It’s the summer of 2013, President Romney and his republican-led congress are marching forward with their election “mandate.” Austerity plans are being written and legislation already has been passed to nip any remaining power from Obama’s now impotent healthcare bill. The libertarians and tea partiers are grinning, the wealthy are relieved, and there is a sense among republicans that freedom has prevailed. YOU are unsure of how these changes will affect you, you haven’t paid much attention to politics, but you’re pretty comfortable knowing that your cushy middle income job with great benefits still provides you with the best medical care in the world, right?
The healthcare system is broad, multilayered, and complex. It is not easily simplified and implications of political changes made to the system are at best hypothesized and at worst derived from thin air. One can only offer suggestions of what will happen. Therefore the following argument is based largely on opinion, educated opinion, and biased toward my experience within a single sector of our healthcare system. A sector I believe to be of great importance and one essential and inherent in any medical system and that is emergency care.
Emergency care is a pillar of medical care and the opening gates to the healthcare system for most who access it. It is what most people think of first when they imagine unexpectedly needing to seek medical care. In this time of growing economic disparity, emergency care is also the almighty equalizer. There are no insurance restrictions, no one can be rejected. A law called EMTALA reigns in any once-practiced curb-kicking. The ER and EMTALA are the last remaining blanket of both social safety net and medical access with firm and likely untouchable political backing to remain this way. It has been this way for some time. And although controversial in some circles of politics, its not going anywhere and likely should not. Its absence would be the last straw, dissolving our already crumbling legitimacy as a just and civilized wealthy nation (e.g. patriot act, guantanamo, vast wealth disparity).
The emergency room, like the courtroom, strips those in its presence of power, money, and status. As honorable judges do, emergency physicians see and triage all in their presence as equal before the law (their law being the hippocratic oath.) With growing numbers of visits each year and ER’s crowding beyond capacity it’s a great opportunity to reflect upon this sector of our healthcare system. Those with platinum health plans, golden parachutes, and Caribbean beach homes have their upper crust sensibilities and entitled “sophistication” become quickly useless and irrelevant when they are sick, sweating, vomiting, and covered in wires head to toe in a curtained room next to my intoxicated homeless patient who I can skillfully recognize by odor alone.
The concept of the ER is simple. It is a place of triage and a place where coming to the diagnosis immediately and treating life-threatening problems is the goal, a room in which trained physicians and nurses place patients in an order to be evaluated. This order is not influenced by first class purchasing power, name brand leather shoes, stock options, or what car keys you hold. In fact, the first thing those trained people do when you step into our room is strip you of everything including your wallet, your lexus keys, your shiny cell phone, and your clothing. You become a gowned patient, simple. And that is how it should be when you are sick, for your own benefit. You form a line, behind those whose illness is of greater urgency. I do not care what insurance you hold or lack (I couldn’t name 3 insurance companies if you asked me), or the thickness of your wallet. This is not a nightclub, we don’t accept bribes, you can’t get ahead with a hoard of models and cash.
I have to stress this, because one day (unfortunately) you are likely to end up as my patient. When the system breaks further, when more people are denied insurance, when medicare is squeezed and primary physician salaries decline and their office hours shrink, when medicaid is cut and the poor can’t refill their prescriptions, when easily controlled chronic conditions spiral out of control because patients cannot afford private insurance or medications, when clinics close and psychiatric services become limited; all of those patients will come to my ER. And guess what, even if you happen to be sicker or have a more urgent medical issue than one of these poor fellows whose been crushed by the medical system, our ER will be slam-packed wall to wall with patients. Our nurses will be stretched too thin, the EKG technician will have 10 more EKGs to perform before they get to you (you are the 10th Chest Pain here, didn’t you realize), the laboratory has too many blood samples to process so I cannot tell whether you are having a heart attack yet, and I will be juggling your care along with 15 other people just as sick, sicker, even dying and perhaps also one with a toothache. At the end of the day, this is not just about you. This will hurt everyone (even the toothache patient).
This is not meant to offend, it is meant to threaten and induce fear. That is because this is scary, it is getting scarier by the day, and with the wrong path by the wrong politician it will certainly get worse. Ensuring our population has some form of insurance for their health and well-being is just common sense. These are the people that pour your coffee and open your door, they deserve the decency to hold a card just like you do that gives them comfort in the face of illness. We need to promote preventive care, primary care practice and training, senior and disabled medication and social support, and help those with chronic illness stay out of trouble. We cannot keep facing this discussion and debate in the eyes of “open markets” as if our hospitals are used car dealerships. Obamacare is a step in the direction of common sense, a move toward decency and peace of mind for those with illness. Peace of mind beyond the current (and entirely inappropriate) Romney-esque concept that, yeah sure in the end of the day we do treat the uninsured because they can end up in an ER. If he wins, and the conservative path of darwinian, survival-of -the-fittest healthcare prevails, don’t be surprised to find yourself in your most ill and panic-stricken moment of your life waiting at the end of a very, very long line. And I assure you, it will not smell pleasant.