which they work? I sure as hell can’t. They would scream their heads off.
The reality of the typical U.S. Emergency Room is that it is one of the few truly egalitarian environments on the planet. Money or status have no bearing on how you are treated. As Kim at Emergiblog puts it:
Rich, poor, old, young, drug-seeker, homeless, insured or not (and we see everything, albeit at a less intense level than an inner-city hospital) if there is a bed in the hospital you get it – and you don’t wait in line.
Long ER wait times are a fact of life in every health care system worthy of the name, including single-payer and socialized systems. In fact, in places like Canada and England, it is so bad that patients are stacked in ambulances.
ER overcrowding in the U.S. has nothing to do with profits. ERs are crowded because our “leaders” in Washington have created incentives (via EMTALA and low PCP reimbursement) for people to use them as clinics.
The authors of this article paint a picture of U.S. hospitals that is wildly at odds with reality. They claim to be “practicing” ER physicians. If so, they are not only irresponsible, they are dishonest.