Saint Nickanuck of the Tundra

the emergency room series, cc by-nc-nd image from Jillian Corinne on Flickr

What follows is a deidentified and slightly dramatized (but only slightly) version of a recent encounter I was privy to:

Setting – The emergency room of a large hospital somewhere on the east coast of the United States, 4:30am.

An employee of said hospital has just brought his wife in from home after she developed excruciating abdominal pain that medications didn’t help. In an examination room, she lies on a gurney, writhing in pain and unable to get comfortable. He looks on, tense with worry; he knows enough to be concerned about several possible things that might be wrong, but is unable to do more than wait for test results to return and pain medication to arrive. He’s also exhausted, both from the stress of the moment and the suddenly truncated sleep.

A slim man, bearing a clipboard, enters the room. He is pleasant, but slightly awkward.

Warren: “Hello, my name is Warren. Are you Anne Turner?”

The woman nods assent before twisting to a new position.

Warren: “And so that makes you Jack Turner?”

The man blinks bleary eyes, and straightens up in his seat.

Jack: “Yeah, that’s me.”

Warren: “Alright, I just need to deal with one small thing about your insurance.”

Jack: “Okay… I work here, and you already know that I have my insurance through this hospital.”

Warren: “Yes! We just need to resolve the matter of the $25 copay. Would you like a payroll deduction, to pay it out of pocket, or be sent a bill?”

The man and the woman exchange a beleaguered look.

Jack: “So, I work at this hospital, I have my medical insurance through this hospital… and I have to pay a copay for this ER visit?”

Warren: “Yes, sir.”

Jack: “And I can do this through a PAYROLL DEDUCTION?! Is that supposed to be a perk?”

Warren: “Um… yes, sir.”

The man and the woman gaze at each other with incredulity.

Jack: “Fine, I’ll just pay it now, then.”

He pulls two $20 bills from his wallet and hands them to the slim man, who quickly exits. The slim man returns about ten minutes later, money still in hand.

Warren: “I’m sorry, Mr. Turner, but do you have change?”

Jack: “Change? Change? The hospital… doesn’t have change?”

Warren: “No, sir.”

The man and the woman share yet another bemused glace. He checks his wallet again.

Jack: “Since I work for this hospital, neither do I, it seems.”

Warren: “Well, would you like me to do a payroll deduction?”

Jack: “You know what? Just send me the bill.”

Burn Fireworks, Burn, cc by image by Orin Zebest on Flickr

I was reminded today, while inadvertently seeing a horrible “interview news” segment on television as I passed through the physician’s lounge for a bagel, that I had meant to link to the now several-months-passed healthcare reform legislation. Even this far after its passage, I continue to be amazed at how many people use this law as a prop to argue for and against various medical and economic issues without, you know, having actually read it.

Although the full text is a legalese-swollen 906 pages, I still recommend it as a must-read for every US citizen, whatever your political bent is. At the very least, there are some excellent (and far more easily digestible) summaries of the key points on the site.

To all Americans, I wish you a happy 4th of July weekend! It’s a time to reflect on the good of the freedoms we enjoy in this country… and note the bad that becoming complacent in said freedoms can result in, as typified by the content of, and the “democratic” process that resulted in, this legislation.

Also, be careful with the fireworks and the adult beverages this weekend, lest you find yourself acutely needing the health care system this is attempting to reform… Enjoy!

image by virtualreality on Flickr

“If holistic-health advocates were content with encouraging sensible preventive medicine or with criticizing the economic organization of American medicine, we might be enthusiastic, but they are not. If the movement were without influence on American life, we would be indifferent, but it is not. Holistic medicine is a pablum of common sense and nonsense offered by cranks and quacks and failed pedants who share an attachment to magic and an animosity toward reason.

Too many people seem willing to swallow the rhetoric—even too many medical doctors—and the results will not be benign. At times, physicians may find themselves in sympathy with the holistic movement, because some fragment of the rhetoric rings true, because of certain practices and attitudes they encounter in their daily work with colleagues and patients, or because of dissatisfaction with the economic and social organization of medicine. One hopes they will speak bluntly, but it does no good to join forces with cranks and quacks, magicians and madmen.”

-C. Glymour and D. Stalker from “Engineers, cranks, physicians, magicians”; N Engl J Med. 1983 Apr 21;308(16):960-4