Universal Healthcare in the U.S.A.?

Another Billary Clinton sales pitch that will never pass Congress you say? Not really. In fact, according to President George Dubayah Bush, it exists, "....you just go to the emergency room."

Well, okay you say, no worries, it's fine that I have no health insurance. When I have a bad enough problem, I'll go to the E.R.

Whoa, hold on there young fella. Before you sink deeper into your delusion, or faith in the Church of Dubayah, read some fine lines below. There are some disclaimers; big financial ones.

First of all, what really happens when an individual without health insurance attempts to get medical care at a hospital emergency room? Well, what George W. refers to is a result of a series of laws that fall under EMTALA (Emergency Medical Treatment and Active Labor Act), which is designed to make sure any one in the U.S. with a MEDICAL EMERGENCY can get medical care. So as a legal obligation, a hospital, via its emergency department, must determine if the individual seeking emergency care HAS an emergency medical condition, and STABILIZE the emergency medical condition. Once an emergency medical condition is either ruled-out, or stabilized, the hospital has met its legal obligation.

What EMTALA or Dubayah doesn't account for is who pays for the care of the uninsured. The answer? The uninsured individual is responsible for paying the medical bill at the full price. What happens, for the most part, is that the majority of the uninsured could not possibly pay these bills. As a result, hospitals, and their affiliated health care providers, end up eating the loss, and compensate for their losses by raising the price tags for just about everything they provided to everyone else with insurance or with the ability to pay. And that's just one small reason why health care is so expensive in America.

So...when the innocent, invincible 20 year old American that still thinks he/she can play with his/her chances without health insurance (nor a sizable inheritance), he/she will be in for a some sticker shock when that, uh-say, appendicitis strikes; or be in for a major run-around PLUS a sticker shock when, hmm-say, a knee injury occurs that requires surgery.

Here's a scenario: Joe gets a belly pain, goes to an E.R., gets blood tests, CT scan, evaluation by doctors and nurses, gets pain medications in the E.R., and diagnosed with appendicitis. Joe undergoes emergency surgery by the on-call surgeon; heals from surgery and leaves the hospital 3 days later. Joe is back to work in a week with a full recovery. Thank you, EMTALA. But the bills? Probably totals to some where in the high 5 to low 6 digit figures (Joe will get multiple bills including the hospital bill, the doctors' bills, the pathologist bill, the radiologist's bill, etc.) Joe now is talking to a bankruptcy lawyer.

Here's another scenario; Jane falls off her bicycle, onto her knee, and the knee swells up and is too painful to stand on. Jane goes to an E.R.. The E.R. evaluation included an examination, and a set of x-rays, which shows no broken bone. The emergency physician's suspicion is a torn ligament or meniscus. To stabilize the emergency condition, Jane gets a splint, crutches, and is discharged. (emergency medical condition ruled-out, and stabilized per EMTALA) Jane is told to follow up with an orthopedic surgeon, perhaps get an MRI, and may need out-patient surgery to fix whatever the problem may be.
Jane spends the next two months with out success trying to find an orthopedic surgeon who take on a new patient that will take un-insured patients (or without a big retainer). Not able to work for two months, Jane loses her job as a waitress, and declares bankruptcy.

And these are just a couple of common scenarios; it gets much worse than this in many situations. So how did America, the most powerful nation on earth, end up with such a healthcare gap? That will be a topic for another blog.

For now, consider this: before you continue to think it's probably okay to be without medical insurance, THINK AGAIN.

Coming soon: navigating your insurance choices...