Why is emergency care a right?

[The White Coat Investor]

I was thumbing through some of ACEP's policy statements last week when I discovered that "we" believe that there is a universal "right" to emergency health care. While I can see the obvious financial benefits of this position, (i.e. if we can convince society and government that what we do is a "right" then the government should reimburse us for everything we do, whether the person can pay for it or not,) I'm not sure I believe it philosophically. Why should someone have a right to emergency health care, but not other, equally important, aspects of care?

Now don't get me wrong, I'm not saying that if a trauma rolls into my trauma bay I'm going to demand he pull out his wallet before I check his airway (negative wallet biopsy boss, I'll just put him in the hallway until we can make some calls), but I like to think I'm caring for that patient out of the goodness of my (and my staff's and my hospital's) heart, not because of some mysterious universal right bequeathed by ACEP.

"Watery tarts in ponds throwing swords are no basis for a system of government."

Do you all really believe emergency health care is a right?

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[aphistis]

Actually, Despy, I believe it's "watery tarts distributing swords..."

 

[superdevil]

i can't believe i stumbled onto a thread where the source of sovereignty of "autonomous collectives" is being debated

python forever!!!

 

[beyond all hope]

IMHO

That's one of the reasons I became an ER doc, because I don't deal with wallet biopsies. Sure, I have to hassle with insurance sometimes, but in general I get what I want for my patients. Americans don't believe in universal coverage but they believe in emergency visits for all, so the ER is our universal coverage. It sucks but it's better than the eighties when poor people could die on the front steps of the hospital from easily-treated conditions.

I think many people trained in Emergency because we believe in care for all, even the poor, mentally ill, illegal immigrants and other outcasts of society.
I believe ACEP is merely affirming what many of us already feel. That doesn't make your daily struggle to treat the penniless, malignant and noncompliant any less heroic.

The real problem is that when we say emergency health care is a right is people get a sense of entitlement. Every little problem that THEY think is an emergency must be worked up RIGHT NOW or you're a bad doctor. In Colorado I heard of a system where nonemergent patients have a choice: Pay cash and be treated right away, or go to clinic. I really hope this idea catches on.

In my mind, all people should have access to health care, but if you're not willing to pay you and nonemergent should be willing to wait.

 

[southerndoc]

There should be a universal right to primary care visits too... it would cost less money than paying to have these patients seen in the ED when their problem gets out of hand.

 

[Tas]

I had to vote yes on this, but I wanted to sort of explain myself (and I'll probably get railed for this...)

I can read your question in two ways...

1) If someone is in a car wreck, diabetic emergency, MI, SOB, that sort of thing... I don't believe anyone should be denied care for a TRUE emergency...

however that said...

2) I don't believe that there is a "right" to just go into whatever ER you want, whenever you want, and get whatever you want for free. Sooner or later there MUST be personal responsibilty to care for yourself or pay for the care you recieve.. just has to be. I would be a huge supporter of having 24hr primary care clinics in which ER docs could transfer non-emergent cases into for more in-depth care and tracking...but that opens another whole can of worms.

 

[canuck MD]

...and in comes the Canadian In our lovely canadian health care system, almost everyone has the "right" to almost all forms of care. Comes out of our taxes but sure eases the minds of many. The problem is that patient's expectations increase with time. The average wait time at most EDs in Canada is 5 hours..for many, the ED is the primary care clinic because folks just can't find a GP willing to take more patients. Everyone complains about wait times for special tests, wait times for specialist appointment and wait time for surgeries etc... To come back to your initial question, I strongly believe that ALL forms of medical care (except the non essential cosmetic crap) should be available to every individual, ED care being one of them. However, I also strongly believe that people have to take care of themselves and be way more responsible for their own health and well being.

One last thing, IMHO medical care should be unbiased at all levels; why should the President (or Prime Minister in my case) have better/prompter care than the local "bum"...I just don't think that we should allow ourselves to justify care based on social and financial standing...it just doesn't make much sense to me! Cheers

 

[devildoc2]

There should be a universal right to primary care visits too... it would cost less money than paying to have these patients seen in the ED when their problem gets out of hand.

If its really a universal right, then the government has the responsibility to pay doctors as LITTLE AS POSSIBLE.

Think about it. If the government doesnt pay doctors as little as possible, then they would be failing in their duty to provide the RIGHT of healthcare to its people.

Higher wages = restrictive access to healthcare = obstruction of healthcare as a right.

Be careful what you wish for.

 

[southerndoc]

If its really a universal right, then the government has the responsibility to pay doctors as LITTLE AS POSSIBLE.

Think about it. If the government doesnt pay doctors as little as possible, then they would be failing in their duty to provide the RIGHT of healthcare to its people.

Higher wages = restrictive access to healthcare = obstruction of healthcare as a right.

Be careful what you wish for.

It's a right that we have fire and police protection. Should they be doing it for free?

It's a right that we have representation for our government. Last I checked, senators and congressmen have pretty nice salaries.

A right to access does not equate to restricting wages. As I mentioned in my earlier post, I believe that allowing access to primary care would decrease ED visits, which would cost less.

 

[Daedalus]

There should be a universal right to primary care visits too... it would cost less money than paying to have these patients seen in the ED when their problem gets out of hand.

I totally agree - this would relieve the EDs from a lot of non-emergency work, and provide for the primary care that should be a universal right. Now the question is, is this best accomplished by universal health insurance (however it is administered) to be used at existing facilities, or some other method of free primary care.

 

[southerndoc]

I totally agree - this would relieve the EDs from a lot of non-emergency work, and provide for the primary care that should be a universal right. Now the question is, is this best accomplished by universal health insurance (however it is administered) to be used at existing facilities, or some other method of free primary care.

How to accomplish this is another question, but you can't deny that a $70 PCP visit is cheaper than a $250-400 ED visit.

 

[docB]

I would like to see a system where you are entitled to a basic level of health care (basic - not the same as those with foresight to secure their own insurance) IF you pay taxes. If you are a parasite you are entitled to nothing. This would essentially move the present resources we (I) spend on the indigent and give that to the working poor.

 

[Jeff698]

Now the question is, is this best accomplished by universal health insurance (however it is administered) to be used at existing facilities, or some other method of free primary care.

Here's my vote for universal, tax-subsidized health INSURANCE. Keep the system private, but regulated. Decouple health insurance from employement so that the policy is the patient's, not the patient's employer's. Mandate a minimum set of benefits (and I do mean minimum) and let the market determine the available plans.

Take care,
Jeff

 

[lloydchristmas]

It's a right that we have fire and police protection. Should they be doing it for free?

It's a right that we have representation for our government. Last I checked, senators and congressmen have pretty nice salaries.

A right to access does not equate to restricting wages. As I mentioned in my earlier post, I believe that allowing access to primary care would decrease ED visits, which would cost less.

I've got the simplest solution: Put a $20 copay on all ER visits. That would save a few billion dollars a year, guaranteed.

 

[lloydchristmas]

Here's my vote for universal, tax-subsidized health INSURANCE. Keep the system private, but regulated. Decouple health insurance from employement so that the policy is the patient's, not the patient's employer's. Mandate a minimum set of benefits (and I do mean minimum) and let the market determine the available plans.

Take care,
Jeff

I've been saying this for a long time too Jeff... if we had a universal health insurance that would equate to "if you work, you have health insurance for you and your family. If you don't, you have no coverage". We should still cover the kids and the TRULY disabled (which needs redefining something terrible).

Why is it so difficult to see this solution?

 

[Sessamoid]

How to accomplish this is another question, but you can't deny that a $70 PCP visit is cheaper than a $250-400 ED visit.

Maybe for the patient, but the actual cost of the visit is likely pretty much the same. What's important here is the marginal cost of the ED visit, i.e. how much more it costs to add one more ED visit to the existing load. Since the ED already has to be open and staffed 24 hours a day, the marginal cost for an urgent visit is pretty low. The only reason it costs so much for the patient is the need to subsidize all the free care that EDs are required by federal law to provide.

 

[MacGyver]

It's a right that we have fire and police protection. Should they be doing it for free?

No, but you do realize that cities try to pay police and fire fighters as little as possible right? Their salaries are artificially lowered because its deeemed a "right"

It's a right that we have representation for our government. Last I checked, senators and congressmen have pretty nice salaries.

Strawman. Senators and congressmen get to set their own salaries however they see fit. No outside review.

A right to access does not equate to restricting wages.

Yes, it does. All services which are deemed "rights" result in artificial wage lowering.

As I mentioned in my earlier post, I believe that allowing access to primary care would decrease ED visits, which would cost less.

Sure it would cost the system less. However, how are you going to implement this? In Canada, where GP visits are "universal" people still have to go to the ER because no MDs want to take new patients. Its not worth it to accept new patients when they are getting reimbursed so poorly for it. Hell, auto mechanics in Canada make more than GPs.

Mandating universal coverage for primary care will do NOTHING to ease load on ERs, because doctors will simply stop accepting new patients. IN order to get around this, you either have to expand scope to midlevels, OR you have to have federal control over the supply of doctors in this country. BOTH solutions are very bad for docs.

 

[Seaglass]

How to accomplish this is another question, but you can't deny that a $70 PCP visit is cheaper than a $250-400 ED visit.

Not if no one ever pays for the ED visit.

C

 

[docB]

Whenever a patient asks me why things are so expensive I tell them, "An aspirin costs $5 because you are paying for your and one for the guys on either side of you. Then you also have to pay to cover me and the hospital if we get sued for giving it to you."

 

[DrMom]

Here's my vote for universal, tax-subsidized health INSURANCE. Keep the system private, but regulated. Decouple health insurance from employement so that the policy is the patient's, not the patient's employer's. Mandate a minimum set of benefits (and I do mean minimum) and let the market determine the available plans.

Take care,
Jeff

I'm all for separating insurance from employement.