As a physician practicing full-time emergency medicine, I’ve spent thousands of hours treating patients in an acute care setting. During that time, I’ve seen America’s health care system at its best – lives saved, diseases cured, health restored. The daily contribution by our health care system towards the reduction of human pain and suffering is incalculable. American health care is unparalleled in the developed world and, without doubt, if a person is sick or injured, America is the place to be.
Regrettably, however, America’s health care system has a dark side as well – one populated by those who abuse themselves by abusing street drugs, alcohol, or prescription pain medications, those who chronically make poor lifestyle choices, and those who are generally out to beat the system. This dark side of America’s health care system is a side that, as a health care provider, I know all too well, yet, ominously, it’s a side many Americans don’t even know exists. Nevertheless, whether one is aware of this dark side of American health care or not, it’s a side that can hurt us all.
Average Americans are actually very decent people – hardworking, dependable, responsible, compassionate, charitable, and concerned about their fellow citizens. Further, the average American isn’t a substance abuser, doesn’t consistently make poor lifestyle choices, and isn’t out to get something for nothing. In fact, such activities are so typically foreign to them as to be beyond their awareness and even comprehension. Therefore, it often comes as a surprise to many of these average Americans when I recount the myriad stories of waste, fraud, and abuse I witness daily in the emergency room.
For instance, not so long ago, I treated a middle-aged woman who presented to the emergency room with a complaint of low back pain. The patient was well known to the ER staff, having been to that particular emergency room 43 times that year alone, of course, all at taxpayer expense. Her story was that someone had stolen her pain medication which she needed for a chronic back problem. Typical of this common scenario, the patient stated she hadn’t been able to see her doctor for a refill. When I asked her to describe the nature of her back problem, she couldn’t. When I asked what her MRI had shown, she explained that she’d never had one – the reason being that she missed her appointment. When I told her I would like to speak to her doctor, she proceeded to tell me she had recently stopped seeing her previous doctor and was in the process of finding a new one but hadn’t gotten around to it yet. Needless to say, I declined to write her a prescription for her pain medication after which she called me a few choice names of the four-letter variety.
The same night, another middle-aged woman arrived via ambulance to the emergency room. She was complaining of chest pain. It was her seventh ambulance transport to the ER that month – seventh – each time complaining of chest pain. Each time her cardiac workup was negative, yet, each time her urine drug screen was positive for cocaine. Though she had a healthy heart, the stimulant effect of the cocaine induced heart strain which resulted in significant pain and discomfort. Nevertheless, we were bound to perform a complete cardiac workup – the seventh that month – to the tune of many thousands of dollars, again, of course, at taxpayer expense.
Frustratingly, the above stories are so commonplace in emergency rooms across the country that they’ve essentially become clichés barely raising the eyebrows of health care providers. In fact, the problem is so extensive that few believe anything can be done to correct it. The waste, fraud, and abuse plaguing America’s emergencies rooms, a problem I’ve spoken about often and written about in the past, is costing productive Americans billions of dollars annually. I’ve long believed that if a portion of those wasted funds could be recouped by the government, Uncle Sam could afford to purchase private insurance coverage for every man, woman, and child in America.
And, yet, nothing is being done. Why? Several reasons. First, those who draw attention to the fact that certain patients abuse the health care system, particularly emergency rooms, are quickly labeled as uncompassionate. Further, medicine is a complex field and those with the expertise to suggest meaningful solutions to its many problems are generally outside the legislative process. In addition, with the ever-present threat of litigation hanging over its head, the health care industry is hesitant to even approach the subject of meaningful reform for fear of becoming mired in future lawsuits.
However, those concerns are no excuse for inaction. The health care reform America desperately needs is not in the form of socialized medicine but rather in legislation that promotes responsible utilization of our health care resources. In an emergency situation, in particular, inappropriate utilization of health care resources puts all Americans at risk. Imagine your mother, or husband, or best friend dying of a heart attack while awaiting the arrival of an ambulance that is delayed because it is being used to transport a crack addict to the hospital for the seventh time in a month. It’s time for Americans to get the word on what’s happening on the dark side of our health care system. After all, it’s what you don’t know about the American health care system that can hurt you.