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This is a repost of my recced listed diary of November 28, 2009.  I am reposted it in honor of Mitt Romney's 60 Minute interview where he posits that ERs  are a good place for the uninsured and underinsured to get basic healthcare.  I have updated one link.



Yeah you, all of you.  Those of you who believe in medicare for all and those of you town hall screamers who feel it's an a front to your pocket books, your "self reliance," your greed, your selfishness and your faith to help others get health care.

(I put "self reliance" in quotes because if you are paying for health insurance you are helping pay for coverage for others and they in turn are helping to pay for yours.  That is if the insurance company doesn't just take all the money you and others have been paying and then decide with rescission, exclusion, pre-existing conditions NOT to follow through on their end of the trust.  How self reliant are you really?)

The issue is the uninsured and the under-insured.  And whether you like it or not you mofos you ARE paying and you are going to continue to pay for them.  And you all are going to pay for my daughter!

I am almost past wanting to smack each and everyone of you town hall yellers, tenthers, blue dogs, Republicans, sacred won't listen to reason, health insurance pawns, over this.

I'd be just satisfied knowing that you will pay lots of money for this, if I weren't having to pay lots of money for this too.

You see, or maybe you don't so I'll do my best to draw you a map, I don't want to pay a lot to help take care of everyone.  You seem to want to pay the big bucks, so let me explain the difference.  I'll use my daughter's  last 2 weeks as an example.

My daughter (Tee) lost her job last year due to the economic down turn.  She's also in college, so she took out more loans so that she could go full time, pay for college and her books.  She also moved into a cheaper apartment, now has a roommate and downsized as much as possible to make that money stretch as long as possible.  That stretching does not include being able to afford the insurance policy available to students at her school.  

We help as much as possible.  Last spring her grandparents (my parents), her step-dad and I paid for her oral surgery to remove 3 wisdom teeth that couldn't break through her jaw (the bone had grown thick over them) and they were impacted and infected.

Her bio-dad died 3 years ago. He couldn't have helped anyway.  He and his wife were living in a trailer on a small plot of land in southern Texas basically subsisting.

To make ends meet last June she began selling her blood plasma.  After two trips to the emergency room after the last two draws, she had terrible adverse reactions.  I am told that the paramedics couldn't get her to lie flat on the stretcher, many of her muscles had seized into one big cramp, her hands would not open, her feet were locked in a painful point and her muscles had her curled up into a ball.  All she could do was scream from the pain.  

After this episode she began to complain that her stomach hurt, all the time.  I wanted her to see a doctor, I worried.  Abdominal issues are my issues.  But she had no insurance to see a doctor, didn't want to spend any more of our money, and didn't want another emergency room bill.

Two weeks ago her stomach pain was worse, she had headaches and she began vomiting.  We all, including her, thought it was the flu.  She got dehydrated and was taken to the ER.  They did the standard blood work, everything came back negative and determined that it was the flu.  They rehydrated her and sent her home.  

By Sunday she was worse, diarrhea had joined the vomiting and the stomach pain was unbearable.  She was taken to the ER again.  Most of the same tests were done, all coming back negative.  She was again rehydrated and given a shot of Dilaudid (because it was the only thing tackling the pain) and sent home.

She called me and told me Wednesday morning that she had been to the ER.  She was still in pain and still having diarrhea and vomiting.  She told me that it wasn't H1N1 because all the tests came back negative.

"Tee, they aren't testing for H1N1.  According to the CDC they are only testing for it after a person dies."  My words seemed to hit like a bombshell.

"Mom," came her clearly scared and worried voice, "I don't know what to do."

She's 25, my first born, my only daughter.  For god's sakes, she's still my baby! I was scared and worried too.  She's in one of the high risks groups, she has asthma.  But this seemed to be hitting her the hardest where she was most vulnerable, her stomach. While we spoke I went to the National Association of Free Clinics web site to find a clinic she could go to.  There is one in the Denver area, at 5045 W 1st Ave.   I gave her the phone number.

During the call she railed against our country's stupid situation saying that if she were in any other 1st world country she'd be taken care of by a doctor and a hospital.

She called the free clinic and left a message.

Thanksgiving came.  She pulled herself together enough to go to my parents.  My Mom says she promptly laid down on the sofa when she got in the door and slept.  Everyone (my Mom, my Dad and my sister) knew she wasn't well but she refused all offers, trying instead to put up a stiff upper lip.

She called that night, crying.  She felt so horrible.  She said she was cranky, mouthy and impatient at the Thanksgiving meal and ruined it for everyone (my parents dispute this).  She cried, saying "I just want my mom," over and over again.  She talked about suicide.

I live in Massachusetts, she lives near Denver, CO. My protective response went into over drive.  You know that response where the most dangerous place to be is between a mother and her child?  I was there.  But I was also impotent, I could, from this distance, do little.

We talked about how all her tests were negative.  I reminded her that for 11 years all my tests kept coming back negative in regards to the cause of the  menorrhagia I suffered from.

I also pleaded with her several times to go to the ER.  Finally she relented and said she would, but only if I agreed not to call her 80 year old grandparents and get them involved.

She took with her a friend, someone who had been in Iraq and was a medic.  The ER ran all the standard tests, they all came back normal/negative.  With this information in hand they were in the process of shoving her out the door and noting in her file that she is a hypochondriac.  She crumbled and began crying, she was giving up.

That's when her friend, her advocate, stood up and said that they were not moving until the hospital ran more tests and found out what was wrong.  He said that he has seen her suffer, that this is not her and that she is not a hypochondriac.

Finally the hospital did an internal ultrasound and found the problem.  She had had an ovarian cyst the size of a golf ball and it had burst.

To give you guys some perspective in this look down at your testicles, and pick your favorite.

Now imagine that testicle having a small cyst attached to it that grows to the size of a golf ball.  A golf ball, if I'm not mistaken, is a little larger than the testicle itself.  Now imagine that cyst attached to your testicle bursting.  Imagine all the ragged torn flesh, imagine what ever filled that cyst draining into your system.  It could be blood, it could be endometrium (well, not if your a guy), it could just be fluid, and it could harbor bacteria, it could become septic. You could die.

Then know this . . . .  it all could have been avoided.

If my daughter had been able to have the standard health care that other industrialized, 1st world nations have she would have seen a doctor long before this.  She would have had an annual gynecological check up, she would have established a report with a doctor who would have known her "normal."

She would have had the first set of tests preformed at an independent but cost effective lab that serves many doctors offices.  And when she got no better the doctor, who knew her, would have ordered more but different tests, thereby saving money by not running the same test 3 times in two weeks.  And since the pain was centered in her abdomen the doctor would have sent her to a gynecologist who would have ordered an ultra sound, maybe even an internal one right off the bat.  This too would save money since most gynecologists have in house ultrasound, meaning lower overhead.

They would have found this cyst prior to it rupturing and would have prescribed medications to shrink it.

If she had had the same access to health care that they have in Canada, the UK, Germany, Japan, etc. the bill for finding out what was wrong with her and treating it would have been lower than the crisis situation it became.

She wouldn't have been at the ER 3 times in two weeks.  The ER is expensive health care, there is a lot of expensive overhead that gets charged to you.  

map drawing re-cap:

If you just want to go on co-pays alone, if your co-pay for an in office doctor visit is $30.00 and the co-pay for a non-admitting ER visit is $100.00 - the ER is over 3 times as expensive.  (These were my actual co-pays 5 years ago).

$$$$ Ca-ching for ER care vs. $ for an in office doctor visit.

Then you have the lab work.  The lab at a hospital is staffed 24/7, it has the same expensive hospital over head attached to it's fees, and there are times when work there is slow.  

A lab contracted by a doctors office is not staffed 24/7 and it has several contract with doctors, there is no down time.

$$$$ Ca-ching for ER lab work  vs. $ for doctor contracted lab work

Then you have the same lab work done two more times because the ER doesn't know my daughter from one day to the next and they must, because of protocols, do all the standard tests.  If those are negative it probably isn't an emergency, they don't dig deeper.

If my daughter had built a relationship with a GP, Family Practitioner and/or a Gynecologist, they would have known what tests were already done a few days ago and moved on to dig deeper.  They would not have wasted money doing the same test.

$$$$ Ca-ching for duplicated lab work  vs. $ for the doctor only doing the same test once.

The ultrasound in the hospital while all the same equipment as the doctor's office has the high overhead attached to it.  

$$$$ Ca-ching for hospital ultrasound  vs. $ for in house doctor's office ultrasound.

$$$$ Ca-ching for all the  pain management medications, the bags of fluid when she became dehydrated, the cost (and pain) of putting a line in (actually 3 lines since they did this for each ER visit), the cost of that equipment x3, and the antibiotics, vs.  $ getting to this in time and only paying for the medication to reduce the cyst.

Given that she can't pay for these 3 ER visits the cost and payment is going to be found in higher ER, hospital fees and health insurance premiums - multiply this fact by 1,000,000 and you may begin to figure out how much you are paying RIGHT NOW for the uninsured and the under-insured.

You know that old bromide about "a stitch in time saves nine?"  It means if you take care of things in the beginning you have less work and less cost than if you wait until it gets worse.

And what's really sad is that you town hall yelling, tenthers, blue dogs, Republicans, sacred won't listen to reason, health insurance pawns, NASCAR fans know this when it comes to your car:

Remember the commercial where the actor portraying an auto mechanic, hawking a popular oil filter, grimly warns that if you fail to take care of your car now with some low maintenance car care that "You can pay me now, or pay me later".

But you have a great disconnect when it comes to people.  

People you are paying for anyway and paying way too much for.

You seem to be happy with this. I am not.  

You seem to want to pay more than necessary. I do not.  

You seem to be happy about the waste.  I am not.

The only time you complain about this situation is when you have to wait 5-6 hours to be seen in the ER.  Well it's your own damn fault.  Stop making the ER the only place the uninsured and under-insured can get medical help, you will stop the over crowding, and your wait times will go down.

You are going to pay no matter what, the cost is up to you.

But you seem to want the status quo.  I do not.

And you know what else, even if it meant paying a little more in taxes, my husband and I would gladly do it if it meant all our daughters and sons had access to real affordable health CARE.


Little Rock Free Health Clinic Dr. Kimberly Garner,  November 21, 2009

starting at 3:53

Videographer (nyceve): So her health, her treatment now will probably cost more than had she been able to just get her medicines

Dr. Kimberly Garner:  Oh going to the hospital, you could provide a lot of outpatient treatment for just one hospital visit.  

nyceve: Right, right, right

Dr. Kimberly Garner: Yeah , the economics, you know.[inaudible] we pay for people to go to the hospital

nyceve: Right

Dr. Kimberly Garner:  We pay for that acute care,

nyceve: Right

Dr. Kimberly Garner: But we won’t pay for them to be prevented. we won’t pay for this situation to be prevented.  We won’t pay for medicines that, that they need to prevent them going to the hospital. Necessarily, unless they qualify for some assistance.

But our system is based on acute treatment and not prevention and not chronic medical  treatment. People with chronic medical problems fall through the cracks.  I mean I’ve seen patients that, you know, have a chronic medical problem they just need medicines.  We won’t pay for the medicine for their chronic treatment, or to keep them from getting worse. But we’ll sure pay for the surgery they need when it gets really bad. Well sure pay for the procedure they need when it gets really bad.  But we won’t pay to prevent. [inaudible].



update 9/24/2012

My daughter has untreated Crohn's Disease.  To treat this disease properly she (and others with the disease) must be seen on a long term basis by the same doctor to get the treatment that will work for her.  This cannot be done through an ER or trips every now and then to a GI doctor because one cannot afford the cost of visits and/or tests.

The time lost to be productive, self supporting adult is incalculable.

But she has had some good news.  Last June she was married  (not to this guy of 2009, but someone else) in a big wedding.  She was so beautiful she did look just like a princess.

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Comment Preferences

  •  Tip Jar (8+ / 0-)

    Bumper sticker seen on I-95; "Stop Socialism" my response: "Don't like socialism? GET OFF the Interstate highway!"

    by Clytemnestra on Mon Sep 24, 2012 at 08:05:42 AM PDT

  •  Missed this story before, so (3+ / 0-)
    Recommended by:
    bjedward, Clytemnestra, Sunspots

    re-posting was worthwhile for me. Thank you

    And you made lots of important points here, beyond the major one you were aiming for.
     Which leads me to a general response, which has lots of implications beyond its application to your diary:

    We live in a really fucked up society, which is all to willing to jump on short-term solutions with no long-term considerations:
    Applies to health-care (still, even with the ACA)
    Applies to our banking system & big money economics
    Applies to our general standards of employee treatment
    Applies to energy-use
    Applies to natural resource use, like our national forests, etc
    Applies to our oceans . . . .
     I could go on.

    Democrats promote the Common good. Republicans promote Corporate greed.

    by murasaki on Mon Sep 24, 2012 at 08:29:16 AM PDT

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