Tuesday, September 25, 2012

Take An Ambulance to ER....Really?

Livin' the dream in the Romney/Ryan America! 

On CBS 60 Minutes Sunday night, Mitt Romney surprised viewers with the suggestion that the uninsured would not go unserved under the Romney/Ryan new world order. Of course there would still be access* to medical care for the uninsured and the under-insured! Instead of dying alone in a cold-water flat, a 70 year-old in cardiac arrest can always call an ambulance and be treated in an ER!

Never mind the pesky problem of the heart-attack or stroke victim possibly being unable to reach a telephone or to dial for help. That could happen to an insured person, too (although a person with insurance who is able to visit a doctor regularly is much more likely to have had not only preventative healthcare but also safety measures in place for just such an emergency). Concerns like that do not figure into the Romney/Ryan calculus for smaller government.

What do you mean gutting
Medicare could leave seniors
high and dry?
Let them take ambulances!
Never mind that an ER is, by its very definition, a triage area where waits can be several hours and any treatment given is only intended to stabilize patients until they can be seen by their regular physicians. Oops! Uninsured patients rarely have regular physicians! That heart attack patient will only be stabilized and then sent home with an expensive prescription for stopgap heart meds and/or blood thinners and a stern recommendation to see his (non-existent) regular physician ASAP for follow-up care regarding actual treatment, surgical options and more personally-tailored drug therapy to treat the underlying condition - all prohibitively expensive for the uninsured. In other words, the patient will go home in almost the same condition in which he arrived and he probably will not receive any actual medical care for his underlying cardio-pulmonary disease.

Never mind that not only is the ER not the place for regular, preventative and wellness "health care", but when the patient receives the bills for that ambulance and ER visit (often thousands of dollars for ambulance transport and ER visit, not counting prescription medications), it could very well bring on the fatal heart attack that will finish him off. Of course, in the Romney/Ryan calculus, this may very well be a positive collateral effect.

Never mind all that. We ought to focus on the economic implications of candidate Romney's blithe assurance that no one need ever go without medical care under a Romny/Ryan regime because "we pick them up in an ambulance, and take them to the hospital".

ER treatment is among the most expensive of medical services and unpaid ER bills are one of the drivers of rising medical costs which make the USA the leader in the world in inefficient spending on healthcare. The vexing problem of the poor and the uninsured using the ER as a healthcare facility was one of the things Governor Romney cited as a good reason for passing his universal healthcare law in Massachusetts. Yet, now he describes it as an option for the proposed Romney/Ryan federal revamp of medicare and medicaid? How exactly does Mr. Romney think such an expensive form of medical attention will save taxpayers money?

Pimp my ride - ambulance edition!
Of course, he probably knows very well that such a backup "plan" for the uninsured makes no sense at all from a fiscal perspective, which makes it even more ridiculous coming from the candidate who claims he will run America like a successful business.  One is tempted to believe that Mr. Romney will say almost anything to avoid giving the President any credit at all for the improvements to healthcare made possible by the Affordable Care Act.

Perhaps Mr. Romney's stunning announcement was a secret message to the bottom 47% - those whom he is "not going to worry about" - that he plans to look the other way while all you freeloaders out there cash in on taxpayer largesse. After all, Mitt has already told us that millions of Americans - nearly half of the entire population, in fact! - are inveterate moochers, impervious to the efforts of productive citizens like Mitt and Bain Capital to get them to be responsible for their own lives. What can anyone expect, Mitt seems to imply, of the feckless rabble of incorrigibly lazy takers?

The Romney/Ryan plan for the future of America is one which not only repeals the Affordable Healthcare Act, but one which goes much further, ending current Medicare and Medicaid programs, too. But, Lord Romney does not see that as something the 47% ought to be complaining about. After all, if he and Paul Ryan succeed in getting elected, the soon-to-be uninsured seniors, veterans and poor children - like Reagan's "welfare queens" - still can (and probably will, damn them!)  ride in style to the ER since they probably won't have the decency to just expire in their slovenly digs and get off the taxpayer dime.  It's pimp my ride - ambulance edition!

No Health Insurance? No Problem. Romney Says That Freeloading In the ER Is Now All Good, Rick Ungar, Forbes Magazine, September 24, 2012.

Hey, maybe Gramps can mooch a
free scooter from the taxpayers, too.
What d'you say, Mitt?
Apparently, when 2002 Mitt Romney decided to divorce himself and split into two, distinct entities, the ‘other’ Mitt Romney gained possession of the Governor’s cognitive skills —including the ability to recall why Romney supported the Massachusetts universal care effort in the first place. It was, after all, 2002 Mitt Romney who often highlighted the inefficiency of emergency room care as the sole option for uninsured Massachusetts residents, allowing them to get free care while those who are insured are left to pay the bill.

It would also appear that it was the ‘other’ Mitt Romney who gained custody of the understanding that while our laws require emergency rooms to treat patients in an effort to stabilize their health condition, the law does not require the treatment that can ultimately restore all of these patients to health.

Mitt Romney, On 60 Minutes, Cites Emergency Room As Healthcare Option For The Uninsured, Huffington Post, September 24, 2012.

"Well, we do provide care for people who don't have insurance," he said in an interview with Scott Pelley of CBS's "60 Minutes" that aired Sunday night. "If someone has a heart attack, they don't sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care."

This constitutes a dramatic reversal in position for Romney, who passed a universal health care law in Massachusetts, in part, to eliminate the costs incurred when the uninsured show up in emergency rooms for care. Indeed, in both his book and in high-profile interviews during the campaign, Romney has touted his achievement in stamping out these inefficiencies while arguing that the same thing should be done at the national level.

Romney's New Health Plan: Go to the ER, Jonathan Cohn, The New Republic, September 24, 2012.

Not kidding, America.
It’s possible to believe simultaneously that ERs provide care to everybody who needs it and that they are an inefficient, expensive way to do that. But the Romney who made that statement in 2010 was making the case for having government do more to cover the uninsured, while the Romney who made that statement yesterday was making the case for having government do less.

And that’s really the most important point of all. Remember, Romney doesn’t simply want to repeal the Affordable Care Act, effectively taking health insurance away from 30 million people who, starting in 2014, are likely to get it from the law. He also wants to end Medicaid, making cuts that would leave between 14 and 27 million additional people without insurance. And he wants to change the tax treatment of employer health benefits, in ways that could make coverage more expensive or harder to get.

Medicare, Just Elderly Welfare Queens: And What IS Insurance Anyway? Heartland Liberal, Daily Kos, September 24, 2012.

What we are talking about here is the attempt by the Republicans to demote and denigrate the elderly on Medicare to the status of welfare queens. After all, they have been so successful with their past campaigns of demonization of target segments of the electorate, recently upping the ante and telling us that unions, teachers, firemen and policeman are the great drain on the economy, why stop now?

But it occurs to me what is totally missing from the Republican definition of the problem is the very simple and straightforward issue of just what is medical health insurance, anyway?

The Republicans seem to think that everyone, even those Americans at the poverty level, if they just set aside enough savings, will have plenty of money to cover all their medical expenses. After all, isn't personal responsibility the watchword of the Republicans?

But that is not how medical insurance works. That is never how it has worked, since it's current incarnation started really less than 100 years ago, nor is it how any insurance works.

*Emergency Medical Treatment and Active Labor Act, U.S. Act of Congress, 1986 (wikipedia)

The Emergency Medical Treatment and Active Labor Act (EMTALA) is a U.S. Act of Congress passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions. Participating hospitals may only transfer or discharge patients needing emergency treatment under their own informed consent, after stabilization, or when their condition requires transfer to a hospital better equipped to administer the treatment.

Move over, Welfare Queens! Granny the ER Queen is on a roll! (photo via daughternumberthree)