''As well-meaning health-care reform legislation looms, I prophesy hard times ahead if we genuinely believe that we can simultaneously reduce the cost of health care even as we give more of it away to those who abuse a costly gift with neither accountability nor consequence for their actions.''
America's physicians provide excellent medical care – but they also face the frustrating economics of running medical practices or teaching centers that constantly struggle to stay financially solvent. Their struggles are not merely due to the absence of adequately insured patients. To explain requires unpleasant truths.
Sadly, some of the hard truths of medicine are considered unspeakable. We can whisper them to one another, but never in a public venue. Physicians
have written to me over the years, in response to columns I have published, and have said, "Thanks for telling the truth; I'll lose my job if I do it!"
We cannot study these truths, for they violate the underlying social bias of politics and academia – which is that those suffering from medical ills only do so because the nation and the medical profession have not provided enough for them. However, those in practice have ample evidence to the contrary. Some facts are self-evident.
Even as we know that our citizens need access to affordable health care, we in medicine simultaneously recognize the truth that many patients are going to abuse and misuse any gift of subsidized care that the nation gives them. This is a simple fact of human nature. A thing that is "free" always costs someone else money. And the recipient of a "free" thing frequently values it at exactly zero.
Those of us who practice in this nation's emergency departments understand that there is a subset of patients who seek our care day after day, night after night, with conditions and complaints that not only fail to qualify as emergencies, but that are actually habitual manipulations of the system put in place to provide care for them. Their numbers are small compared to those truly needing care, but their presence serves to disrupt necessary work, increase wait-times, cause unneeded drama and significantly increase the costs to those genuinely sick and injured. In fact, according to the AMA, uncompensated emergency care cost $4.2 billion in 2001. Most of these patients needed the care they received. Many did not.
The emergency department where I practice sees some 37,000 patients each year. Last year, 200 of those patients accounted for 15 percent of the total. That is, some 27 visits per patient. Again, some are chronically ill. Far too many are not. But it's difficult, if not impossible, to quantify that number nationally. It isn't nice, after all. http://www.wnd.com/index.php?fa=PAGE.view&pageId=118649