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The emergency room should be a place where care is given and lives are saved, not a place where questions about private insurance policies run the risk of making a health crisis even worse. (File)

Theater of the Macabre: U.S. Health Care in 2014

Donna Smith

What are we doing?  Really. What is it we are doing to one another?  Our health care system is so dysfunctional and so profit-driven that most of us have come to accept as routine the inhumane, greedy and dangerous practices many (most) providers employ when we become their widgets. 

It's a theater of the macabre, and the players on stage are you and me and every other American who finds himself or herself injured or ill and in need of medical attention.  So it was last night when my husband's blood pressure soared to dangerous levels and he felt the vague ache of the chest pain that in the past has signaled an on-coming cardiac event.  It took some convincing, but I got him to go to the emergency room shortly before midnight.

Exempla-St. Joseph's Hospital is a fine hospital in our area, and that's where we ended up.  In the emergency room, nurses wasted no time in taking my husband, Larry, to an ER bed and starting the EKG, blood work and other assessments that would help the doctors know better what was going on.  Larry was still pretty shook up but clearly a bit relieved to be in a place where if he was on the verge of a heart attack (or had already had another one), he would likely survive.  It is terrifying for him to wonder when or if that next big event will come.

Once he was settled and test results were pending, a business office representative came into our room.  She asked the usual sorts of questions about insurance coverage and handed us some Medicare literature and patients' rights handouts.  Then she did what she probably legally is compelled to do but what ought to be illegal in any hospital.  She said to Larry, "You know if you are admitted, we do not accept your Humana supplemental insurance up on the floors.  Down here in the ER, we accept it, but not once you go upstairs.  Our competitors at St. Luke's take it, though, so I guess you just need to know that."  She went on to show her disdain for the Affordable Care Act/Obamacare, and acknowledged that she would support an improved and expanded Medicare for all, single-payer type reform.  "Who wouldn't want that?" she asked as she left the room and thanked us for our time.

I watched Larry's face tense and his cheeks flush as he started worrying about what we might owe if he were admitted.  He looked to me for some indication of what we ought to do.  I was certain if I told him that might mean we'd owe a substantial amount to St. Joe's for his care if he became an in-patient, he'd probably had said "No way" and demanded to go to a facility that accepted both his Medicare and the Humana supplemental for which he pays more than $200 each month.  We already owe this hospital for in-patient care given to me last January and biopsies in April that we are struggling to get paid off, and Larry would never tolerate owing them more.  Since I didn't want him to get all stressed out again and since that stress might well exacerbate the symptoms for which we were seeking care, I worked quickly to reassure him that he should not worry.  Never mind that his new cardiologist does her surgeries at this hospital, and now we find out his insurance may not provide full coverage.  What a mess.

We'll figure it all out, I told him, even as internally I thought this was potentially a really bad thing.  I put on such a great performance last night.  I was calm and comforting and as loving as I could be.  To do otherwise when someone could be suffering a heart attack or other serious heart event is unconscionable and cruel.  He is my husband of 38 years.  I protect him with all that I am and will continue to do so.  But it's the middle of the night, and I am tired and cold.  Yet there is no one to reassure me -- the fear and the worry are not helping.  I turned my attention back to Larry.

This is the mission statement I found on this provider's web page (just to add a touch of irony to the tale): Mission: We reveal and foster God's healing love by improving the health of the people and communities we serve, especially those who are poor and vulnerable.

Two things every hospital and provider must stop doing: first, do not enter a patient's ER room and deliver potentially awful financial news when you do not yet know what is going on with that patient's medical condition and/or care and you do not know what such information might do to that patient's condition; and, second, do not expect patients and their families to fully understand that our insurances can be good on one floor or in one department of your facility but invalid or not accepted as payment for any other part of what you do within your facility.  Both of those things ought to be illegal.  Oh, and maybe stop lying about your overall mission?

Finally, I say it so many times, but it is true.  None of these situations would arise if we provided coverage to all underan improved and expanded Medicare for all for life system.  And I aim to help make it so.  Only then will we stop playing our unintended roles in the theater of the macabre that is our dysfunctional, for-profit health care system.

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Donna Smith

Donna Smith

Donna Smith is the former executive director of Progressive Democrats of America and currently a Medicare for All campaign surrogate for Sen. Bernie Sanders.

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