Skip to main content

missing the safety net

What if you graduated from high school, left home, got a job delivering pizza, and were critically injured in a motor vehicle accident?

What if you had a part time job at a big company, a house, a family and got cancer?

What if you lost your job and your 8 year old daughter got appendicitis?

In the United States there are systems that act as safety nets for situations such as these, but they are not self sufficient and are severely strained in their ability to provide services with the progressive loss in adequate insurance coverage, the floundering economy and the increasingly outrageous costs of various forms of medical care.

If you were the first guy, ejected from your Geo Metro when you were t-boned at an intersection by a drunk driver, you would be taken to an emergency room at any hospital, transported to a trauma center if necessary, and treated until you were on the mend by that hospital. If you were eligible for medicaid or medicare due to the severity of your disability the hospital would eventually be reimbursed for the cost of your care (at least partly), and if you were not eligible, the hospital would attempt to bill you and when you were unable to pay, would eat the cost, part of which would be tax deductible.

If you were the second guy, the doctors who treated you would do so with little hope of being paid, might bill you, and would eventually eat the costs. You might be able to apply for a county emergency payment program to pay for things like surgery and CT scans, but you would eventually be expected to repay these costs. You would apply for public assistance based on disability, but the process of being approved for it would be slow. Your savings would inevitably be used up. You might lose your house.

In the case of the child, we have guaranteed medical insurance available for children through the government, but you do need to apply for it. The child with appendicitis might die or have some other bad outcome due to delay in treatment from lack of insurance. In a perceived emergency, though, treatment through the local emergency room would be assured.

Much of the problem with American health care stems from the escalating costs associated with it. Yet many of these costs, especially those associated with procedures and tests, go to hospitals who are the basis of our safety nets. In cutting costs, it is going to be vital that we pay attention to making sure that hospitals stay solvent. Providing adequate universal insurance will be a project that takes time, probably years. It is this insurance that can support hospitals and allow them to continue to support the communities in which they operate.

An article in the New England Journal of Medicine (http://content.nejm.org/cgi/content/full/361/23/2201) addressed our safety net system, and just how fragile it is. Because some hospitals are located in areas of particularly acute economic and social disaster, they are simultaneously vitally important to a safety net and totally inadequately reimbursed. Allowing hospitals like that to go under threatens the whole fabric of the larger medical system.

Comments

Popular posts from this blog

How to make your own ultrasound gel (which is also sterile and edible and environmentally friendly) **UPDATED--NEW RECIPE**

I have been doing lots of bedside ultrasound lately and realized how useful it would be in areas far off the beaten track like Haiti, for instance. With a bedside ultrasound (mine fits in my pocket) I could diagnose heart disease, kidney and gallbladder problems, various cancers as well as lung and intestinal diseases. Then I realized that I would have to take a whole bunch of ultrasound gel with me which would mean that I would have to check luggage, which is a real pain when traveling light to a place where luggage disappears. I heard that you can use water, or spit, in a pinch, or even lotion, though oil based coupling media apparently break down the surface of the transducer. Or, of course, you can just use ultrasound gel. Ultrasound requires an aqueous interface between the transducer and the skin or else all you see is black. Ultrasound gel is a clear goo, looks like hair gel or aloe vera, and is made by several companies out of various combinations of propylene glycol, glyce...

Ivermectin for Covid--Does it work? We don't know.

  Lately there has been quite a heated controversy about whether to use ivermectin for Covid-19.  The FDA , a US federal agency responsible for providing unbiased information to protect people from harmful drugs, foods, even tobacco products, has said that there is not good evidence of ivermectin's safety and effectiveness in treating Covid 19, and that just about sums up what we truly know about ivermectin in the context of Covid. The CDC, Centers for Disease Control, a branch of the department of Health and Human Services, tasked with preventing and treating disease and injury, also recently warned  people not to use ivermectin to treat Covid outside of actual clinical trials. Certain highly qualified physicians, including ones who practice critical care medicine and manage many patients with severe Covid infections in the intensive care unit vocally support the use of ivermectin to treat Covid and have published dosing schedules and reviews of the literature supporting...

Actinic Keratoses and Carac (fluorouracil) cream: why is this so expensive?

First, a disclaimer: I don't know why Carac (0.5% flourouracil cream) is so expensive. I will speculate, though, at the very end of this blog. Sun and the skin: what happens If a person reaches a certain age, has very little pigment in her skin, and has spent lots of time in the sun, bad stuff happens. The ultraviolet radiation of the sun does all kinds of great things: it makes us happy, causes us to synthesize vitamin D which strengthens our bones and it gives us this healthy glow until we get old and wrinkled and leathery. And even that can be charming. The skin cells put up with this remarkably well for a long time, partly aided by melanin pigment which absorbs the radiation, which is why we tan and freckle, if we are fair skinned. Eventually, though, we absorb enough radiation that it injures the skin and produces cells which multiply oddly. It also damages the skin's elasticity which creates wrinkles. The cells which reproduce in odd ways peel, creating dry skin or...