The Real Problem with Healthcare

The massive flux of infected individuals to emergency departments during this most recent flu outbreak underlines an integral weakness of our healthcare system: the reliance on emergency rooms for minor, non-life threatening ailments that could be evaluated in a more appropriate setting, and even worse, the usage of the ER for no medical reason at all.

Emergency rooms all across the country are bearing the greatest burden in dealing with this recent flu outbreak. Data for the most recent week show that over 800 individuals visited emergency departments throughout New York City. However, of these more than 800 visits to emergency departments, fewer than 100 required hospitalization. This means that roughly only one out of every eight people who sought care at an emergency department in New York City had an influenza case that directly or indirectly required hospitalization. Can you imagine how much more manageable this outbreak would be for hospital staff if only about 100 patients sought care this week rather than 800?

This outbreak serves to highlight an issue that is insidious, but omnipresent in emergency departments around the country day in and day out. Inappropriate use and misuse of the ER is a social problem that needs to be dealt with and is not addressed by legislation.

Many Americans turn to emergency departments because they have no primary care doctor, face long waits for appointments, or are otherwise restricted from or unwilling to participate in the broader healthcare system. Many of these patients are of low socioeconomic status in urban areas and have nowhere else to turn for routine medical care owing to lack of resources. Still others resort to the ER to get off the street, out of their houses, or generally for no medical reason at all. All of this contributes to excessive medical costs.

A 2010 study by the RAND Corp. estimated that 13.7 -- 27.1% of all emergency department visits could have been handled at another, more appropriate location. The study estimates that this inappropriate use of the emergency department cost about $4.4 billion annually. Additionally, the study cites that if an urgent care center or retail clinic were utilized instead of the ER, costs for the same care received in the ER would be $228 - $414 and $279 - $460 cheaper, respectively. This would amount to an additional monetary savings overall. While the monetary cost of this misuse is significant, the real cost lies in the loss of time and resources in the ER that could have been dedicated to treating those with an acute, life-threatening conditions.

The system is undoubtedly broken. This is perhaps best demonstrated by the extent of abuse in the ER as opposed to the misuse explored above. Before entering medical school I was a volunteer emergency medical technician (EMT) for many years. I also worked EMS in an urban environment for two years. The reality is far from what you see on television. The vast majority of the calls I answered as an EMT did not even require a hospital, let alone an ambulance. A nosebleed at 2 AM? A toothache at 5 AM? These examples don't include the drunk, high, homeless "frequent-fliers" that didn't quite do anything bad enough to be arrested, but couldn't quite legally stay where they were. These individuals became the emergency department's problem.

It doesn't end there. So many people spend their time learning how to game the system, as anyone who works in the healthcare field can tell you. The homeless know that the ER means a warm bed and a hot meal. The drug seeker with the new iphone, 50 inch HDTV, and medicaid card knows he stands a chance at getting pain meds if he fakes an injury or complaint. The toothache is convinced that if they arrive by ambulance they'll be seen faster (not true) and thus decides to call 911 rather than drive themselves. The same homeless man from above knows that when he is about to be discharged if he states that he wants to kill himself he'll be able to keep his bed and add a few more courses to his meal. Everyone is trying to game the system.

The sad truth is that while responding to calls such as those listed above, others who summoned 911 with a legitimate medical emergency, in many instances, had to wait. These incidents occur around the clock, all over the country. This is what is causing the astronomical healthcare costs in America. These are the issues that need to be tackled.

To my knowledge, no legislation has been proposed to revamp our healthcare infrastructure and tackle these issues. Obamacare has been approved and is slowly being implemented, but it is merely a shell game that does nothing to solve the issue of revamping the system. It will shift money around, raising some taxes, lowering some reimbursement rates, increasing government dependence, and essentially robbing Peter to pay Paul. You can expand health insurance to the uninsured (though even under Obamacare the CBO estimates 30 million will still be uninsured in 2022), but it doesn't fix the mindset, habits, and reality of our healthcare system and those that abuse it.

We need to begin work on taking concrete steps to reconstruct the healthcare infrastructure. The creative math and overall complexity of Obamacare does little to alleviate the ills of a faltering health system. This is reaffirmed by its lack of bipartisan and, on a larger scale, American support. Americans don't want to have to worry about whether or not their employers will drop their coverage or if they'll have to enroll in a new government plan. They want access to the superb, quality care of the country with the greatest technology, science, and facilities.
I am not an expert on health law. As a second year medical student I am early on in my medical career, but I have been around long enough to become disgusted with the misuse, abuse, and, at times, downright malice with which our healthcare system is used. Until we tackle the issues that contribute to this abuse and combat the mindset that perpetuates them, shifting money and expanding government coverage is futile.

The massive flux of infected individuals to emergency departments during this most recent flu outbreak underlines an integral weakness of our healthcare system: the reliance on emergency rooms for minor, non-life threatening ailments that could be evaluated in a more appropriate setting, and even worse, the usage of the ER for no medical reason at all.

Emergency rooms all across the country are bearing the greatest burden in dealing with this recent flu outbreak. Data for the most recent week show that over 800 individuals visited emergency departments throughout New York City. However, of these more than 800 visits to emergency departments, fewer than 100 required hospitalization. This means that roughly only one out of every eight people who sought care at an emergency department in New York City had an influenza case that directly or indirectly required hospitalization. Can you imagine how much more manageable this outbreak would be for hospital staff if only about 100 patients sought care this week rather than 800?

This outbreak serves to highlight an issue that is insidious, but omnipresent in emergency departments around the country day in and day out. Inappropriate use and misuse of the ER is a social problem that needs to be dealt with and is not addressed by legislation.

Many Americans turn to emergency departments because they have no primary care doctor, face long waits for appointments, or are otherwise restricted from or unwilling to participate in the broader healthcare system. Many of these patients are of low socioeconomic status in urban areas and have nowhere else to turn for routine medical care owing to lack of resources. Still others resort to the ER to get off the street, out of their houses, or generally for no medical reason at all. All of this contributes to excessive medical costs.

A 2010 study by the RAND Corp. estimated that 13.7 -- 27.1% of all emergency department visits could have been handled at another, more appropriate location. The study estimates that this inappropriate use of the emergency department cost about $4.4 billion annually. Additionally, the study cites that if an urgent care center or retail clinic were utilized instead of the ER, costs for the same care received in the ER would be $228 - $414 and $279 - $460 cheaper, respectively. This would amount to an additional monetary savings overall. While the monetary cost of this misuse is significant, the real cost lies in the loss of time and resources in the ER that could have been dedicated to treating those with an acute, life-threatening conditions.

The system is undoubtedly broken. This is perhaps best demonstrated by the extent of abuse in the ER as opposed to the misuse explored above. Before entering medical school I was a volunteer emergency medical technician (EMT) for many years. I also worked EMS in an urban environment for two years. The reality is far from what you see on television. The vast majority of the calls I answered as an EMT did not even require a hospital, let alone an ambulance. A nosebleed at 2 AM? A toothache at 5 AM? These examples don't include the drunk, high, homeless "frequent-fliers" that didn't quite do anything bad enough to be arrested, but couldn't quite legally stay where they were. These individuals became the emergency department's problem.

It doesn't end there. So many people spend their time learning how to game the system, as anyone who works in the healthcare field can tell you. The homeless know that the ER means a warm bed and a hot meal. The drug seeker with the new iphone, 50 inch HDTV, and medicaid card knows he stands a chance at getting pain meds if he fakes an injury or complaint. The toothache is convinced that if they arrive by ambulance they'll be seen faster (not true) and thus decides to call 911 rather than drive themselves. The same homeless man from above knows that when he is about to be discharged if he states that he wants to kill himself he'll be able to keep his bed and add a few more courses to his meal. Everyone is trying to game the system.

The sad truth is that while responding to calls such as those listed above, others who summoned 911 with a legitimate medical emergency, in many instances, had to wait. These incidents occur around the clock, all over the country. This is what is causing the astronomical healthcare costs in America. These are the issues that need to be tackled.

To my knowledge, no legislation has been proposed to revamp our healthcare infrastructure and tackle these issues. Obamacare has been approved and is slowly being implemented, but it is merely a shell game that does nothing to solve the issue of revamping the system. It will shift money around, raising some taxes, lowering some reimbursement rates, increasing government dependence, and essentially robbing Peter to pay Paul. You can expand health insurance to the uninsured (though even under Obamacare the CBO estimates 30 million will still be uninsured in 2022), but it doesn't fix the mindset, habits, and reality of our healthcare system and those that abuse it.

We need to begin work on taking concrete steps to reconstruct the healthcare infrastructure. The creative math and overall complexity of Obamacare does little to alleviate the ills of a faltering health system. This is reaffirmed by its lack of bipartisan and, on a larger scale, American support. Americans don't want to have to worry about whether or not their employers will drop their coverage or if they'll have to enroll in a new government plan. They want access to the superb, quality care of the country with the greatest technology, science, and facilities.
I am not an expert on health law. As a second year medical student I am early on in my medical career, but I have been around long enough to become disgusted with the misuse, abuse, and, at times, downright malice with which our healthcare system is used. Until we tackle the issues that contribute to this abuse and combat the mindset that perpetuates them, shifting money and expanding government coverage is futile.