47 Million Uninsured My Ass

(With apologies to Deborah Peel -PB)

So I had this uninsured patient with a chronic medical problem that was being addressed at The Big Academic Medical Center Sixty Miles Away who came to the department with worsening symptoms from her chronic medical problem, a problem that was competing, I might add, with several others that were lifestyle related.  No problem, of course, because people can’t choose when they are going to get sick and if we have to fill in for The Big Academic Medical Center Sixty Miles Away then so be it.

An expensive workup ensued which confirmed the worsening of her chronic medical problem.  Score!  A slam-dunk admission.  A pleasant phone call to the admitting physician who, even though it was 3 AM would agree, ruefully and without the usual surliness and rolling of the eyes that it is our lot to elicit in every doctor in town at one time or another, that the patient really was sick and really did need admission.  Unfortunately, as soon as I mentioned the patient’s name he related to me that at her last admission for a similar exacerbation of her chronic medical problem she had eloped, leaving the hospital and her doctor’s care because she believed she was being treated rudely. On her way out she had sworn to “never let them touch me again.”

A week after her elopement and while visiting her sister at the Big Academic Medical Center Sixty Miles Away (a sister who interestingly enough had the same chronic medical problem), she checked herself into their swank Emergency Department for a similar worsening of her chronic medical problem and was admitted; receiving an expensive workup and, on discharge, a follow-up appointment with one of the Leading Specialists in the Field of Herchronicmedicalproblemology, a lady who has written textbooks and who had followed her at the Big Academic Medical Center Sixty Miles Away.

The admitting physician adamantly refused to admit and suggested, not unreasonably, that I transfer her to The Big Academic Medical Center Sixty Miles Away as they were the last to lay hands on her and were most familiar with her condition.   The Big Academic Medical Center Sixty Miles Away agreed, without hesitation, to accept her and I even spoke to the Leading Specialist in the Field of Herchronicmedicalproblemology who happened to be on call.  Oh how the heavens sometimes align and, just when you think you are heading for a knock-down, drag out patient transfer brawl you see the triumphal field just ahead and prepare to eat the cheeses and hams of victory!

Unfortunately, despite having no insurance, no ability, and no intention of ever paying a thin dime for the hundreds of thousands of dollars of free medical care that she has received and will receive until that tragic day when the treasure we spend will only bore the Reaper, the patient refused transfer to The Big Academic Medical Center Sixty Miles Away citing a litany of complaints against them from rude nurses to bad food, perhaps most damning being her observation that the Leading Specialist in the Field of Herchronicmedicalproblemology didn’t know what she was doing and, “Didn’t do nothing for me.”

Not to mention that the one hour drive would inconvenience her family, their constant attendance with cell phones at ready being a necessary adjuvant therapy for her chronic medical problem.

Oh my gentle readers, scholars all and deeply interested in this insane goat rodeo known as American Medicine, you would have wept at the sincerity of our efforts to prevent her, unsuccessfully, from eloping and leaving the department to nestle in the bosom of her uninsured family.  There may be 47 million uninsured (most of whom are young enough to never require expensive medical care or wealthy enough to afford insurance except they have other priorities) but this particular one of them was so unconcerned for her own health that she spurned our best efforts over a matter of overblown pride and convenience for the many visitors she expected.  Is she typical of the uninsured?  Maybe not.  But we can and do move heaven and earth to care for all of our patients, even those who cannot pay. I have never heard of a patient who needed treatment being turned away which is why a wino living on the streets of our country can receive medical care that European politicians living in The Health Care Paradise Across The Water have to fly to other countries (ours) to get.

9 thoughts on “47 Million Uninsured My Ass

  1. Love your stuff. Mind commenting about a breakdown of this mythical 47 mill?such a huge % of themate illegal aliens that it boggles me when people go apeshit over this figure.

  2. It is my greatest hope that I will one day be able to eat the cheeses and hams of victory. But alas, I will most likely go home saying, “this job sucks!” for the rest of my life.

  3. Very cool blog. But as a working physician at a university hospital in the EU, I have never had the necessity of transferring patients to the US. I believe the care at my hospital is on par with any US university based program.

    Just my 2 euro-cents


    Good luck with your blog.

  4. Allow me to put another face on the uninsured…My wife has MS. We cannot afford the only insurance available to her (IL Chips program–it is not insurance it is extortion!). She is lucky, her symptoms are episodic and she keeps herself in great shape–she was diagnosed in 1986 and until recently she could probably fool you, good doctor, into thinking that she was a specimen of health for her 54 years (now she limps too much).

    Her reward for her effort to stay in shape is to be treated like a leper by the insurance industry and financially raped by the likes of you, who charge her up to 60% more than insurers pay for the same services even though she enters your hallowed halls with cash in hand. Medical providers often refuse to provide true itemized bills. Hospitals and doctors often appear to have no earthly clue what their services actually cost. A hospital recently quoted $400 for an ultrasound and sent a bill for $900. Try that in any other industry.

    (I have never financially raped anybody. In fact, if you look at it without your jerking knee obscuring your vision, the money paid to your doctor is probably the least of your costs. In my case, I get a certain hourly rate, the exact amount of which I can’t disclose secondary to a contractual clause. Suffice to say that, considering I see two to three patients an hour, my typical payment for any given patient is probably less than most couples spend for a modest night on the town. Now, you may wince at paying the money to me when you could more productively spend it at an Outback Steakhouse but my time is worth something and I do have many years of training that hopefully results in a good “product.”

    Let me reiterate that, with the exception of doctors in cosmetic practices, I don’t know a single physician who doesn’t work some free care into his schedule, whether involuntarily in my case, or deliberately for those in private practice. I don’t know of too many other professions or careers where people give away their goods or their services routinely and whether physicans are paid better than 95 percent of the country is immaterial. It is only in or new Commubamnistic nation that you feel justified in helping yourself to the fruits of somebody else’s labor as a right. -PB)

    If, good doctor, you know anything about MS, you know stress is her number one enemy. Yet my wife has to endure days, sometime weeks of haggling with administrators over every little medical bill, a process that often reduces her to tears.

    Please stick to learning your craft and stop trying to dehumanize people who responsibly face legitimate health challenges only to get kicked in the teeth by your industry.

    A young hotshot doctor who really knows anything about what it’s like to be uninsured? My ass!

  5. You must forgive those whose situation makes it difficult to be objective in their despair.
    I place the blame on the “if you have a phone, you have a lawyer” crowd whose excesses are hidden by by the politicians they purchase. Physicians are caught in the vise of spiraling operating costs and malpractice threats; likely escapegoats because they are the ones that heal.face of health care.

  6. I am a layman, but I have personally witnessed similar some stories in the emergency room that would back you up. My brother-in-law, who is in the medical field could tell you many stories, including one about a gentleman who showed up in the emergency room. When asked what was wrong, he said he needed a checkup.
    If you check Bing for “breakdown of medical uninsured”, you will find the numbers, and this site…
    My daughter is among the young legitimate uninsured and has arthritis, so I am in favor of reform (but not the insanity being proposed)

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