A new patient came to see me to discuss a recent episode of chest pain. They had a long history of smoking. They had experienced severe squeezing chest pain which radiated down the left arm. They went to the ER where testing revealed that, fortunately, they had not had a heart attack.
A stress test was needed to complete the workup, to prove that they weren’t at risk to have a heart attack in the near future. The test hadn’t been done at the hospital for a couple of reasons. First of all, hospitals are often paid a set amount of money for an episode of care. So, for a patient like this who is having chest pain, when they get admitted, the hospital receives one predetermined amount. The more services provided to the patient, the less the hospital ends up making. So, hospitals try to get patients out as quickly as possible, and to provide as little care as possible.
The second reason was that the patient had no insurance. And this was the crux of the reason the patient had come to see me. The initial hospital visit had generated a sizable bill. The patient couldn’t afford to pay that, much less the cost of a stress test, which might cost a few thousand dollars.
The question for me, therefore, the actual reason for the visit, was whether they really needed the stress test. The medical answer was obvious. The stress test was clearly necessary from a medical standpoint. The patient knew that. The question for me was whether it was worth it to get the test. In other words, was the risk to the patient, of having a heart attack, so great that it was worth the expense of the stress test.
That’s a tough question, though, and one completely different from the medical one that I was trained to answer. But that is health care in America today.
A few days later, the good-times American health care system was at it again. In one day, I had three patients come in for hospital follow-up visits. They had all been in the same hospital. The first patient had had an abdominal surgery. They did not look well. They had a fever, pain at the surgical site, and trouble breathing. I had to send them right back to the hospital, where they were found to have a severe infection. The second and third patients were each found to have had significant errors in their hospital discharge instructions. Each of the patients complained that the hospital seemed to be short-staffed, and had trouble getting even basic aspects of their care addressed. One had sat on a bed pan for hours.
I called the hospital to checkup on that first patient, who was re-admitted to have their infection treated. I spoke to the nurse taking care of the patient. I asked if there was something wrong at the hospital. The nurse confirmed that they were terribly under-staffed. But also, she told me that the hospital staff is so busy and so distracted by the data collection and documentation required to comply with government quality improvement programs, that there is little time left to tend to patients.
And finally, I had the pleasure of speaking to an elderly patient whose spouse had had a stroke, and was now in a nursing home. The patient told me that the nursing home was taking all the money they had. The nursing home billing office told the patient that whatever money there was had to be forked over. The billing was so complicated that the patient had to hire an attorney to review the legal implications. That cost the patient thousands of dollars as well.
This is the brutal, heartbreaking mess that is the American health care system in the era of Obamacare. It was a mess prior to Obamacare and it is a mess now. It is what happens when we organize health care to maximize health insurance company and health system profits, and around the whims of wrong-headed bureaucrats.
Republican lawmakers pledge to repeal Obamacare. But not one damn thing that they are proposing will make things better. If they have their way, things will remain a mess.
But I guarantee it—if we organized health care around the needs of patients, and we helped health care workers to help those patients rather than hindered them, we could again have the best health care in the world. Until then, take good care of yourselves.