"Arrrgh!! Two hours on this motor vehicle accident case with CTs of the head, face, chest, abdomen, pelvis, lower extremities, and cervical, thoracic, and lumbar spine for numerous injuries, and now I find out the patient has no insurance. He'll be in the ICU—studied every day—for months, and we won't get a cent."
"Did you see last month's collections? The uninsured rate went from 30% to 40%. We are losing millions because of these people. They should go to the county hospital."
"Uhh! Now they're sending a total body scan on his wife. This'll be another two hours wasted and $6000 lost." "I'm getting a total kid scan on my workstation. What are names of those two you're looking at?"
"John and Barbara White."
"It's their kid. We are totally screwed. They'll scan everyone in the car, whether they need it or not. The ER should do only what is absolutely necessary on these uninsureds."
"Barbara White? Isn't she that nice woman who works part-time in admissions?"
"Yeah, but she was laid off last month. Such a wonderful person. Three kids."
"This is so sad."
"I know. That means there are probably two other kids in that car we'll have to read without being paid. We are going to lose thousands. I'm sad, too."
"Sixty hospitals in California have closed their ERs just to avoid having to take uninsured patients. Admin should close ours."
"Absolutely."
I have an embarrassing confession to make. No, not about my liking Simon Cowell on "American Idol." I used to work in a hospital where more than a third of our patients had no insurance, and all that work would go unpaid. Yet I could still be sued for malpractice— while doing work for free! Neither seemed particularly fair to me. What other private business in the U.S. is forced to provide free services to anyone who wants them?
Just try that at Nordstrom, Wal-Mart, or McDonald's, and you'll become intimate friends with their security personnel.
I have another confession. I don't like Hillary Clinton. I think this goes back to 1993, when she was trying to force universal healthcare on everyone. I thought it would be bad for the practice of medicine and, yes, my income. My perception of universal healthcare was medical care delivered with the efficiency, quality, and caring offered by your local DMV office combined with a fee schedule tied to a lowest bidder mentality. I was influenced by all the negative propaganda that flooded the airwaves at the time against Hillary's proposals, which was paid for, of course, by insurance executives who were afraid their incomes and personal fiefdoms would be adversely affected. Dr. William McGuire, the CEO of United Healthcare who made $125 million a year and $1.6 billion in stock options, comes to mind.
My opinion changed with an article in the October issue of Archives of Surgery, "Race and insurance status as risk factors for trauma mortality." This study demonstrated that an uninsured trauma victim, when compared with a victim of the same sex, age, and severity of injury, is 50% more likely to die than one who is insured. If you are black and uninsured, you are 78% more likely to die than an insured white person, while for Hispanics the figure was 130%.
