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Injured Uninsured More Likely to Die in ER than Insured

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Wed Nov 18, 2009 at 08:30:03 AM PDT

Among those 45,000 deaths a years among the uninsured are those dying in emergency rooms as the result of traumatic injuries, and the uninsured are much more likely to die than those with insurance.

An analysis of 687,091 patients who visited trauma centers nationwide from 2002 to 2006 found that the odds of dying from injuries were almost twice as high for the uninsured than for patients with private insurance, researchers reported in Archives of Surgery.

Trauma physicians said they were surprised by the findings, even though a slew of studies had previously documented the ill effects of going without health coverage. Uninsured patients are less likely to be screened for certain cancers or to be admitted to specialty hospitals for procedures such as heart bypass surgery. Overall, about 18,000 deaths each year have been traced to a lack of health insurance....

The research team from Harvard University and Brigham and Women's Hospital in Boston used information from 1,154 U.S. hospitals that contribute to the National Trauma Data Bank. The team found that patients enrolled in commercial health plans, health maintenance organizations or Medicaid had an equal risk of death from traumatic injuries when the patients' age, gender, race and severity of injury were taken into account.

The risk of death was 56% higher for patients covered by Medicare, perhaps because the government health plan includes many people with long-term disabilities, said Dr. Heather Rosen, who led the study while she was a research fellow at Harvard Medical School.

The risk of death was 80% higher for patients without any insurance, the report said.

The reason for this much higher risk of death isn't immediately clear. The researchers point out that, while federal law requires that emergency rooms provide care, the uninsured often have longer waits in the ER, and sometimes have to go to various ERs to find one that will treat them. They are also likely to receive fewer services, especially expensive ones like MRI scans. They also are likely to have more untreated underlying condidtions that compromise their overall health. Additionally, the demographics of the uninsured and traumatic injuries is a factor; "gunshot and stabbing victims -- frequently younger people involved in crime" are more likely to die and more likely to be uninsured than other trauma patients.

Bottom line, being uninsured is potentially deadly. The moral and financial costs to the country are unacceptable, and any member of Congress who obstructs this effort to reform the system will carry the responsibilty of those deaths.

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Tags: healthcare reform, uninsured (all tags) :: Previous Tag Versions

Permalink | 101 comments

  •  I've seen, firsthand, why (7+ / 0-)

    this would be so. When my daughter was in a car accident with friends, she had insurance but one of her friends did not. They were in rooms side-by-side, and I watched as my daughter got x-rays and her friend did not, and then she was given pain medicine and her friend did not. Luckily, in this case the other girl was ok, but it could have been different. Given that they were in the same car and had similar complaints, it was pretty easy to figure out the reason for the differences in treatment.

    •  Two ways to look at that... (8+ / 0-)

      although I'm sure your interpretation is the correct one, it could also be that your daughter got procedures that she didn't actually need because the hospital knew that they could milk your insurance for the fees.

      Free speech? Yeah, I've heard of that. Have you?

      by dinotrac on Wed Nov 18, 2009 at 08:39:11 AM PDT

      [ Parent ]

      •  That is also a possibility (3+ / 0-)

        Recommended by:
        Heart of the Rockies, mcmom, dinotrac

        Our system ends up failing everyone, though in different ways.

      •  I Was Pumped Like a Well In Cardiac IC (4+ / 0-)

        Recommended by:
        tmo, Heart of the Rockies, mcmom, dinotrac

        for what every intern suspected at checkin and verified several days later as mitral valve.

        Turns out 20 yrs later it wasn't even that, just a bit of rhythm variation.

        We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

        by Gooserock on Wed Nov 18, 2009 at 08:53:43 AM PDT

        [ Parent ]

        •  ER admitted me to a cardiac ward. (1+ / 0-)

          Recommended by:
          Heart of the Rockies

          When the cardiologist finally came by, he asked me a few questions, listened to my heart, and told me he was pretty sure that my problem (I had passed out on the commuter train) wasn't cardiac, but scheduled a stress test and a sonogram (At least I think it was a sonogram -- to look at the beating heard) the next morning.

          So...
          all manner of disruption and expense for no good reason.  The tests were probably a good idea, but could have been done out-patient.

          Free speech? Yeah, I've heard of that. Have you?

          by dinotrac on Wed Nov 18, 2009 at 09:22:52 AM PDT

          [ Parent ]

          •  Outpatient exams would have been a bad idea (0+ / 0-)

            If it was indeed a cardiac issue then you are at risk for potentially fatal abnormal cardiac rhythms.  Best to know about these things in the hospital in a monitored setting such as a cardiac ward.  If the stress test and echo-cardiogram are normal then it is safe to go home.

            I accuse your cardiologist of poor communication skills.

            I assume the outcome was good?

            If more of us valued food and cheer and song above hoarded gold, it would be a merrier world. - JRR Tolkien

            by ManicZen on Wed Nov 18, 2009 at 11:21:20 AM PDT

            [ Parent ]

            •  Cardiologist was correct. (0+ / 0-)

              By the time he had seen me, they had already done a number of blood tests -- the ones looking for the enzymes or whatever it is that signals a heart attack -- and I was feeling pretty good, all things considered. And that was in addition to the EKG, which he had the chance to see.

              So, no, the outcome wasn't good because I was stuck with a bunch of bills, but yes, my heart was not a problem.

              Free speech? Yeah, I've heard of that. Have you?

              by dinotrac on Wed Nov 18, 2009 at 11:59:21 AM PDT

              [ Parent ]

      •  thats very cynical (1+ / 0-)

        Recommended by:
        dinotrac
      •  Probably true for the x-rays (1+ / 0-)

        Recommended by:
        dinotrac

        I think probably not for the pain meds.

        You're right, though.
        We should be able to do better than this.

        •  The sad part comes when you think about universal (0+ / 0-)

          coverage.

          If costs were reasonable (which includes eliminating "care" that isn't beneficial to the patient), fewer people would be uninsured.  Smaller companies with thinner margins could afford to offer coverage.  More individuals could afford to buy insurance.

          Fewer uninsured people times a lower cost of care means a radically lower cost for universal coverage.

          Oh well, one can dream.

          Free speech? Yeah, I've heard of that. Have you?

          by dinotrac on Wed Nov 18, 2009 at 09:29:01 AM PDT

          [ Parent ]

      •  Statistics - Torture Them Until ... (1+ / 0-)

        Recommended by:
        dinotrac

        ... you get the results you want to see.

        I agree with McJoan that the uninsured would statistically be more likely to have underlying untreated conditions which may skew the statistics.  Also, there are other issues which may skew the statistics.  Do not misinterpret my intent as a categoric dismissal of the results of the study, but there's a lot missing from the picture which may (or may not) exaggerate the statistics and promote the desired perception.

        There has to be a socioeconomic factor where those without insurance are statistically more likely to end up in emergency rooms to begin with (although as more and more of us get pushed from the train, that's diminshing).  Are people with serious conditions such as alchohol and substance abuse related accidents more likely to be uninsured?
        If obesity correlates with socioeconomic position, people with obesity related complications are also more likely to be ininsured.

        •  A couple of obvious things come to mind. (1+ / 0-)

          Recommended by:
          JohnnySacks

          And one -- criminals and their propensity to get shot -- was directly mentioned.

          Another occurred to me was "uninsurable" people, those who have conditions that cause insurance companies to refuse coverage or to offer it at prices that can't be paid for.

          On the other side of the equation, I'm pretty sure that many ER visits require some kind of outpatient action -- additional treatment, drugs, therapy, tests,etc to which the uninsured have little or no accees.

          Free speech? Yeah, I've heard of that. Have you?

          by dinotrac on Wed Nov 18, 2009 at 10:39:55 AM PDT

          [ Parent ]

    •  Sorry but I don't buy your inference (0+ / 0-)

      First of all it seems likely that in the case of an auto crash, the driver and occupants are covered by the auto insurance irregardless of health insurance coverage.

      You and others are implying that care is dictated by insurance status in an emergency setting?  Do you truly believe that pain medication was withheld because of insurance status?

      Sorry but that's a slap in the face to all the people who work hard to deliver this care.  Nurses, technicians, paramedics and physicians, all of whom are professionals and are all patient advocates.  The majority of us support HCR.

      I do not claim that there are no problems in the system.  I do believe that insurance plays an issue when patients are transferred, when elective procedures are performed, when after care is needed and other aspects of medicine.  

      I would use caution when issuing blanket statements. You do not say what happened to your daughter.  I hope she fared well.

      If more of us valued food and cheer and song above hoarded gold, it would be a merrier world. - JRR Tolkien

      by ManicZen on Wed Nov 18, 2009 at 11:35:51 AM PDT

      [ Parent ]

      •  Did you read the (0+ / 0-)

        suggested reasons for the disparity in outcomes??  No one is accusing ER staff of malice, although one or two commenters here have personal (or second hand) knowledge of disparate treatment of the uninsured.

        But these are the proposed reasons for the worse outcomes by the uninsured:

        "The researchers point out that, while federal law requires that emergency rooms provide care, the uninsured often have longer waits in the ER, and sometimes have to go to various ERs to find one that will treat them. They are also likely to receive fewer services, especially expensive ones like MRI scans. They also are likely to have more untreated underlying conditions that compromise their overall health. Additionally, the demographics of the uninsured and traumatic injuries is a factor; "gunshot and stabbing victims -- frequently younger people involved in crime" are more likely to die and more likely to be uninsured than other trauma patients."  Actually having universal medical insurance would take care of all but the last of these problems.

        •  Not looking for fight (0+ / 0-)

          But the poster did not mention the article.  Just a first hand account of differences in treatment that must be because of insurance differences.

          It stands to reason then, that there are people who are making those decisions to treat differently based on insurance coverage.  A decision made in the ER on the spot.

          Who are these people making these decisions?

          Again I do believe that insurance plays an important role but not in the sense stated.

          Again, not trying to cause a fight and perhaps I am too closely involved with this line of work to make an impartial judgment so I may indeed be at fault.

          Peace.

          If more of us valued food and cheer and song above hoarded gold, it would be a merrier world. - JRR Tolkien

          by ManicZen on Wed Nov 18, 2009 at 03:48:26 PM PDT

          [ Parent ]

  •  The more people die, (0+ / 0-)

    the less Social Security and Medicare that will have to be paid to the retired.

    Sometimes I wonder if that is the unspoken quotient in this discussion.

    While the Democrats and Republicans take incoming from each other and corporations are pwning America, the Chinese are taking over the world. C'est le vie.

    by Village expects idiot home soon on Wed Nov 18, 2009 at 08:34:39 AM PDT

    •  I heard that it was openly discussed in the (1+ / 0-)

      Recommended by:
      Eloise

      smoking debates of the 1940s, when they knew.  I heard it late on NPR in 2003.  I wish I would have written down who it was.

      Health Care for Profit. More Profit less Health Care.

      by 88kathy on Wed Nov 18, 2009 at 08:44:21 AM PDT

      [ Parent ]

  •  We must have a robust PO or single payer (3+ / 0-)

    Recommended by:
    mcmom, JohnnySacks, Greasy Grant

    It is the responsibility of Congress to save these people's lives. This crackerjack research by Harvard Medical School must be listened to and acted upon. They wouldn't make these figures up, they are a reputable organization with no political agenda (unlike Republicans and insurance companies!). We have an opportunity to insure everyone AND reduce the deficit while creating millions of jobs. We must act now!

    •  ... In Conjuction With Med Provider Reform (0+ / 0-)

      Where medical procedures (MRI, X-Ray, etc.) are not paid on a per patient basis, but at a fixed cost regardless of the number of referrals pumped through.  Fraud and overutilization for profit motives is and will be a serious issue in any system.

      Don't infer that I'm for them or against them because there's quite a few pros and cons, but capitated services are one example of cost containment.

      •  We can't get caught up in. (0+ / 0-)

        The hurdles the far right put in front of us like cost "containment", document status, etc. We need a robust public option or a single payer plan. It is unconscionable that 45,000 Americans die solely because they do not have health insurance. As kossacks if we stand for one thing, if it's not fighting for GLBT marital rights, it's for health care for everyone living in America, and worries about costs and such is just a deterrent from achieving that goal.

  •  National SHAME (2+ / 0-)

    Recommended by:
    beltane, Greasy Grant

    we should be ashamed of ourselves.  all of us.

  •  Some Are Religion Affiliated (5+ / 0-)

    I'd love to see which of our religious-affiliated hospitals puts their money where their mouth is, and has equal outcomes for poor and rich ER patients.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Wed Nov 18, 2009 at 08:35:53 AM PDT

    •  They earn their salvation cred (0+ / 0-)

      by not performing abortions. Those who are already living can therefore be allowed to die.

    •  This is a valid point...Also.. (1+ / 0-)

      Recommended by:
      beltane

      How many fundamentalist churches are actually very opposed to the health care reform bill?  They just don't want government doing it as if ideology is more important than people. This is something that I've never understood.

      I'm very happy this is not true of all churches and denominations. I know my church, The UCC, strongly supports Medicare for All and will support the HCR bill. I think other denominations feel similar. I  am sure that many Jewish denominations feel similar as well as other faiths.

      "Comfort the afflicted and afflict the comfortable" - Dorothy Day

      by joedemocrat on Wed Nov 18, 2009 at 08:40:56 AM PDT

      [ Parent ]

      •  Roman Catholics Fighting It Hard, Dead Baby Cross (0+ / 0-)

        array was out on the local church's lawn for months. Fundamentalism is mostly fighting it too for what I can see.

        They both want the Stupak amend to get rid of even privately paid insurance for abortions.

        I think it's more likely that fundamentalism is against it in principle because they oppose basically all social safety net and everything liberal, whereas my guess is Catholicism is only holding it hostage to win abortion suppression.

        We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

        by Gooserock on Wed Nov 18, 2009 at 09:19:13 AM PDT

        [ Parent ]

    •  If Mother Teresa were still alive (0+ / 0-)

      this sounds like a good project to put her on . . .

    •  They also dump patients (1+ / 0-)

      Recommended by:
      mcmom

      I work at a public med school with a teaching hospital. Private hospitals, including religious ones, will stabilize a patient or do the bare minimum and then find a way to transfer them to us. As a public facility, we truly take all comers. We are the last stop.

      _Karl Rove is an outside agitator._

      by susanala on Wed Nov 18, 2009 at 09:58:57 AM PDT

      [ Parent ]

  •  Just as with the Titanic disaster (6+ / 0-)

    lifeboats are allocated on a class basis.

  •  Could it be selection bias? (7+ / 0-)

    I'm always skeptical about these purely correlative observations, because you never know which direction the causation runs. People who lack health insurance could include a disproportionate number of people who just generally don't have their lives together -- which would also include things like bad diet, no exercise and depression or other mental health issues. All of those would increase the risk of death in the ER.

    I mean, you could probably also measure the size of the TV's that ER patients own, and I bet that larger TV sizes would correlate to better survival rates. But you should be skeptical of that result and wonder whether what you're really measuring is the hidden variable of income, not immediately proclaim that everyone should buy a bigger TV so they can be healthier.

    •  Trauma centers (4+ / 0-)

      and the study compared these folks to people on Medicaid, who should have the basic impoverished american health profile.

      •  Only if they enroll. (1+ / 0-)

        Recommended by:
        milton333

        Lots of people just don't have their lives under control enough to (1) know that the program exists, (2) know that they are eligible, and (3) take the initiative to enroll. Look at the participation rates for those eligible for food stamps for a good example; I believe it's under 50%.

    •  The research was controlled for other factors. (2+ / 0-)

      Recommended by:
      JohnnySacks, Betty Pinson

      It seems that private hospitals are transferring patients to public hospitals, and the transfer process might be exacerbating the injuries sustained by the uninsured patients.  Getting moved from one institution to another soon after suffering grave injuries adds to the risk of death, unless the second hospital has equipment and personnel the first one doesn't; that's just common sense.

      Barack Obama in the Oval Office: There's a black man who knows his place.

      by Greasy Grant on Wed Nov 18, 2009 at 08:44:16 AM PDT

      [ Parent ]

      •  Agree, there was a lot of data reviewed (0+ / 0-)

        including many measures of quality care. It was a well designed study.

        "Private health insurers always manage to stay one step ahead of the sheriff." Sen. Sherrod Brown

        by Betty Pinson on Wed Nov 18, 2009 at 09:12:00 AM PDT

        [ Parent ]

      •  It's always going to be imperfect though. (1+ / 0-)

        Recommended by:
        JohnnySacks

        There is no perfect measure of "how much someone has his life under control" -- at best, there are a million rough proxies. You can run credit scores, review criminal histories, check out raw income levels, educational achievements, drug abuse records, etc., but you can never get to the core of the matter with a correlative study; and it's quite possible that your ability to account for the lurking variable with these proxies will be inexact enough that a statistically significant level of similarity will be left over. Obviously if a controlled study is impossible, then we can never know for sure if this is the case -- so we're reduced to making arguments one way or the other. In this case, I think there's a powerful argument for a lurking variable.

    •  As was hinted at in this posting (1+ / 0-)

      Recommended by:
      mcmom

      Medicare patients are usually on SS disability insurance and thus start out in the ER in a poorer level of physical and/or mental health overall. I think that is probably the main factor in the higher death rate.

      I seriously doubt ER staff are somehow treating Medicare patients differently.

      •  The article is about the wholly uninsured (0+ / 0-)

        and only incidentally about those one Medicare, Medicaid, private insurance, etc.  The results for Medicaid (poor people) and private insurance (employed people) are the same.  Those on Medicare -- the old -- have 56% greater chance of death, but that's explained by their generally poor health.  The puzzle is not those on Medicare, but the totally uninsured who have an 80% greater chance of death, far worse even than the old people on Medicare.  

        I think probably because of a greater incidence of untreated underlying conditions.

         

      •  Also this is not true: (1+ / 0-)

        Recommended by:
        Heart of the Rockies

        "Medicare patients are usually on SS disability insurance"

        Most medicare patients are simply over 65 years old.  Some are younger and eligible because they are disabled, however.  As a group, they have more chronic illnesses than the other groups studied -- the uninsured, those on Medicaid, and those with private insurance.

      •  But don't medicare patients count (0+ / 0-)

        as having insurance?

        (I haven't read the study yet but the hospital knows it will get paid if the patients are already enrolled in medicare, yes?)

        •  Medicare is not the same as private insurance (0+ / 0-)

          Medicare is insurance, but it is not private insurance. Nor is Medicaid, as long as we're on the subject. Government programs do not cover or pay the same as private insurance, and government programs are not all the same. In a well designed study, they are examined separately. That is exactly what these investigators did. You need to read the study.

          _Karl Rove is an outside agitator._

          by susanala on Wed Nov 18, 2009 at 10:06:21 AM PDT

          [ Parent ]

        •  Yes, (0+ / 0-)

          those on Medicare have a kind of health insurance.  And even though they are old or disabled, and thus more likely to die anyway, they do far, far better than those who have no insurance at all.  

          This is a stunning result.

      •  I have a physician friend (0+ / 0-)

        who was instructed to give a different level of care in the ER, depending on ability to pay

      •  No all Medicare patients are on SS disability, (0+ / 0-)

        just 62 and older. And, as seniors, Joe, AKA, Old Timer, get excellent care, even tho Idaho ranks 50th among the states in primary physicians. We have a great GP, that we have seen for decades, but he does not accept new Medicare patients. He and his partners are swamped, as it is.

        I think, therefore I am. I think.

        by mcmom on Wed Nov 18, 2009 at 11:43:01 AM PDT

        [ Parent ]

  •  But you can walk into any ER (9+ / 0-)

    and get mammograms and chemo and diabetes meds and all that stuff. ERs are like big candy stores and everything is free.

    That's what Glen told me. Glen is such a smart man.

  •  Not to mention crime... (0+ / 0-)

    gunshot and stabbing victims -- frequently younger people involved in crime" are more likely to die and more likely to be uninsured than other trauma patients.

    Stop that, people!

    Free speech? Yeah, I've heard of that. Have you?

    by dinotrac on Wed Nov 18, 2009 at 08:37:45 AM PDT

  •  Sometimes I think it's a good idea, (0+ / 0-)

    half-jokingly and half-seriously, that people should wear a Medic-Alert bracelet saying "I've Got Insurance" (perhaps including their carrier name and account number) along with their other Medic-Alert bracelets that they already wear for their other medical conditions.

    IMO our culture made a big mistake when we decided to worship money above all else, including life and death.  We of course benefit from our free-market economy; entrepreneurs ought to be able to profit if they invent a better mousetrap... but when we let people die of treatable conditions for lack of money, our free-market ethic has gone too far.

    Barack Obama in the Oval Office: There's a black man who knows his place.

    by Greasy Grant on Wed Nov 18, 2009 at 08:38:55 AM PDT

  •  Correlation dos not impute causation (3+ / 0-)

    Recommended by:
    BachFan, Mr Rick, Pender

    Your penultimate paragraph admits as such, so your "bottom line" conclusion isn't supported, unfortunately.

    More understanding of the research is needed before this could be used as a weapon. The bad guys could easily shoot it down.

    Use every man after his desert, and who should 'scape whipping?

    by UncleDavid on Wed Nov 18, 2009 at 08:39:04 AM PDT

    •  yes, see my comment below (0+ / 0-)

    •  So could the good guys (1+ / 0-)

      Recommended by:
      Heart of the Rockies

      There was a perfectly valid question posed in a diary yesterday. Location affects access but is not included in the multivariate model. Uninsured in my city happen to have access to the only level 1 trauma center in the state, which is housed at a top-25 NIH funded research institution. But a lot of poor and uninsured are in remote or underserved areas. If they have a level 1 type injury, they're screwed with or without insurance.

      Dog's Diary

      The bad guys are what they are. I've already dealt with a few. They won't even read the mass media reports on the study. (And I doubt most of them could understand even the abstract or conclusions if they had access to the original article.)

      Some guru told them that tin-foil hat CT is just as good as science so they don't need any stinkin' study. And it's just political anyway. Part of the democratic plot to come between you and your doctor, &c.

      _Karl Rove is an outside agitator._

      by susanala on Wed Nov 18, 2009 at 10:17:58 AM PDT

      [ Parent ]

  •  Wonderful diary, mcjoan (2+ / 0-)

    I've requested that you write diaries like this one, and I thank you for taking up my request.

    Well done, mcjoan.  Hopefully, we'll get more diaries like this one.

    Financial assistance to those displaced from a hurricane = disaster assistance; financial assistance to the uninsured = socialism - Uwe Reinhardt

    by jim bow on Wed Nov 18, 2009 at 08:39:39 AM PDT

  •  the reason for the higher number of deaths (0+ / 0-)

    was already hinted at here - patients covered by Medicare are usually disability insurance claimants who, in general, have poorer mental and physical health to start with. I also don't know what ER's these Medicare patients are going to - the overall quality of care at some facilities may be somewhat less in poorer communities with fewer resources. I will need to read the article to see if they controlled for these factors in their analysis.

    I seriously doubt ER staff are treating Medicare patients differently than everyone else.

    •  The article isn't primarily about Medicare folks (1+ / 0-)

      Recommended by:
      Heart of the Rockies

      It is about the wholly uninsured, and only incidentally about those on Medicare, who are the controls, along with those on Medicaid, private insurance, etc.  The results for Medicaid (poor people) and private insurance (employed people) are the same.  Those on Medicare -- the old -- have 56% greater chance of death, but that's explained by their generally poor health.  The puzzle is not those on Medicare, but the totally uninsured who have an 80% greater chance of death, far worse even than the old people on Medicare.  

  •  Pre-existing, untreated conditions? (4+ / 0-)

    Just speculation, but it could be that the uninsured trauma victims will have more pre-existing, untreated conditions than do the insured trauma victims. Some of those conditions could impair the recovery from an unrelated trauma injury.

  •  But I thought all of that screening/testing was (1+ / 0-)

    Recommended by:
    Heart of the Rockies

    just a surreptitious wink and nod between doctor and patient for unnecessary tests?

    Oh, that was Maher before he covered his tracks.

    Nobody really knows how the markets will react; the right thing, always, is to pursue policies that look right on the substance. P.K.

    by gereiztkind on Wed Nov 18, 2009 at 08:41:01 AM PDT

  •  It's not the ER (1+ / 0-)

    Recommended by:
    beltane

    People without insurance are less likely to have preventative health care, more likely to be less educated and more likely to live in unsafe areas.

    Add all that up and one is more likely to die from pneumonia or a gun shot wound than someone who comes in needing a few stitches.

    The care of human life and happiness, and not their destruction, is the first and only legitimate object of good government. - Thomas Jefferson

    by ctexrep on Wed Nov 18, 2009 at 08:41:05 AM PDT

  •  This actually is hard to explain, if reported... (1+ / 0-)

    Recommended by:
    beltane

    accurately.  I'm painfully aware of problems like folks who don't seek care until it's too late because they lack insurance, but this is trauma victims who all pretty much come in in the same sort of acute way.  And it states that they were corrected for severity of injury.  My own experience with ERs is that they pretty much treat those major trauma victims the same without regard to insurance, so it's hard to believe that's an issue.  One possibility that occurs is that the high-skill consultants like neurosurgeons may be slower to come in for the uninsured patient?  They often aren't paid by the hospital but come in on their own and are paid fee-for-service.  This needs digggin in further to find explanations.

    "I was asked what I thought of the mainstream media. I said I thought it would be a good idea" - Amy Goodman.

    by Chico David RN on Wed Nov 18, 2009 at 08:45:19 AM PDT

    •  its pretty easy to explain (0+ / 0-)

      Patients covered by Medicare are on medicare because they are receiving a Social Security Disability Insurance benfit check every month, and therefore, in general, have poorer mental and physical health to start with. It also takes two years for a disabled person to be eligible for Medicare once they get on SSDI, so they slip even further down the drain if they don't have access to healthcare some other way.

      A factor may also be the ER's these Medicare patients are going to - the overall quality of care at some facilities may be somewhat less in poorer communities with fewer resources.

      I would need to read the article to see if they controlled for these two factors in their analysis.

      But I seriously doubt ER staff are treating Medicare patients differently than everyone else.

      •  But it's not about Medicare -- (0+ / 0-)

        the wholly uninsured are even worse off than those on Medicare.  The uninsured are 80% more likely to die than the privately insured; the old people on Medicare are only 56% more likely to do so.

      •  You're wrong about this (1+ / 0-)

        Recommended by:
        David in NY

        I don't know what point you're trying to make.  According to CMS, as of 2008, there were about 37.6 million >65 enrolled in Medicare, and 7.7 million receiving SSDI (PDF).  

        The overwhelming majority of people on Medicare qualify by reason of age, not disability.  You keep repeating false information on this thread, what are you trying to say?

        Thought is only a flash in the middle of a long night, but the flash that means everything - Henri Poincaré

        by milton333 on Wed Nov 18, 2009 at 10:32:52 AM PDT

        [ Parent ]

  •  Unfortunately, they don't care... (0+ / 0-)

    The moral and financial costs to the country are unacceptable, and any member of Congress who obstructs this effort to reform the system will carry the responsibilty of those deaths.

    A man has made at least a start on discovering the meaning of human life when he plants shade trees under which he knows full well he will never sit.

    by freewilly on Wed Nov 18, 2009 at 08:50:55 AM PDT

  •  What's with the ad posted just after this entry? (0+ / 0-)

    Sing the petition AGAINST government run health care?
    There's a real bait and switch thing going on here, IMHO.  Kos? Administrators?

    WE must hang together or we will all hang separately. B.Franklin

    by ruthhmiller on Wed Nov 18, 2009 at 08:52:36 AM PDT

  •  Off topic, but ... (0+ / 0-)

    Check out this video from a VA Tech survivor -

    http://www.youtube.com/...

    He buys an AK-47 under-cover at a gun show with no ID or paperwork!

    Get out of control, but appear under control. It's not bad to alarm other people, though - it's good for them.
    - Hunter S. Thompson

    by bisenbek on Wed Nov 18, 2009 at 08:57:56 AM PDT

  •  without insurance you have followup at a clinic (1+ / 0-)

    Recommended by:
    milton333

    the ONE TIME I was without insurance I fractured my hand and had to go to the hospital for emergency care...  the first question (of course) was What is your insurance to which I said, I have none...  the triage nurse wrote furiously in the chart and then I sat there, with a fractured hand swelling to ugly proportions and I sat and sat and sat and FINALLY I was seen by a doctor who spent all of 3 minutes, no xray, a bandage and a ticket to return to the clinic in 5 days.

    Without insurance I had to go to the clinic for followup and that was a real eye opener... it was Jammed with people without insurance waiting for medical care... I waited for over 3 hours and was finally seen by an intern... who decided I needed a harder bandage and a return visit to the clinic in 5 weeks.  5 weeks later, still without insurance, I returned and the same intern took the bandage off and told me to start bending my hand and to return in 2 weeks...  after 3 days of doing the bending I had to rush BACK to the clinic and after an exray I was told the hairline fracture had now become a FULL BREAK and I needed to get a plaster cast...  and return in 3 weeks...  got the cast and returned in three weeks...where I was told that the intern who had been treating me was on vacation and I would have to wear the cast until he returned...

    another 2 weeks passed and I went back to the clinic and the intern told me the fracture had NOT healed and he needed to put yet another cast on my hand...   by this time we were about to get INSURANCE again and so instead of returning to the clinic I went to see a REAL DOCTOR who took the cast off, xrayed the hand and said "who treated you, they made a mess of your hand" and immediately started real treatment SANS a cast.

    I think of the bad and mistreatment I got and it was JUST my hand... if I had something seriously wrong and no insurance  OY!! may I never find myself in that situation.

    "We have passed beyond the absurd, our position is absolutely preposterous" - Ron Tavel

    by KnotIookin on Wed Nov 18, 2009 at 08:58:12 AM PDT

  •  This was diaried yesterday (3+ / 0-)

    here.  I thought somethingthedogsaid did a good job on it.
    http://www.dailykos.com/...

    The bitter truth of deep inequality has been disguised by an era of cheap imported goods and the anyone-can-make-it celebrity myth - Polly Toynbee

    by fladem on Wed Nov 18, 2009 at 09:05:28 AM PDT

  •  I really would like to see the details (0+ / 0-)

    of this study.  You have to wonder if geographic locations and/or income levels or any of several other factors might be contributory.. or even be the main factor with insurance being coincidental.

    "Those are my principles, and if you don't like them... well, I have others." - G. Marx

    by Skeptical Bastard on Wed Nov 18, 2009 at 09:13:55 AM PDT

  •  This bears repeating... (0+ / 0-)

    The moral and financial costs to the country are unacceptable, and any member of Congress who obstructs this effort to reform the system will carry the responsibilty of those deaths.

    ...over and over again.

    Reconciliation is a process I hope we can engage in every year - Eric Cantor, 2005

    by blueyescryinintherain on Wed Nov 18, 2009 at 09:18:48 AM PDT

  •  Two thoughts (0+ / 0-)

    I agree with the concept of an underlying health condition attributing to death in these situations. And without knowing for sure, I would bet that those exposed to life situations requiring ER intervention lead lives with more exposure due to nothing else than being poor. In other words, the exposure in poor neighborhoods is significantly greater than those in more affluent neighborhoods. Secondly, again without actually knowing but based on life experiences, I would bet that survival rates are higher in "blue states" as opposed to "red states".            

    Healthcare is a human right, not a commodity.

    by nomorerepukes on Wed Nov 18, 2009 at 09:23:32 AM PDT

  •  This is a national disgrace. n/t (0+ / 0-)

  •  A great way to reduce crime. (0+ / 0-)

    If I'm reading this correctly, then universal coverage will reduce violent crime because fewer people will be involved in stabbings and gunshot wounds.

    I also imagine fewer young people will be involved in accidents or suicide attempts, which must also increase the rate of uninsured people that die in emergency rooms.

  •  My uninsured room mate (0+ / 0-)

    in a local hospital was scheduled for surgical repair of a multiple leg fracture until his uninsured condition was brought to light. The doctor decided to set five breaks in our room without benefit of general anesthesia. Bones crunching and howling ensued. It was quite dreadful. Post procedural intravenous pain medication was made available to him and he was allowed to recover for several days prior to being discharged.

    The frog jumped/ into the old pond/ plop!

    by Wolf10 on Wed Nov 18, 2009 at 09:43:28 AM PDT

  •  context - hospital health care in FIRST WORLD (0+ / 0-)

    VIDEO CLIPS:
    Free Universal Health Care Around The World

    De-Bunking Free Universal Health Care, Canada, France, Britain, Cuba

    Sicko: Michael Moore interviews doctor in UK

    www.youtube.com/watch?v=xlDAUKSh9CQ

    Watch the Trailer for Michael Moore's 'SICKO'

    www.youtube.com/watch?v=rQ1lPPTPSR4

    Sicko - Canada Hospital Waiting Room Scene

    youtube.com/watch?v=PwGLdYBm1bY

    Sicko clip: Linda Pino admits denying health care for dying man

    www.youtube.com/watch?v=V2sFT7T0mCs

    Sicko - What hospital bills

    www.youtube.com/watch?v=BbAWNnGSVCw

    Michael Moore's Sicko - NHS in Britain

    www.youtube.com/watch?v=OnserZOf1-4

    Sicko - chilling excerpt by Tony Benn

    utcitizenscandidate.org

    by anyname on Wed Nov 18, 2009 at 10:20:37 AM PDT

  •  This reminds me of a diary from 2006 (0+ / 0-)

    by nyceve about the dramatic difference in care you will receive in a life-threatening situation.  

    Kossack Melody Townsel reveals her health nightmare. Be Warned.

  •  Anecdotes (0+ / 0-)

    Well, lots of anecdotal stories in this thread, so I'll add mine.  I work in an ER.  I've worked in few others, but not a huge sample.  In all of them, the medical staff doesn't know the insurance status of patients.  Data on insurance and payment is gathered and kept by a registration person who works for another department.  This segregation of information was in response to EMTALA so that nothing the medical staff says or does can be interpreted as an attempt to "dump" the patient for financial reasons.  Does this mean that ERs aren't dumping uninsured patients?  No - just that some aren't.  On the other hand, the people I know outside of work who are uninsured tend to be poorer or perhaps can't get insurance due to a pre-existing condition that makes them more fragile in a trauma situation.  Medical people are under great pressure from patients, insurers, the hospital administrators and the government to reduce costs. Frequently, a decision will be made to defer an MRI or similar expensive procedure when a less expensive alternative exists.  I then hear lots of complaints that "you just won't give me an (whatever) because I don't have insurance."  No, actually I don't know if you have insurance or not.  My point is that while the finding of this study is disturbing, I'd be cautious in jumping to the conclusion that it is due to ER "dumping".  

    •  my experience as spouse of patient going in:was (0+ / 0-)

      asked on arrival if insured, when ambulance put person into ER, question by triage nurse. And for the papers.  I think it goes on the chart, yes?
      And there's the possibility that people without insurance can sit longer (or lay on guerney) waiting to see a doctor....since it's the triage nurse who is directing traffic via entry on forms,yes?

      •  Could be in some ERs (0+ / 0-)

        Not in ours.  Insurance info is not on the chart.  I could log off my ER software, log onto another system, and go through several screens and discover the existence of an insurer - if I was so inclined and had time.  On alot of 12-hour shifts, I don't even have time to finish the cup of coffee I bring to work.  My point still stands - the finding of this study is disturbing.  Whether poor outcomes are due to a patient being poor, having a pre-existing condition, coming to a less functional ER, not having primary care, whatever - there's a problem that needs investigation and fixing.  However, you can't, as some have, jump to the easy conclusion that this is proof of ER dumping, because it isn't.  

        •  OK. I wonder,too. &are all shifts 12hrs? that's (0+ / 0-)

          rough on workers.  Had a bad experience while accompanying a patient, several years ago.  It was 5AM and dr. had orders not to be disturbed, except for #1 emergency (not exactly sure of the code), so she wrote lesser # on form. (I found out later as result of state investigation.) There was no one supervising the triage nurse.  The person was having a TIA,  but it was not clear if it was going to be more severe.  I asked the investigator, from the state, "what do you do if there is no one supervising, again?".  He said, "You're f....ed".  His mother had had a stroke and was not seen, in similar experience, right away.  And this story is about someone with insurance. Good luck that it was not more severe.  And the ER was empty.

        •  PS:forgot to say result of state investigation: (0+ / 0-)

          ER staff required to hear lecture on strokes that do not have paralysis and weakness.

  •  Seems like (1+ / 0-)

    Recommended by:
    NYCartist

    a legal issue -- no equal treatment under the law.  But, of course, some are more equal than others, I guess.

  •  I would imagine that one reason... (0+ / 0-)

    Is that a disproportionate number of the uninsured are black. And black folks have always received poorer treatment than white folks.

  •  Perspective from an ER Doc (0+ / 0-)

    Although I've been working a lot, I've read this post, skimmed, the article, and skimmed the comments.

    First, everyone needs to understand that there is a difference in studies like this between association and causality. This study, by its design, is able to show an association between insurance status and death. However, also because of the study design, the study cannot show causality. In other words, we cannot say from this study that lack of insurance caused the mortality, only that it was associated with mortality. There are many other factors that could have caused the mortality.

    Second, those of us who work in EDs are obligated by law to treat patients with emergent conditions without considering their ability to pay. This is an "unfunded mandate", we don't get paid to treat uninsured patients, but he government requires us to do so. The vast majority of us don't pay any attention to insurance status until we have to prescribe medications or refer patients for follow up. We typically provide more uncompensated care than any other specialty.

    There are many reasons why patients with and without insurance might be treated differently, however, most of the time this would not have anything to do with the physician or hospital realizing they do not have insurance.

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