We fling open the doors of America’s emergency departments to help those who can’t afford health care. We have legislated this protection: No person can be turned away for financial reasons. This is very compassionate and represents the higher angels of our culture. Alas, it also is emblematic of the stupider demons of government. You see, the ER demonstrates the inverted priorities of American society.
In the ER, expensive tattoos abound. Piercing is ubiquitous. Almost every adult and child has a smartphone, it seems. All too many spend the duration of their ER visit glaring at the screen of said phone; barely looking up at the physician who is attempting to engage them in meaningful conversation about the reason they came for care.
Cigarettes populate purses and drug screens are notoriously positive for at least chronic narcotic pain medications, but often other substances, among them marijuana and amphetamines.
Dental care? It is regularly ignored because, in the words of my patients, “I don’t have dental insurance.” Guess what. Neither do I, and I pay a lot for insurance. Dental care has typically been a cash business. That’s why dentists, crafty guys and gals that they are, spend their time mucking around the human mouth. Floss and toothpaste? Seems a bit excessive compared to a nice new tattoo.
But, on the southern end of things, carefully groomed pubic hair is not at all out of the question. The teeth may fall out; the nether regions will be carefully tended.
It’s all about priorities: those of individuals and those of leaders. Our leaders, ever convinced that we must give medical care to those perceived to be in need, often forget that modern definitions of poverty and need may be a bit different from need throughout human history. And that if a family has an expensive cell plan, new truck and big-screen TV with satellite, it might not be unreasonable to ask them to put up a little money for their own health care.
A woman told me, recently, that her daughter (at birth) had a minor congenital abnormality that required daily application of a cream. “And I had to spend $200 of my own money!” She was aghast. As are all of those who will gladly pay anything for Oxycontin (legal or otherwise), but who are offended and downtrodden when their antibiotic isn’t free at the local pharmacy.
We can’t keep this up. We’ve created a monstrosity of entitlement. I care for the poor; I love the poor and have always tried my best to help those in genuine need. Those truly hurting.
But when cosmetics, vices and electronics are considered reasonable expenditures while the rest of us pay for necessities like prescriptions (or over the counter Tylenol and Motrin as I’m often asked to prescribe for Medicaid), then we are entering the death spiral.
Hate me if you want. The truth is unpleasant.
But it is clean-shaven.
Edwin Leap is an emergency physician who blogs at edwinleap.com and is the author of The Practice Test.
elpasospeak 
I understand what he is saying, and I know that far too many people, largely through ignorance, fail to practice sound preventative measures. I also know that a good bit of these problems that the good doctor sees weren’t such problems in the pre-Reagan world that outlawed health care for profit. I seem to recall more health services actually provided by local and State health departments, and the cost of a doctor’s visit being more within the range of affordability of most people. As for tatts and drug use, and dental neglect, I’d say that ignorance also plays a part there, but again, more could be done by a government that cared about people to prevent these things than we have seen since the days of St. Ronnie.
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Wow.
First of all, this author, if you visit his blog, was one of those doctors that predicted the passage of the affordable Care Act would be the end of healthcare in America as we knew it and that all doctors would quit en mass and sell real estate. That didn’t happen. So his credibility, to begin with is suspect.
My understanding is that hospitals are required to stabilize patients in emergencies. They aren’t required to take on all cases, like a sore throat, and yet they continue to do so. Why? It makes a profit. If you don’t think ERs are money machines, then why are so many ER Clinics popping up around El Paso? It is because those places can charge ER prices for even the smallest of emergencies. Have you noticed the commercial that shows the little girl twisting her ankle while roller skating? Where does dad take her? The ER!
His take on tattoos is kind of strange as well. As far as I can see, people get tattoos over a long period of time and tattoos cost about $300. What is the difference between a poor person having a tattoo a rich guy having a Mercedes? The point is, I bet the guy with the tattoo and the guy with the Mercedes probably were not thinking about their next trip to the emergency room when they purchased what they purchased.
His take on body grooming is bazaar. So someone shaves their private parts. So what? I don’t think that costs a whole lot of money. Because someone shaves their pubes he equates that with rotting teeth? I think that he is drawing a false equivalency there. There are many causes of poor dental health: addiction, alcoholism, poor diet, genetics, cancer treatments… To lump bad teeth with shaved nether regions is frankly crazy.
As for Smartphones…most people of substandard means that I see have Android phones, which are given away for free by many carriers. Heck, there was one smartphone vendor that offered FOUR free smartphones with a single family account. So his “expensive electronics” comment is probably incorrect as well.
He touches on the opioid crisis with the woman and the $200 cream story. Funny story there: Opioid addiction is directly tied to doctors and pharmaceutical companies over prescribing that particular type of medication. Whose fault is it when DOCTORS are the primary dispensers of narcotics? He blames the patient. He needs to look in the mirror. (My bet is he probably only blames poor people for being addicted and not folks like Rush Limbaugh, probably America’s most famous opioid addict who is now clinically deaf because if it.)
We would not even be having this discussion if healthcare in the US was in any way reasonably priced. He might have a decent argument if physicians didn’t charge $150 for a 10 minute visit, if hospitals didn’t charge $15 for a Tylenol, or a root canal didn’t require a loan from the bank.
If anyone thinks that health care is reasonably priced, just take a three minute walk over the Santa Fe bridge downtown and see how much your prescription, made by the same company, in the same factory, costs in Juarez. You might also see the number of Americans lined up in Juarez dental clinics, getting the same treatments at about 1/3 of the cost.
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The point is that people spends lots of money on tats, cell phones, manicures, etc but expect someone else to pay for their health care. If a guy with a Mercedes expected someone else to pay for his health care, that’s the same thing.
We would not be having this discussion if health care in the US were competitive and pricing transparent so people could shop around. We would not be having this discussion if people could shop for the best insurance program nationally, not just in the state they live in. We would not be having this discussion if health care were decided by the patient and doctor without the insurance company and government getting involved.
25-30 years ago a person could walk into a doctor’s office and pay a reasonable amount out of pocket for the visit. What was a $30 office visit has now become a $300 dollar visit. Gotta pay all those folks at the insurance company and the person at the doctor’s office who submits the insurance.
It would be nice if you discuss the issues without the ad hominen attacks on Rush Limbaugh and the author of the blog.
What do you think should be priorities? A person’s health or tats, cell phones, and manicures? Should I be responsible if a person choses a smart phone over his family’s health? I don’t think so, but maybe you do. If you are ok with enabling unwise choices why are you education?
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AH,
Not ad hominem anything. If you are discussing an essay, it is important to see where the author is coming from. I merely went to his blog site and reported what I saw. The vast majority of his entires are right leaning. That is neither good nor bad. It just is.
The author lumps the opioid crisis victims into a “poor people making bad decisions” stew, when in fact is is across economic strata, as I pointed out with Rush Limbaugh. I wasn’t attacking Limbaugh, I was merely saying that the author is painting a picture that is not completely correct. He leaves off the fact that rich people are addicts as well.
I have a big problem with this entry, because he is painting with such a broad brush: All poor people make bad decisions/poor decision when it comes to health care so they don’t pay. When in fact the problem is much more complex than that.
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Tim Holt and others
It doesn’t matter if rich or poor still the Doctor bitching about opioid use many of these drug got on the street because Doctors wrote the prescriptions and handed these drugs out like candy and took the kick backs from big pharma reps. Example about two months ago we had pretty major cancer surgery and yep we were handed a whole heaping helping of opioids which we only took one with in less than 24 hours after the surgery. Yep we had pain but toughed it out. The problem is we have some people if they get a hang nail they demand pain medication and the medical community feeds into to this demand.
In addition it took us four year to get our cancer treated but we were told the other day everything is looking great. We had to wait until we could offered our own private insurance to get it done which we never could get done with ACA insurance because the cost was prohibitive even at UMC El Paso. Oh we have no tattoos or have we every owned a smart phone or cell phone for that matter or did we every get the big screen TV or have we every had a lone star card. Sure the entitled are a problem but the other side Doctors, insurance company and the medical industry has also been an entitled class for some time now in taking the public dime to and they have had zero problems with taking their entitlements!
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ManMoon – I agree with what you say about over prescribing of opioids. I know someone with a major addiction to to pain killers and her doctors just keep prescribing. Some doctors are finally catching on. My doctor has told all his patients he no longer prescribes controlled substances. This is by choice, not because he’s sanctioned by the DEA. He’s tired of being hit up for pain killers. You’re right. Not all people who need health care and insurance has expensive toys. We are living with a broken system and Congress won’t even do anything about it because of politics. Doctors who have worked for years for their degrees are caught in the rotten system too. I wouldn’t want to be a doctor these days. Tell your kids to go into engineering.
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Can’t speak with any expertise regarding cost of healthcare but do believe insurance and corporate profits add to the problem. The entitlement culture I believe is part of the peoblem too. Notice the woman with ornate manicure and pedicure, intricate coffure, multiple body piercings, and the tatoos paying for groceries with a Lone Star card. Or the woman with a babe in diaper sitting in the cart, another toddling in tow, and a bun in the oven about to burst out, again paying with the Lone Star card. See the deli tray full of chicken wings with a center bowl of ranch dressing all ready for the football party, displays a sticker notifying the item can be purchased with the Lone Star card. All indications of a welfare entitlement culture we have allowed to develop and continue.
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Having worked in the ER for many years, it honestly is a lot like a restaurant. The ER doctor is the waiter. I am shuffling several patients at once, trying my best to make them all feel like the center of my attention even though there are 8 of them all with their particular demands. I am essentially a highly skilled waiter.
The difference is the method of payment. In a restaurant, everyone pays for what they order. In the ER “restaurant” you order but there are no prices listed. By law, they cannot mention price until your initial order. And when done with your meal you walk out without paying.
Now, the restaurant sends you a bill in the mail. Essentially there are three types of customers:
1. Some do not pay their bill at all and have no real means to pay it so they get away for free.
2. Others pay but have meal insurance that contracts a pre-determined price that it will pay no matter what the bill is.
3. Others can pay all or some and hope for the best when the bill comes.
Now, the restaurant, like any business, is out to make money. And, unfortunately they have 17-36% of their customers that just do not pay. And the second group pays a contracted rate that is negotiated with steep discounts off the full rate. Finally, the last group pays the full rate. Or, at least that is the starting point for negotiating how much they will pay.
So, you are setting rates for the restaurant, and you want to maximize profit. Raising your rate has no effect on customer #1, they are just an ongoing business expense. It doesn’t affect customer #2 right now but it might eventually when the contract is renegotiated. Finally, the more you charge #3, the more you will likely get from them. There is no benefit to lowering rates. This isn’t Walmart, you don’t get more customers by a lower price point. Supply and demand is irrelevant.
So, what rates do you set?
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I am a doctor, why would anyone with a brain choose to become one these days. I hate tell the misguided soul, with the entitlement mentality excuses that posted above, that a very large number of doctors have quit or been absorbed by huge hospital corporations in the last three years. it has been mentioned that patients take their children to the ER for sprained ankles. Just try finding a doctor outside of an ER to see in short notice-they don’t exist anymore-ACA assured that! I get up every day and wonder how much longer I can tolerate the BS that is necessary to see patients in today’s medical environment. And-NO-you are not entitled to medical care-myself or any other doctor can go home permanently. Last I checked this WAS a free country!
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The doc blogger is obviously a member of the grand old party that likes to complain about and blame the poor guy and the immigrant for draining our economy, taking our jobs, committing all the crimes, and somehow managing to invade the country getting past fences, walls, and ICE patrols. Maybe he should worry more about the costs or , truthfully, profiteering of war mongers, gauging executive payolas, tax free billionaires, de-regulation of health and safety restrictions on polluting companies, and big pharma charging an arm and a leg for those brand meds. Maybe the doc who loves poor people didn’t have much to say when his senators were secretly “drafting” a better health care bill that was going to take away health care for 20 to 30 million people to give more tax breaks to the rich. Maybe he should look in the mirror instead of at those cell phones and tats. I’m a retired middle class educator with insurance who went to the ER last year and saw a nurse practitioner for 5 minutes who gave me a morphine shot for my pain after asking me a couple of questions, never examining me, not doing one lab test or other exam. The bill was about $1500 for the ER services and about $3500 for the doctor who I never laid eyes on. Let’s not be hypocrites; take a good look at who’s really raking it in.
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Some doctors and clinics play the system but most doctors who want to help people (yes, mambo man there are quiet a few) are caught in the broken system with the rest of us, whether we have insurance or not. Rich and poor alike used to be able to go to the doctor and pay a reasonable fee out of pocket. Then insurance companies got between he patient and doctor and ruined that. Those with insurance were told they wouldn’t have to pay for doctor visits anymore. Ha, what a joke. They actually pay more with the cost of insurance. Poor people with no insurance got screwed, emergency room visits started to increase, etc. etc. Mamboman, look at the facts and don’t play identity politics. It doesn’t do you or anyone else any good.
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Why would anyone want to be treated by a doctor who speaks publicly about patients, any patients, in such a demeaning, negative way?
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The truth is the truth.
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A copy needs to be sent to all politicians!!
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