Welcome to sick season.
According to the CDC, New York City — along with New Jersey and at least 16 other states — is now experiencing “high” to “very high” levels of respiratory-illness activity as measured by the number of weekly visits to health-care providers and emergency rooms by people having symptoms of fever, cough, and sore throat.
The culprits are the usual suspects: this year’s strains of influenza, COVID, and RSV. And though flulike-illness levels have been above baseline nationally for several consecutive weeks, the CDC warns that we still haven’t hit the peak.
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As always, seniors remain the most at-risk demographic for severe outcomes from respiratory illnesses, which is why the low vaccination rates for that group remain troubling.
Beyond vaccination, for everyone, the best way to prevent the spread of respiratory illnesses like the flu and RSV is regular handwashing; avoiding touching your eyes, nose, and mouth; and staying home if you get sick. High-filtration face masks still work great, too, and not just for avoiding COVID.
Let’s see if I can add something to this conversation. I’m a fourth year medical student in the United States, who in a few short months will hopefully begin training to be an emergency medicine physician. You are absolutely correct, that the government subsidizes health insurance, and that in a decent number of cases, individuals without insurance or the means to pay for healthcare are eligible for Medicaid. You are also correct that the ideal use of the emergency room is to evaluate for medical emergencies, I say this as someone soon to be an emergency room doctor. Lastly, there are certainly physician groups which are capable of providing cash pay based care.
However, the process to apply for Medicaid can be quite complicated, particularly amongst those with low medical or even just general literacy levels. This disproportionately impacts individuals for whom English is a second language. As I said above, in a perfect world, the emergency department is only for true medical emergencies. However, patients as a whole are notoriously bad at knowing if their symptoms are from an actual emergency or not. Secondarily, in many communities, the emergency department is the only reliable access some individuals have to the health system due to difficult difficulties with transportation and scheduling. With regards to your last point, while there are certainly clinics that can provide cash based care, the majority of individuals who cannot afford insurance are also likely the patient who cannot afford a cash pay clinic.
The fact is also that a large number of uninsured patients will simply have their ER bills written off by the hospital, and/or social workers within the ED will help sign the patients up for Medicaid if they qualify so they become insured can then have the visit billed for, as opposed to the individuals giving fake names.
Unfortunately, the current state of the US Healthcare system is that for many disadvantaged populations, the ER is their primary care physician. This is not ideal, but I will not admonish my patients for doing what they can to seek care in a system that otherwise leaves them abandoned and uncared for
Well spoken, good points. I do take exception to:
and
You are going into emergency care. You are doing gods work. For your sanity, I think you have the best outlook to take on what you are about to take on. That said…
An ER is always going to cost orders of magnitude more than a private practice. When the hospital “writes off” bills, they aren’t waving a magic wand and making that expenditure of resources disappear. The hospital is making the call that collections activities cost money and will never see a return, so they roll the debt into pricing.
That is precisely why hospital care is so cripplingly expensive today.
Insurance or not, hospital care will bankrupt you. That is because poor uneducated people are misinformed and are exploiting the system, causing MASSIVE damage to the system as a whole.
Again, great compassionate mindset for when you are in the ER seeing the patients, but very damaging rhetoric to be preaching to the open internet.
I’m aware that those costs do not magically disappear and are absorbed into other billing/passed on to society. However that is not why healthcare is so ludicrously expensive in the United States. It is the substantial and unnecessary administrative costs, predominantly driven by for-profit insurance companies, for-profit hospital systems, and pharmacy benefits managers. The continued exploitation of the ill for shareholder benefit is a uniquely American take on health care, and coupled with our incredibly individualistic tendencies bring about a huge fraction of the poor health outcomes we have in comparison to other developed nations, despite spending generally more than double per person.
Some of this is certainly driven by system inefficiencies such as forcing people into a situation where they have to use the ER for primary care. Or where they cannot afford their blood pressure or cholesterol medicine, and instead of our society helping provide these very affordable interventions, we pass the buck. So when those individuals inevitably have a heart attack, we then pay many times more for care that they may not have needed had they simply gotten good preventative care.
I will happily stand up and bash the current US healthcare system. I despise its insistence that human lives and suffering are secondary to wealth-extraction. But as much as I hate it I can’t change it, and while I will advocate for policy to change things, for now all I can do is continue to provide care to the patients presenting as a symptom of an ill society.
I hope others can see that these patients presenting to the ER are simply doing the best they can to take care of themselves and their families, and that the real blame and consternation should be placed on the government, hospital, insurance, and pharmaceutical officials and lobbyists who continue to exploit their illness for profits.
But noone is forcing them to use ER as primary care.
You are you so fervently spreading that misinformation?
Obama passed a bill to get EMERGENCY care to those who need it and people like you have exploited that legislation to scam hospitals.
15 dollars a month gets you insurance.
If you didn’t bother to go through the process, you can still see a doctor for 200 dollars, which can be held as debt and paid back in however small installments you need. You do need to pay it though.
There is literally no reason for an uninsured person to run up a 2000 at the ER for primary care. Absolutely no reason.
You are telling people in a bad place to do the thing that will make their situation, and all of our situation, worse to the maximum degree.
As I said previously, the process needed to get insurance under these programs can be too complicated for individuals with low literacy or for whom English is a second language, limiting their access to these resources. And believe it or not, there are individuals for whom $15 a month is still not affordable for something they may or may not use that month, like medical insurance.
So those people need to put in effort, learn, and be functional members of society.
Bullshit that you can’t pay 15 dollars a month and 15 dollars to your medical debt a month.
If you can’t do that, you need to figure your shit out… until we implement single payer Healthcare. Which we should.