Transcript for the Piece Audio version of Why Single Payer, Part 4: Emergency Rooms and Prevention

MILES EDDY
Access to healthcare is becoming increasingly difficult, even for those with good insurance. As wait times to see doctors increases, and as number of people with no insurance increases, hospital Emergency Rooms are becoming the primary health service for a lot of people. I'm Miles Eddy, and in this segment on this series about healthcare, we talk about Emergency Rooms, preventative care, and some of the inefficiencies in the current system. I spoke with Dr. Beth Kinney, an ER doctor in Alamosa, and Russ Johnson, the CEO of the Alamosa Hospital.

DR BETH KINNEY
Emergency rooms in the big cities now are pretty rough, tough places. It's not uncommon for people who do have true medical emergencies have to wait up to 12 hours just to be seen. So the poor doc's who work there are running the entire time that their there and they're often dealing with patient who are sick. They feel lousy and their angry over the wait that they have had, but the system is so broken at the level right now that it is at that many people wait hours and hours and hours.

MILES
You mentioned the system was broken, what do you mean by that and what do you thing the problem is.

DR KINNEY
The system is broken in any number of ways. What I was eluding to there was the fact that in many, many places there is so poor access to care by primary care physicians that many people have ended up using the emergency room as a doctors office.

MILES
It seems that preventative care is gone by the wayside in the current medical system. Do you agree with that?

RUSS JOHNSON
I think that preventative care has clearly taken a distant second place, and there's a lot of reasons for that, but the financing of our healthcare system is really around acute medicine.

DR KINNEY
Even if you have a regular physician here in the valley, if you come down with a sore throat, or your child has an ear infection, the chances of getting a visit that day when your sick are very, very small and as a result you go to the ER because there is no place else to go. That over burdens the ER with client visits and when people are truly sick with true emergencies, sometimes they have to wait when they shouldn't. You see someone come in who doesn?t have insurance who does have a significant injury; for example a farmer who has accidentally amputated his hand. He gets sent off to a hand surgeon somewhere who by law is required to take care of him because he came in through the ER and so specialist everywhere are giving billions of dollars of free care for which they have no reimbursement whatsoever. It's what we call unfounded mandates by the federal government.

RUSS JOHNSON
Someone presents and they don't have an emergent situation, they don't have any insurance; what do we do about that? Right now what we do is we begin a discussion about is this person qualified for Medicaid, are they qualified for the Colorado Indigent Care Program? Then we offer them a discount, for example our hospital offers as much as 70% discount. But ultimately there are patients who come here for an out patient procedure that's not emergent that we don?t take care of, and it's really a struggle for us to balance that charitable mission with keeping a 45 million dollar operation that has less than one and a half percent operating margin.

DR KINNEY
We see all the time things like the following scenario: Person goes to the emergency room, their diagnosed with pneumonia, their prescribed an antibiotic, they go to the pharmacy to fill the antibiotic, and the pharmacy says that Medicaid doesn't cover that antibiotic, so they don't get it. So they go home without their antibiotic and three days latter they come back to the ER sicker and have to be admitted now because they haven't been treated. So a problem that could have easily been remedied had they been able to get an antibiotic has become so severe that now they need a hospital admission at many, many, many times the cost, and the system is so inefficient that that happens all the time. There's not an easy way to go back and get a different prescription from the ER unless they come in the ER again and pay another bill and it's a crazy, inefficient system.

RUSS JOHNSON
I think that one of the things that we have to decide as a healthcare system is what can we afford to do? Believing that we can afford to do this heroic medicine at the end of life for people may not be the right thing when in fact what that's doing to us is keeping us from covering children, from covering pregnant moms, and from providing healthcare resources in areas where perhaps they can be better utilized.

DR KINNEY
We often see Medicaid make just stupid decisions. There's one I read about the other day. They suddenly decided that patients should not be on more than five or eight medications. So, they go see their primary care doc and suddenly, in one month, you're suppose to wean them down to five or eight medications because Medicaid won't pay for any more.

RUSS JOHNSON
So I think we have missed placed our priorities, and as we look at a more broad universal coverage program, we must refocus on the preventative and primary care aspects of our population and when we're talking earlier about making some decisions about what's not covered, how do we make that decision? So I think that what that does is it switches the burden of planning and thinking and considering what ethically and morally and financially we should do about end of care issues, end of life issues as a policy discussion.

MILES
That was Russ Johnson and Dr Beth Kenney. Next time, we'll talk about the impact of the legal system on healthcare, the cost of medical school, and the flow of medical information. Reporting from Alamosa, Colorado, and produced in the studios of Midi Age Productions, I'm Miles Eddy.