Stanley Feld M.D., FACP, MACE Menu


Perverse Outcomes Resulting From a Distorted Healthcare System.


Stanley Feld M.D.,FACP,MACE

A great comment was sent to me by an Emergency Physician in reference to the increased Emergency Room visits despite the increase in insured people in the state of Massachusetts. He referred me to his blog.

Unfortunately the destined to fail Romney healthcare plan of Massachusetts is being hailed as a breakthrough by healthcare policy wonks all 50 states. They do not understand the healthcare system.

I am very happy that physicians are starting to use the blogosphere to explain the defects in the healthcare system. Politicians and citizens should listen. It is going to take a citizens’ movement to change the frightful direction of the healthcare system.

In the 1970’s,my father drove my brother and me (both Texans by then) through destroyed neighborhoods in New York City. He wanted to show us the degradation of once viable neighborhoods.

I will never forget him telling us politicians cannot see any of this from 30,000 feet above the ground. The reason health policy wonks and politicians do not see the destruction of the healthcare system is because no one is looking at it at street level. The street level physicians could tell politicians what is going on but none of the politicians are asking or listening. The blogosphere has given physicians a voice. I am happy physicians are taking the time to tell people what is going on. Hopefully someone will listen soon.

Charity Doc is an emergency room physician who describes himself as follows;

“ I once had aspirations to make a difference in the world, now I just work at it one guaiac card at a time. The lucky ones come back negative. Blue’s a bad color!”

He states:

“In honesty though, we’re not all heartless, money-grubbing bastards. We’re here to help everyone who truly needs our expertise.”

I believe him because physicians at all levels are feeling as dispirited as Charity Doc.


“Our current health care system here in America cannot continue on its current course for long for all of the reasons above. “

Charity Doc gives multiple examples and abuse of the emergency room system.

“ I fear a slippery slide to socialized health care if we don’t quickly overhaul the system. When ~20% of the GDP (30% depending on which studies you read) of this country is projected to go toward health care expenditures by the end of this decade, our inefficient system cannot be sustained. The breakpoint is about to come. We are headed toward a huge national crisis and our politicians do not seem to care. In fact, we are already in a crisis and it’s about to get worse.”
“The problems that I bitched and moaned about above are not unique to my hospital alone. It is happening at every Emergency Dept. in this country. More and more Americans are uninsured these days. The numbers are expected to continue to rise. And where do they go for their health care? They show up to the ER’s across the country, of course, bogging down the system causing a serious overcrowding.”

Emergency Room abuse is only a fraction of the problem. If patients do not own their healthcare dollar they do not care how they spend healthcare monies. If they do not have insurance or money they know they will be taken care of nonetheless.

“Thus, uninsured patients show up in hoards to the ERs because we don’t and cannot make them pay first to be seen. The Federal EMTALA law (Emergency Medical Treatment and Active Labor Act) requires that every patient who shows up to a hospital ER must receive a medical screening and stabilization if that hospital participates in Medicare. Without Medicare funding, a hospital is certain to go belly up bankrupt and thus EMTALA is pretty much inclusive of all hospitals in the US of A.”

Private clinics, however, are not bound by EMTALA to do the same.

“So in a way, we already have, sort of, universal health care here in the USA. The word is long out. If you have no health insurance and can’t pay for health care, go to the nearest ER. You don’t have to pay up front and we are too scared of law suits not to take care of you. You can make up phony information about yourself, fake who you are, give ’em aliases, fake phone numbers and addresses, phony social security numbers and you’ll never have to see that hospital bill.”

It is inconvienent care but free care none the less.

“ EMTALA is a well-intentioned law meant to prevent patient dumping and abandonment. Too many people, however, take advantage of it and abuse the system.”

How do the hospital systems make a up for the loss? The government and healthcare insurance companies pay the hospital losses through cost shifting and non transparent accounting.

Charity Doc’s blog is  worth reading if you really want to know what is going on at the street level. The silly things our Presidential candidates are saying are not going to solve these problems. The Republican administration methodical destruction of our safety net charity hospital system is going to make things worse.

America! Please wake up.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

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