New Healthcare Versus Old Healthcare: Mirror Images?

by Gillian Hubble

categories: Doctors and Nurses, Hospitals and Health Systems, The Uninsured and Underinsured

Published October 12, 2009 @ 06:00AM PT

 

This weekend I was in the Bay Area for a trail race, but I got to experience more than the scenic views from the Oakland hills. The bonus was a personal evaluation of Berkeley’s emergency care (yes, only a healthcare consultant could possibly see it that way.) It earned a “C”, meaning it was average US healthcare: not really good, not terrible, and anxiety-producing for all the wrong reasons. So what would change under proposed healthcare reform?

First, some background. For two days before the race I had vague abdominal discomfort, but chalked it up to female cyclical issues. A few hours into the race I was no longer able to breathe, much less move, without severe, stabbing abdominal pain. I was bloated, nauseated, lightheaded, and clammy. Later I learned it was a large ovarian cyst, extremely inflamed by the constant pressure of my hydration pack belt. It left me unable to ingest anything so I became dehydrated, which made existing kidney stones symptomatic. My race was over, but the fun had just begun.

EMTs wheeled me into the ER under 5 blankets and with a heated IV. I urgently told my significant other, “Call my insurance to make sure this hospital is in-network!” (In-network deductible: $5,000; out-of-network deductible: $15,000) [NO CHANGE.] He dashed off, cell phone in hand. Turns out they wouldn’t tell him anything; he wasn’t authorized. They hadn’t included an authorization form with the enrollment paperwork [NO CHANGE.]

A nurse did an initial assessment, and the next person through the door was the “Patient Counselor,” to complete bedside registration. The counseling part is for the uninsured, to sign them up for qualifying public programs so the hospital gets paid [PROCESS: NO CHANGE. FREQUENCY: LESS.]  “Do you have insurance?” she asked, demanding to see my ID and insurance card. My S.O. had them. Very irritated, she marched off to find him—after first obtaining all of my contact information, and his [NO CHANGE.]

Nurse #2 came in, and asked for the 7th time if I had any allergies (1-6: EMTs, first nurse.) Yes, NSAIDs – non-steroidal anti-inflammatory drugs, like ibuprofen or aspirin. She asked me (7th time) if I was taking any medication. Again, yes [NO CHANGE.] Finally the doctor came in to do an evaluation. He cut off my S.O. when he answered some questions; I was a little incoherent. Nope, it had to come from me. And it better not take more than a minute. He ordered a CT, morphine, and anti-nausea medication [NO CHANGE.]

Four hours later I was discharged after the ER doctor told me to continue taking narcotics and NSAIDs. Um, I’m allergic to NSAIDs. Oh, that wasn’t in the computer. Seven times, people, SEVEN TIMES! He also told me to come back to the ER tomorrow for follow-up (personal calculator: minimum $400 and 3 hours, to add to that days’ $1,000+) [NO CHANGE.] Thanks, I’ll see my primary care doctor back home, with nothing but a discharge summary as the staff refused to print my labs or burn my CT onto CD (though I own that information under HIPAA.) They said to talk to medical records tomorrow [NO CHANGE.]

In the final analysis I have to agree with Ezra Klein. The “new” healthcare system looks a lot like the old one: it includes a few more patients in our insurance patchwork quilt of expensive, inefficient, and uncoordinated care. There is no requirement for a national healthcare record, though the HITECH bill provides incentives. But plans for Medicare pilot payment “bundling” programs may be our salvation, as they are the basis of “pay for performance.” That would certainly affect my Berkeley ER bill!

Since the Senate Finance Committee bill is widely expected to be rubber-stamped on Tuesday, we will focus on another type of healthcare bill this week – the one you get in the mail – and how reform may change its relationship to the care you receive. Tune in tomorrow for a crash course on how perfectly legal Medicare abuse can pad your healthcare bill.

Photo Lachlan // CC BY 2.0