I started a post about what one is not entitled to. This thought led to some very interesting conversations, both before I started my draft and after, when people at work were on the same thought wave. We have been inundated with – well, Mexicans (by nationality not necessarily ethnicity) – at work, and many many lower income lower socieoeconomic strata people lately. They, many of them, seem to think that we ‘owe’ them something and take offense at the least appearance of slight. I can’t tell you how many times I’ve heard that I’m discriminating against someone because of their insurance, race, sex, perceived sexual orientation recently. Now, along with the pressures that I’ve been facing with the disintegration of my marriage, the destabilization of my job, and worry about the future, I simply don’t have the mental reserves or general optimism I used to have to be able to take the time to really think about what the motivations were for these peoples’ anger and dissatisfaction.
It finally dawned on me that it comes from resentment. People have been fed this bullshit lie that they are entitled to the newest car, the best clothes, the nicest and biggest house, the most money, and probably most importantly, happiness as a 24/7 proposition. No wonder they’re so resentful! They come to the emergency room expecting the TV version of what happens — you get seen right away, you get whatever you want in the cleanest room, with the nicest and handsomest doctor, and the most pleasant nurse who attends to your every need. And they are naturally demanding, because they have been led to expect that they will be treated as customers who are always right and whose every desire (note desire, not medical need) will be catered to.
Of course, this is not the reality. When expectations don’t meet with reality, things go downhill.
One of the triage nurses who has worked at the facility for over 30 years told me of a woman she triaged a while ago; this woman was Mexican and Spanish speaking only , so through an interpreter she had to get the information about the woman’s reason for being there to be seen. Well, she had just gotten emergency state insurance and was at our facility to get breast implants; it seems that she was led to believe that if she could just get insurance she could have whatever plastic surgery she desired. Even though the triage nurse and the interpreter both spent about 15 minutes explaining to her that even if she had private insurance that still would not be covered, she didn’t believe them. So she went to a room, cost the state several hundred dollars in emergency room and doctor fees, only to have the physician explain to her the exact same thing. This is more common than you might realize. People get upset that we won’t give them their prescriptions, that we only give them a paper script they have to take to a pharmacy and fill themselves. They get upset that we won’t call them in (if we did that we’d have to hire a nurse to do nothing but that 24/7). They get upset that we won’t give them a voucher for over the counter medications or prescriptions that cost a whopping $4.
As the social safety nets continue to break down, the level of resentment will only increase. We are seeing more and more people that are in the emergency room because they have lost their jobs, don’t have insurance, and although they have a doctor, the doctor will see them on a cash only basis. So when they get sick, or need medication refills, they come to the emergency room because they know they have to be seen. Between the people who expect us to treat every little thing like it is a doctor’s office, and the people who can’t see their doctor due to no money, we have five and six hour waits lately just to get to a room. Now admittedly that is better than in many parts of the country, but for us at our facility that is simply unheard of. And it creates a problem of its own: LWOT.
Left WithOut Treatment. Why would this be a problem you ask? Well, for one thing we didn’t see them; we failed in our duty. For another, usually it’s the people with actual private insurance who leave; they have other options and while most of the time the wait isn’t any less anywhere else, they simply can’t stand the waiting any more and leave. This hurts the hospital financially because the private insurance actually pays the bills. State insurance pays about 5% or so less on average than it costs the hospital to provide services for the patient.
This means that hospital costs go up, for those that actually DO have insurance, which means that premiums go up, which increases costs to businesses and subscribers, which bumps more people out of the market of affordability for insurance…do you see a trend here? If you want to know why insurance costs are so high, why healthcare is unaffordable (aside from the obvious greed of turning a service to one’s fellow man into a profit making machine) you need look no farther than here: the gap between insured and uninsured.
We no longer have the money for it, but we need nationalized health insurance. Not the crap Obama is proposing, which still benifits only those who can afford insurance and those running insurance companies and big pharma, but true access to doctors in their offices for all — preventative healthcare, not emergency room focused treatment.
If this trend continues, there will be more and more emergency rooms across the nation closing down. As well as labor and delivery facilities. We already had one of each close in our metropolitan area due to the overwhelming numbers of illegals and uninsured vs. insured patients. It simply became too costly for the hospital to continue. Which is sad because it was, at one time, a very nice facility with state of the art equipment and staff. I would hate to see that happen to ours, but I can see it eventually coming without some serious changes in how we view these things.