Entitlements


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.

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2 responses

  1. I find your point of view quite interesting. I, personally, see the problem as having the same cause, but the exact opposite solution. So-called “universal health care” definitely IS also a problem of entitlement. But it’s not simply a problem of “those other people” or illegal immigrants. Sure, those people add to the burden, but they are not the cause of the problem. The cause of the problem is US. Regular Joe Sixpack who thinks that he is entitled to the best health care that money can buy at little to no cost to himself. Nobody is entitled to health care. While it would be nice if everyone had it, in order for someone to be “entitled” to such a thing it requires that time/money/resources be forcibly taken from someone else in order to provide it.

    I don’t want to see anyone go hungry, but that doesn’t mean that we should demand McDonald’s and Safeway to start giving away food. In the same way, I don’t want to see anyone’s health problems go untreated, but we cannot demand that hospitals give out free health care.

    We need to go back to a system where people pay for what they need rather than expecting everyone else to pay for it. We need to go back to the ideal that insurance is there to insure against catastrophe and not to cover the cost of unnecessary doctor visits and overpriced medications that most people probably don’t really need. Mostly, we need to get it through our heads that demanding “free” health care is no different than stealing from our neighbor or our local health care provider.

  2. But see, that’s what I’m talking about. The biggest problem is that people abuse the system. They have no idea what the true cost of the health care they are receiving IS and therefore they expect way too much. If we had universal health care — not universal hospital care — people would go to their doctors, and the doctors would see them because otherwise they wouldn’t get paid, and many of the problems that end up in the ER would be avoided entirely. I would say 90% or more of the things we deal with in the emergency room could have and should have been dealt with via the doctor’s office. The fact that doctors no longer directly admit their patients, who need admission for stabilization and more intensive treatments, also impacts us. Instead they send their patients to the ER where they get the $3 million dollar workup, wait hours, and might get to a bed on the floor within 24 hours.

    I do agree with you that people should have a stake in their care. And if everyone paid taxes for that, and the money actually WENT toward that, instead of paying for bailouts of multinational corporations, it would work. The problem is that we advertise our country as being an equal opportunity place and it’s NOT. The reason other countries have a better system is that no, they don’t have all the cool (and mostly unnecessary) bells and whistles, but they do have access to basic care as well as hospital care when needed; they fact that they get basic care means that they need much less hospital care and what they do use is lower cost. If Cuba has the same lifespan as the US with literally 1/10 the cost inputs, then we are doing something very wrong…and that’s the profit motive at work, but also the expectations of our populace. They work hand in hand to create the monstrosity we now have.

    There is a large difference between health care and hospital care; you are talking about hospital care which I agree no one is entitled to. I am talking about health care, preventative maintenance if you will, that I firmly believe everyone IS entitled to. Take care of the health to start with and you won’t have the volume of ‘sick’ to deal with in the end. And hospitals are already required to give out free care; they cannot turn anyone away due to lack of ability to pay, and they cannot NOT admit a person who doesn’t have insurance if they need admission, and they can’t transfer the patient to another facility due to lack of ability to pay. So hospitals ARE required to give it away. That’s why the people with insurance get screwed, because they’re shouldering the entire burden of the costs.

    The whole system needs to be scrapped. And I say this as a cog in that great machine.

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