A picture of health | The Columbus Dispatch

Attending physician Sorabh Khandelwal, left, talks with medical resident Benjamin Tweel in the OSU Medical Center emergency department.

[ER Doctor]

The problem is multifactorial. 1) Many patients have no insurance and come to the ER because no one else will see them. 2) Patients on welfare come because it is quick, easy, free despite the fact they could be seen elsewhere. It is a big lack of responsibility and unlike insurance patients who have a co-pay for non-emergencies, these patient can come and pay nothing 3) They are no enough beds in hospitals to quickly get the sick out of the ER and into an inpatient bed in the hospital, so they stay in the ER way too long and create a huge back-up 4) Lack of parenting education. It does not matter who you are or if you are rich or poor, 1st time parents need parenting classes. Most of the illnesses we see in children could be treated at home not in the ER.

[Former Democrat]

The are all kinds of people dropping their health insurance now because of the rising costs directly related to reform legislation. Many will be uninsured for the first time, unable to qualify for Medicaid or Medicare, and unable to afford the state health insurance exchange, privately purchased insurance or employer sponsored insurance. Tax credits will only be available for those who purchase private insurance and even then, the costs must be paid for up front. Unaffordable, unaffordable, unaffordable.

Why didn't this article mention the newly and soon-to-be-uninsured as unintended consequences of the health care reform? McDonald's may be dropping mini-med insurance for 30,000 workers; insurance companies are no longer writing politices for children, etc. As often happen, what looks good as an idea - if not implemented correctly - can turn out to be disastrous.

[Just wondering]

I've read that the biggest users of ER's are Medicaid patients, so won't this problem get worse as the government expands the Medicaid program? People who really need the ER won't stand a chance.

[EMU Alum]

I agree with ER doc. I am also an ER doc and what he says is spot-on. No amount of education, dis-incentives or behaivor modification will disway someone from an ER. Even medicaid patients who have a doc still will clog my ED just because they don't want to wait to be seen at an office and hey "it's free"

[Reader]

ER Doctor wrote:

The problem is multifactorial. 1) Many patients have no insurance and come to the ER because no one else will see them. 2) Patients on welfare come because it is quick, easy, free despite the fact they could be seen elsewhere. It is a big lack of responsibility and unlike insurance patients who have a co-pay for non-emergencies, these patient can come and pay nothing 3) They are no enough beds in hospitals to quickly get the sick out of the ER and into an inpatient bed in the hospital, so they stay in the ER way too long and create a huge back-up 4) Lack of parenting education. It does not matter who you are or if you are rich or poor, 1st time parents need parenting classes. Most of the illnesses we see in children could be treated at home not in the ER.

As a parent who has put in time in the ER, I would suggest that one additional factor needs to be added in, and that is the propensity of physicians' offices to refer to the ER. Every answering service opens with an aviso that if the call is an emergency, please hang up and dial 911. There is some reluctance to advise a parent over the phone to treat without seeing a child, and same-day appointments hard to get.

While all parents need ongoing sources of parenting support and advice, I think that "classes" per se may be thinking according to yesterday's forms. What can help is a mix of available quality information (online, 24 hour call lines, etc) and home visiting for some populations with risk factors (isolation, young first-time parents, low-income parents, medical risks, etc).

[JulieBuckeye]

I made my first ever trip to an ER one evening last month. I was shocked to see the number of drug addicts there trying to get drugs for some fake illness and all of course for "free". I actually witnessed 2 people leave the waiting room after they made contact with their dealers on their cell phones. The resources wasted (check-in, triage, financial registration) on these people is a crime, not to mention how it backs up the system for those that truly need help. I can't imagine how frustrating and disheartening it must be for the nurses and physicians who have chosen to practice emergency medicine. The care I received was excellent,and I "walked" out with my new crutches 5 hours later.

[Reader]

Former Democrat wrote:

The are all kinds of people dropping their health insurance now because of the rising costs directly related to reform legislation. Many will be uninsured for the first time, unable to qualify for Medicaid or Medicare, and unable to afford the state health insurance exchange, privately purchased insurance or employer sponsored insurance. Tax credits will only be available for those who purchase private insurance and even then, the costs must be paid for up front. Unaffordable, unaffordable, unaffordable.
Why didn't this article mention the newly and soon-to-be-uninsured as unintended consequences of the health care reform? McDonald's may be dropping mini-med insurance for 30,000 workers; insurance companies are no longer writing politices for children, etc. As often happen, what looks good as an idea - if not implemented correctly - can turn out to be disastrous.

I wonder if you have any solid indicators of what you describe. While it is true that for-profit companies can be counted on to raise rates for any reason at all, it is difficult to draw as straight line from current reforms and any change in rates, other than mere opportunistic thinking.

I did hear a blurb abour McDonald's, but I don't know that it is a done deal. What percentage of McDonald's employees are covered by the minimal plans currently? How many work full-time? What percentage of the cost is born by the employees themselves? How many McDonald's employees currently have no coverage, or qualify for government coverage. These are all important considerations. And at the end of the day, is it right that tax-supported plans should be shouldering the weight for a coroporation the size of McDonalds (or Wal-Mart, or others)?

Yes, reform does mean change. And profit making corporations (both insurance companies and those in other fields who will have to contribute to the coverage of their employees) are going to be going crazy in the next months trying to shift costs. But--we have stood still for too long doing nothing while more and more individuals lost coverage.

[Get Real]

Health Reform hasn't even kicked in yet except for a few minor provisions. Costs were rising 20%+ BEFORE health reform plus people with employee plans were already either foregoing raises for coverage or getting dropped when sick. This sounds like a GOP post spreading myths. When you ask people if they like health reform they say "no". But ask them if they like the fact they can't be dropped for getting sick, adult children can stay on, no lifetime maximums, and no pre-existing conditions, they say "YES".

Examine the GOP health plan and it is a non-starter. More of the "Health Savings Accounts" which do no good if you're laid off or salary is cut - fairly common in our outsourcing, can-the-old-guy economy. Only works for the rich. Plus they won't enforce the no-preexisting condition clause. They also push high risk pools for those that get sick but this simply puts the burden on State budgets. GOP plan is still "get sick, die quick". Since we're all going to get sick eventually, we shouldn't have to go bankrupt to live. Believe me, health insurers got the better end of the deal with the latest plan.

Former Democrat wrote:

The are all kinds of people dropping their health insurance now because of the rising costs directly related to reform legislation. Many will be uninsured for the first time, unable to qualify for Medicaid or Medicare, and unable to afford the state health insurance exchange, privately purchased insurance or employer sponsored insurance. Tax credits will only be available for those who purchase private insurance and even then, the costs must be paid for up front. Unaffordable, unaffordable, unaffordable.
Why didn't this article mention the newly and soon-to-be-uninsured as unintended consequences of the health care reform? McDonald's may be dropping mini-med insurance for 30,000 workers; insurance companies are no longer writing politices for children, etc. As often happen, what looks good as an idea - if not implemented correctly - can turn out to be disastrous.

[Got THAT right]

I've carefully read all the posts in this thread and I'll have to give the highest kudos to "Reader" for bringing up the laissez faire, robo messaging nearly every M-F medical facility gives to its' off hour callers of 'just go to the ER' in case of 'emergency'. But yet, the industry complains?? about the increasing numbers they're seeing in the ED's of unwarranted visits?? and increasing costs??? Are you kidding me? Blaming the paying PUBLIC (taxpayer) for the industry's own failure/inability? to better address and enforce that their practitioners actually do their jobs for a change?

I've worked in the health care industry now for nearly thirty years, long long before it became the impersonal, mindless for-profit quagmire it has become now and I don't ever remember our docs putting autopilot messages on their off hour phones sending ppl to ER's. We used an answering service and triage nurses to assess and determine the emergencies from the 'can wait till Mondayers'.

THANK you Reader for bringing up the robo messaging point. It's a big one when it comes to solving the problem of unnecessary ED visits and getting these clueless, lazy physicians to quit confusing their jobs with those of M-F businessmen. They aren't businessmen, they are Doctors. In case they forgot their hippocratic oaths.

[gokeefe]

Got THAT right wrote:

I've carefully read all the posts in this thread and I'll have to give the highest kudos to "Reader" for bringing up the laissez faire, robo messaging nearly every M-F medical facility gives to its' off hour callers of 'just go to the ER' in case of 'emergency'. But yet, the industry complains?? about the increasing numbers they're seeing in the ED's of unwarranted visits?? and increasing costs??? Are you kidding me? Blaming the paying PUBLIC (taxpayer) for the industry's own failure/inability? to better address and enforce that their practitioners actually do their jobs for a change?
I've worked in the health care industry now for nearly thirty years, long long before it became the impersonal, mindless for-profit quagmire it has become now and I don't ever remember our docs putting autopilot messages on their off hour phones sending ppl to ER's. We used an answering service and triage nurses to assess and determine the emergencies from the 'can wait till Mondayers'.
THANK you Reader for bringing up the robo messaging point. It's a big one when it comes to solving the problem of unnecessary ED visits and getting these clueless, lazy physicians to quit confusing their jobs with those of M-F businessmen. They aren't businessmen, they are Doctors. In case they forgot their hippocratic oaths.

Yes, Reader did get that right. I've received such a message myself on a Saturday evening from my personal physician's office when a minor problem cropped up after an in-office procedure on a Friday. Not wanting to go to the ER or urgent care, I was thankfully able to wait it out. It was a situation that didn't seem to be mentioned in the after-care instructions.

I have no answers, solutions, anything to this situation. However, it was strikingly informative to me to see the time range of evening to morning as being the time most used for ERs--it doesn't reflect to me anything about a patient's insurance or financial status.

But I do have to somewhat disagree with the notion that doctor's aren't businessmen. They do have to treat the practice as such--there is a large investment of equipment, time, and personnel in order to run a practice. Also they do have run at least at some profit. Another problem would be a stress factor for doctors--many probably refer to ERs or urgent cares simply to lighten the work hours.

[Enzyte Bob]

gokeefe wrote:

<quoted text>
But I do have to somewhat disagree with the notion that doctor's aren't businessmen. They do have to treat the practice as such--there is a large investment of equipment, time, and personnel in order to run a practice. Also they do have run at least at some profit. Another problem would be a stress factor for doctors--many probably refer to ERs or urgent cares simply to lighten the work hours.

Like it or not, money is how we keep score. My brother is a doctor. He makes a very nice living (Obama doesn't want to give him any tax cuts), better than me. But he works his arse off and has lots and lots of pressure he has to deal with. He has a staff of about 15 people, lots of rent to pay, and he's got the beeper/cell phone on all the time. Yes, medicine is a business as is everything else in life.

As a matter of fact, my parents are the ones who taught me that even running a household is a business. If you run one like a business, you can be successful and build a little wealth for yourself. Most people, however, don't see things that way.

[Former Democrat]

Reader wrote:

<quoted text>
What can help is a mix of available quality information (online, 24 hour call lines, etc) and home visiting for some populations with risk factors (isolation, young first-time parents, low-income parents, medical risks, etc).

The health care reform provides $1.5B to include home visits to high-risk mothers. Personally, I think it should be available to all new mothers but there I go again!

[Former Democrat]

Got THAT right wrote:

I've carefully read all the posts in this thread and I'll have to give the highest kudos to "Reader" for bringing up the laissez faire, robo messaging nearly every M-F medical facility gives to its' off hour callers of 'just go to the ER' in case of 'emergency'.

Legal ramifications IIRC.

[Former Democrat]

Reader wrote:

<quoted text>
I wonder if you have any solid indicators of what you describe. While it is true that for-profit companies can be counted on to raise rates for any reason at all, it is difficult to draw as straight line from current reforms and any change in rates, other than mere opportunistic thinking.
I did hear a blurb abour McDonald's, but I don't know that it is a done deal. What percentage of McDonald's employees are covered by the minimal plans currently? How many work full-time? What percentage of the cost is born by the employees themselves? How many McDonald's employees currently have no coverage, or qualify for government coverage. These are all important considerations. And at the end of the day, is it right that tax-supported plans should be shouldering the weight for a coroporation the size of McDonalds (or Wal-Mart, or others)?
Yes, reform does mean change. And profit making corporations (both insurance companies and those in other fields who will have to contribute to the coverage of their employees) are going to be going crazy in the next months trying to shift costs. But--we have stood still for too long doing nothing while more and more individuals lost coverage.

Sure, I just have spent the last 7 years or so fighting for mere opportunistic thinking, only to find out the insurance companies got a bailout. I don't post very personal information or other people's very personal information on public forums such as these. Should you choose not to believe me, then don't. Regardless, I'm done. I expect to be fined in 2014 by the IRS for not being able to afford health insurance. When the Dispatch reports that people are outraged that the fine was taken from their tax refunds, I hope you'll remind them that it was better than doing nothing.

I will enjoy voting third party for the first time this year.

[Former Democrat]

Get Real wrote:

Health Reform hasn't even kicked in yet except for a few minor provisions. Costs were rising 20%+ BEFORE health reform plus people with employee plans were already either foregoing raises for coverage or getting dropped when sick. This sounds like a GOP post spreading myths. When you ask people if they like health reform they say "no". But ask them if they like the fact they can't be dropped for getting sick, adult children can stay on, no lifetime maximums, and no pre-existing conditions, they say "YES".
Examine the GOP health plan and it is a non-starter. More of the "Health Savings Accounts" which do no good if you're laid off or salary is cut - fairly common in our outsourcing, can-the-old-guy economy. Only works for the rich. Plus they won't enforce the no-preexisting condition clause. They also push high risk pools for those that get sick but this simply puts the burden on State budgets. GOP plan is still "get sick, die quick". Since we're all going to get sick eventually, we shouldn't have to go bankrupt to live. Believe me, health insurers got the better end of the deal with the latest plan.
<quoted text>

Better just report me to the White House for disinformation:

"There is a lot of disinformation about health insurance reform out there, spanning from control of personal finances to end of life care. These rumors often travel just below the surface via chain emails or through casual conversation. Since we can’t keep track of all of them here at the White House, we’re asking for your help. If you get an email or see something on the web about health insurance reform that seems fishy, send it to [e-mail]."

http://www.whitehouse.gov/blog/Facts-Are-Stub...

[gokeefe]

Enzyte Bob wrote:

<quoted text>
Like it or not, money is how we keep score. My brother is a doctor. He makes a very nice living (Obama doesn't want to give him any tax cuts), better than me. But he works his arse off and has lots and lots of pressure he has to deal with. He has a staff of about 15 people, lots of rent to pay, and he's got the beeper/cell phone on all the time. Yes, medicine is a business as is everything else in life.
As a matter of fact, my parents are the ones who taught me that even running a household is a business. If you run one like a business, you can be successful and build a little wealth for yourself. Most people, however, don't see things that way.

I don't disagree with this premise. In fact, I fully agree. What people often fail to realize is that medicine over the years has become highly technical and was driven in part by the advances of technological research. It's no longer an environment where the country doc can come to your home, take your temp and give a diagnosis. Whether we like it or not, technology makes for medicine to be a complex and expensive career decision. Many doctors seem to not have simple practices any longer but incorporate for the sake of handling the financing, insurance issues, and technological investments required. We can no longer trade chickens and eggs for a doctor visit.

Personally, I prefer that we do have the technology available, even if it comes at a cost. Diagnosis is more accurate, treatments have advanced, and knowledge has advanced.