CodeBlueBlog: EMERGENCY

April 2005

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If you have worked in a hospital, as I have, over the past 15-20 years, you have noticed a striking increase in emergency room visits.

And we aren't talking about people with crushed bones and severed limbs. No. If your emergency room is anything like mine, it is filled to bursting, 24 hours a day with patients complaining of runny noses, stomach cramps, headaches, bruises, nearsightedness...the quotidian medical affairs that at one time were attended to by the family doctor.

If you walk through the waiting room, where patients sit for 5 and 6 hours to see a doctor for these mundane ailments, you'll see a population predominently composed of the young, the poor, immigrants, illegal aliens, migrant workers, and a smattering of the middle class.

Although this population is disparate, it has a common bond drawing it to the ER at all hours, for any physical complaint: no health care insurance.

The Emergency Medical Treatment and Labor Act of 1986 (EMTLA) prohibits hospitals from turning away patients who arrive with a complaint. Originally intended to prevent patient "dumping" (where a private hospital buys a taxi ride to a public hospital for an uninsured patient), the omnipresence of liability lawyers has forced expansion of the Act's intent to cover everyone (including noncitizens and illegal aliens) who walks through the door, no matter what the complaint.

Because people know a good thing when they see it, smart consumers who are pinched for cash drop their health insurance because now they are covered. Covered for cuts and scrapes, for pregnancy, for cancer -- you name it. It can be a $15.00 problem or a million dollar problem.

In addition, foreigners, illegal aliens and migrant workers pass the word around their community and in their home countries: free care in the U.S. at the hospitals. All you have to do is wait in the ER! I have seen many patients who fly to Florida from the Carribean and walk into the ER to get an obstetrical ultrasound, or be casted, or just for a check-up. A flight from the Dominican Republic is cheap compared to an MRI of the brain to follow-up a lesion.

So when politicians claim that there is a HEALTH CARE CRISIS, and then adduce the growing number of uninsured as proof of this crisis -- toss it right back at 'em. Ask them to show you a graph showing the percentage of uninsured per year before 1986, and after 1986. Ask them about EMTLA.

The cost of all this free care? $22 billion last year, and going nowhere but up.

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health care also health·care (hlthkâr) n. :efforts made to maintain or restore health especially by trained and licensed professionals -- usually hyphenated when used attributively

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