# American Hospitals Let The Uninsured Die? **URL:** \ **Category:** Factual Questions\ **Created:** [January 16, 2007, 8:25am UTC](https://boards.straightdope.com/t/american-hospitals-let-the-uninsured-die/388173 "2007-01-16T08:25:11Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![xiix](https://avatars.discourse-cdn.com/v4/letter/x/d6d6ee/32.png) [@xiix](https://boards.straightdope.com/u/xiix)\ **Post date:** [January 16, 2007, 8:25am UTC](https://boards.straightdope.com/t/american-hospitals-let-the-uninsured-die/388173/1 "2007-01-16T08:25:11Z")
I was party to an interesting discussion recently by a number of canadians who reflected upon he American healthcare system and how they imagine it works. One consensus was that persons without insurance are more likely to die in the event of a trauama situation (GSW, car accident etc). I find this somewhat hard to swallow. Is there really any difference if an insured person gets hit by a car or an uninsured persons gets hit by a car, as far as the immediate quality of car until the person is stabalized? Are there not laws (aside from the hippocratic oath) affording everyone equal treatment in these sorts of situations? ---
**Author:** ![xiix](https://avatars.discourse-cdn.com/v4/letter/x/d6d6ee/32.png) [@xiix](https://boards.straightdope.com/u/xiix)\ **Post date:** [January 16, 2007, 8:28am UTC](https://boards.straightdope.com/t/american-hospitals-let-the-uninsured-die/388173/2 "2007-01-16T08:28:34Z")
I’m not so much concerned about “the immediate quality of car” after the accident as I am about the immediate quality of care, as this thread is about health insurance, not auto insurance :smack: ---
**Author:** ![friedo](https://avatars.discourse-cdn.com/v4/letter/f/8edcca/32.png) [@friedo](https://boards.straightdope.com/u/friedo)\ **Post date:** [January 16, 2007, 8:37am UTC](https://boards.straightdope.com/t/american-hospitals-let-the-uninsured-die/388173/3 "2007-01-16T08:37:41Z")
No, it’s complete bullshit. All hospitals and trauma centers are required by law to provide medically necessary care to anyone, regardless of ability to pay. Where differences arise occurs after an injured person is stable, and might affect what drugs they can afford, if they can get physical therapy/rehab, etc. ---
**Author:** ![picunurse](https://avatars.discourse-cdn.com/v4/letter/p/7bcc69/32.png) [@picunurse](https://boards.straightdope.com/u/picunurse)\ **Post date:** [January 16, 2007, 9:04am UTC](https://boards.straightdope.com/t/american-hospitals-let-the-uninsured-die/388173/4 "2007-01-16T09:04:58Z")
Trauma care in America is cutting edge. The people who care for trauma patients don’t know or care what kind of insurance patients have. A street person gets the same care as a CEO. We have ethics. We are not paided by insurance companies, we get paided no matter what the outcome. Pre-hospital care is some of the best in the world. Here is information from [Vanderbilt University](http://www.mc.vanderbilt.edu/surgery/trauma/) on their trauma system. I’ve heard something similar about Canadian and British health care. I’ve heard that it takes months to get necessary diagnostic test and surgeries, allowing the disease to progress to a point beyond help. I’ve also heard that suicides are not treated but allowed to die, since it was their wish. I don’t believe that Canadians or Brits are that callous. I believe your medical people take care of their patients with the same expertise that we do. Most hospitals have funds that cover much, if not all, of the care for the uninsured. Medicaid also covers many of the uninsured. Also, many states now have health coverage for low income families. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [January 16, 2007, 9:35am UTC](https://boards.straightdope.com/t/american-hospitals-let-the-uninsured-die/388173/5 "2007-01-16T09:35:30Z")
OTOH, if no trauma is evident, then things get spiky. Procedures which are considered “necessary” in other countries are not in the States (ex transplants). I once called emergency to bring to the hospital a woman who had been bleeding for about 8 hours and they started giving us some serious shit about nobody seeing her until the insurance papers got there and about me not being able to stay with her (her daughter had stayed behind to look for the papers); the head of the rescue unit stepped in, told them she had internal bleeding and that I bloody well stayed because I happened to be The Person In Charge. That made them shut up and move. If we’d gone in a taxi, they may not have listened until the blood became visible again, we’d washed her before dressing her and given her a pad to wear. ---
**Author:** ![xiix](https://avatars.discourse-cdn.com/v4/letter/x/d6d6ee/32.png) [@xiix](https://boards.straightdope.com/u/xiix)\ **Post date:** [January 16, 2007, 11:02am UTC](https://boards.straightdope.com/t/american-hospitals-let-the-uninsured-die/388173/6 "2007-01-16T11:02:16Z")
I’m just trying to debunk this myth, but here’s what I found so far: “Uninsured trauma victims are less likely to be admitted to the hospital, receive the full range of needed services, and are 37% more likely to die of their injuries.” [http://www.commondreams.org/headlines02/0522-05.htm](http://www.commondreams.org/headlines02/0522-05.htm) (as published Published on Wednesday, May 23, 2002 in the USAToday) Does anyone have a cite that supports picunurses assertion that “The people who care for trauma patients don’t know or care what kind of insurance patients have. A street person gets the same care as a CEO.”? ---
**Author:** ![xiix](https://avatars.discourse-cdn.com/v4/letter/x/d6d6ee/32.png) [@xiix](https://boards.straightdope.com/u/xiix)\ **Post date:** [January 16, 2007, 11:03am UTC](https://boards.straightdope.com/t/american-hospitals-let-the-uninsured-die/388173/7 "2007-01-16T11:03:50Z")
[http://www.usatoday.com/news/health/healthcare/2002-05-22-insurance-deaths.htm](http://www.usatoday.com/news/health/healthcare/2002-05-22-insurance-deaths.htm) Original Article. ---
**Author:** ![Johnny\_L.A](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/johnny_l.a/32/1084_2.png) [@Johnny\_L.A](https://boards.straightdope.com/u/Johnny_L.A)\ **Post date:** [January 16, 2007, 1:12pm UTC](https://boards.straightdope.com/t/american-hospitals-let-the-uninsured-die/388173/8 "2007-01-16T13:12:10Z")
[QUOTE=picunurse] Trauma care in America is cutting edge. The people who care for trauma patients don’t know or care what kind of insurance patients have. A street person gets the same care as a CEO. [/QUOTE] I was training for an EMT certificate and spent a day in an ER. A black guy is brought in with a bullet in his arm. The doctor and the nurse have a quiet conversation: Doctor: Let’s get him stabilised and get him over to County. Nurse: He has insurance, Doctor. Doctor: Oh. Then I guess we can take care of him here. ---
**Author:** ![picunurse](https://avatars.discourse-cdn.com/v4/letter/p/7bcc69/32.png) [@picunurse](https://boards.straightdope.com/u/picunurse)\ **Post date:** [January 16, 2007, 1:23pm UTC](https://boards.straightdope.com/t/american-hospitals-let-the-uninsured-die/388173/9 "2007-01-16T13:23:08Z")
[QUOTE=xiix] [http://www.usatoday.com/news/health/healthcare/2002-05-22-insurance-deaths.htm](http://www.usatoday.com/news/health/healthcare/2002-05-22-insurance-deaths.htm) Original Article. [/QUOTE] No, [this](http://www.iom.edu/Object.File/Master/4/160/Uninsured2FINAL.pdf) is the original article (report), from 2002 (It’s a PDF) The article seems to be generated by an insurance/financial group. There doesn’t seem to be any physician contributors. I’m not saying there are no problems at all. The healthcare system, in general, is financially strapped. [Here is an article](http://www.coderedtexas.org/files/Report_Chapter08.pdfadequate) (also a PDF) that speaks to the “anti-dumping” law in Texas. > [@](#): > > Additional federal legislation that impacts trauma > care includes the Emergency Medical Treatment > and Active Labor Act (EMTALA) (Kamoi, 200). > Passed in 198 as part of the Consolidated Omnibus > Reconciliation Act of 1985 (Pub Law 99-22), this > law, often referred to as the ‘anti-dumping law’, cre- > ates a requirement for medical screening and sta- > bilization of patients with emergencies presenting > to a hospital emergency center. Moreover, this law > imposes regulations and restrictions on transfer of > patients between hospitals. While provisions have > been made for payment for screening examinations, > this law still largely imposes an “unfunded mandate” > on hospitals and trauma centers caring for injured > patients (Fields, et al., 200). Sorry, I couldn’t the law for other states, but I’ve worked in 6 states and they all had laws concerning the care of indigent patients. Here is a [congressional hearing](http://www7.nationalacademies.org/ocga/testimony/Health_Care_Access_Affordability.asp) on the subject. This addresses the [dwindling resources](http://www.saveourers.org/crisis.html) in Emergency medicine. Another from [Hawaii](http://www.hawaii.gov/lrb/rpts06/traumacare.pdf). ---
**Author:** ![RealityChuck](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/realitychuck/32/195_2.png) [@RealityChuck](https://boards.straightdope.com/u/RealityChuck)\ **Post date:** [January 16, 2007, 1:30pm UTC](https://boards.straightdope.com/t/american-hospitals-let-the-uninsured-die/388173/10 "2007-01-16T13:30:21Z")
Hospitals do get funds (Hill-Burton Funds) from the Federal Government to help cover indigent care, though these are less than their usual rate. On a pure business basis, indigent patients are paid for by a combination of Hill-Burton Funds, donations, and the rate structure on paying patients. Some hospitals – often for-profit ones – have been charged with refusing treatment to indigent patients. AFAIK, this is illegal and can lead to large fines. ---
**Author:** ![mack](https://avatars.discourse-cdn.com/v4/letter/m/b19c9b/32.png) [@mack](https://boards.straightdope.com/u/mack)\ **Post date:** [January 16, 2007, 1:36pm UTC](https://boards.straightdope.com/t/american-hospitals-let-the-uninsured-die/388173/11 "2007-01-16T13:36:21Z")
[QUOTE=xiix] “Uninsured trauma victims are less likely to be admitted to the hospital, receive the full range of needed services, and are 37% more likely to die of their injuries.” [http://www.commondreams.org/headlines02/0522-05.htm](http://www.commondreams.org/headlines02/0522-05.htm) (as published Published on Wednesday, May 23, 2002 in the USAToday) Does anyone have a cite that supports picunurses assertion that “The people who care for trauma patients don’t know or care what kind of insurance patients have. A street person gets the same care as a CEO.”? [/QUOTE] FTR there’s a difference between coming into an ER and being admitted to a hospital. Very often people will come to the ER to get fixed up but will not be admitted to the hospital. They’re practically separate entities. So while it’s true that not everyone eventually gets admitted to a hospital floor, it’s also true that anyone needing it receives emergency care. ---
**Author:** ![Annie-Xmas](https://avatars.discourse-cdn.com/v4/letter/a/ecc23a/32.png) [@Annie-Xmas](https://boards.straightdope.com/u/Annie-Xmas)\ **Post date:** [January 16, 2007, 1:41pm UTC](https://boards.straightdope.com/t/american-hospitals-let-the-uninsured-die/388173/12 "2007-01-16T13:41:35Z")
If [Jonathan Larson](http://wuphysicians.wustl.edu/newsArchive.asp?navID=1&ID=145) had been properly treated at either hospital he went to, he might be alive today. At the time he was without insurance and not very wealthy, so the hospitals didn’t even admit him. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [January 16, 2007, 2:02pm UTC](https://boards.straightdope.com/t/american-hospitals-let-the-uninsured-die/388173/13 "2007-01-16T14:02:37Z")
[QUOTE=Annie-Xmas] If [Jonathan Larson](http://wuphysicians.wustl.edu/newsArchive.asp?navID=1&ID=145) had been properly treated at either hospital he went to, he might be alive today. At the time he was without insurance and not very wealthy, so the hospitals didn’t even admit him. [/QUOTE] Yes but misdiagnoses happen everywhere, no relationship with having insurance or not. I’ve got a series of medical problems I’ve suffered for 23 yerars; still undiagnosed. My mother started suffering from rheumatism when she was in her teens, it got diagnosed when she was 30 and the doctors still had problems believing that someone so young could have rheuma. No insurance problems in either case. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [January 16, 2007, 2:22pm UTC](https://boards.straightdope.com/t/american-hospitals-let-the-uninsured-die/388173/14 "2007-01-16T14:22:02Z")
[QUOTE=Annie-Xmas] If [Jonathan Larson](http://wuphysicians.wustl.edu/newsArchive.asp?navID=1&ID=145) had been properly treated at either hospital he went to, he might be alive today. At the time he was without insurance and not very wealthy, so the hospitals didn’t even admit him. [/QUOTE] Now hold on a second. I’m a Renthead, and hate the fact that he died as much as anyone, but he presented with chest pains, nausea and headaches. During final tech week of a show that was his life’s ambition. While he was presumably eating extra worse than poor artists in NY eat anyway and not taking care of himself. In January. Is it any wonder a young, relatively healthy man wasn’t admitted when it was obvious he had not had a heart attack? Absolutely not, when there were so many other reasons (stress, food poisoning, the flu) which were likely culprits at the time. There was no medical reason to admit him. Even your article points out how difficult Marfan’s is to diagnose, and that the solution is better ER education on how to spot it. His death was tragic, and a shame, but it has nothing to do with him not having insurance, from a medical standpoint. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [January 16, 2007, 2:33pm UTC](https://boards.straightdope.com/t/american-hospitals-let-the-uninsured-die/388173/15 "2007-01-16T14:33:22Z")
Oh, wait, there was an OP here, wasn’t there? \*\*picunurse \*\*is right. So is that article. \*\*picunurse \*\*is, unsurprisingly, a nurse. She, personally, doesn’t know if you have insurance or not and will treat you the same as a CEO. This is good and proper and legal. The chief of medicine, or the attending on her floor, is the one who has to deal with the murky ethical waters treading between what’s ethical, legal, and within his budget. Everyone gets stabilizing care. Not everyone gets information about the newest and most expensive treatment options for long term care. ---
**Author:** ![Sapo](https://avatars.discourse-cdn.com/v4/letter/s/ec9cab/32.png) [@Sapo](https://boards.straightdope.com/u/Sapo)\ **Post date:** [January 16, 2007, 2:35pm UTC](https://boards.straightdope.com/t/american-hospitals-let-the-uninsured-die/388173/16 "2007-01-16T14:35:15Z")
And then there was the famous case of the uninsured patient who was admitted for head trauma, had part of the skull removed as part of emergency care and then the doctors wouldn’t put the removed piece of skull back until they could secure payment. This took months. Let try and find a cite since I know I will get an earful if I don’t. ok, here it is: > **[BBC NEWS | Health | "I lived without part of my skull"](http://news.bbc.co.uk/2/hi/health/3706631.stm)** > > A young US woman lived "without half her skull" for four months while awaiting a health insurance decision. ---
**Author:** ![AnnieChrist](https://avatars.discourse-cdn.com/v4/letter/a/3ec8ea/32.png) [@AnnieChrist](https://boards.straightdope.com/u/AnnieChrist)\ **Post date:** [January 16, 2007, 2:40pm UTC](https://boards.straightdope.com/t/american-hospitals-let-the-uninsured-die/388173/17 "2007-01-16T14:40:26Z")
The Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals, especially emergency rooms, to assess and stabilize patients regardless of insurance or ability to pay. After they’re stable, then you can look at ability to pay and decide whether to admit them here or transfer them to the county hospital that is specifically funded with taxpayer money for these patients. Violating EMTALA can bring huge fines and other sanctions, so hospitals are generally scared to death about not complying. Google “EMTALA” and you’ll find that there’s a whole industry of consultants and lawyers who advise hospitals on how to comply – the bottom line being that you have to treat everyone for trauma or anything potentially life threatening if they show up at your door. Whether they can pay can’t even be discussed until the patient is stable. ER docs and staff are taught to be extremely careful on this issue, lest they say the wrong thing and bring on federal investigators. Plus – and this really shouldn’t be underestimated – most health care workers actually care about their patients and are in that business to do good. Even if there were no laws compelling the right action, a nurse or ER doc isn’t likely to just shove a dying poor patient aside in favor of the soccer mom with Blue Cross. This idea that Americans without health insurance don’t get medical care is bunk. After the initial trauma or emergency, do they get the same amount and quality of care of health care as people with more money and insurance? No. But the bodies of poor people don’t pile up outside the doors of emergency rooms. ---
**Author:** ![Renob](https://avatars.discourse-cdn.com/v4/letter/r/8c91f0/32.png) [@Renob](https://boards.straightdope.com/u/Renob)\ **Post date:** [January 16, 2007, 2:51pm UTC](https://boards.straightdope.com/t/american-hospitals-let-the-uninsured-die/388173/18 "2007-01-16T14:51:05Z")
[QUOTE=xiix] I’m just trying to debunk this myth, but here’s what I found so far: “Uninsured trauma victims are less likely to be admitted to the hospital, receive the full range of needed services, and are 37% more likely to die of their injuries.” [http://www.commondreams.org/headlines02/0522-05.htm](http://www.commondreams.org/headlines02/0522-05.htm) (as published Published on Wednesday, May 23, 2002 in the USAToday) [/QUOTE] That study is bunk. To quote Dr. David Gratzer, a practicing doctor in both Canada and the U.S., in his book _The Cure_: > [@Dr. Gratzer](#): > > . . . the institute’s number [18,000 deaths due to lack of insurance] doesn’t reflect the result of a study. In fact, their original report on the uninsured didn’t mention the figure. It was only later, when the organization called for universal health care, that they decided to provide an “estimate.” The number 18,000 is based on various small studies suggesting poorer clinical outcomes when people lack insurance. > > Most of these studies are not clear-cut. Consider, for instance, the landmark study on breast cancer outcomes in relation to insurance status. . . . Dr. Ayanian [study co-author] found even lower survival rates for those with Medicaid. In other words, if lack of insurance can be argued to have a negative effect on health, Medicaid coverage is worse. . . . > > Other studies are equally unsatisfying. Health outcomes are influenced by complex variables, such as socioeconomic status, but almost none of the commonly quoted studies make the necessary adjustments. ---
**Author:** ![Harmonious\_Discord](https://avatars.discourse-cdn.com/v4/letter/h/74df32/32.png) [@Harmonious\_Discord](https://boards.straightdope.com/u/Harmonious_Discord)\ **Post date:** [January 16, 2007, 3:27pm UTC](https://boards.straightdope.com/t/american-hospitals-let-the-uninsured-die/388173/19 "2007-01-16T15:27:24Z")
Emergency care will be the same for anybody that enters. The problem is long term deterioration that happens before or after the emergency room visit. You may come in with a broken leg that they put a cast on, but nothing requires them to do follow up care or removal of the cast unless it’s involed in an emergency for a second time. Many hospitals have closed the emergency rooms to avoid the the problem of people being treated that will never be able to pay for the service. ---
**Author:** ![Frylock](https://avatars.discourse-cdn.com/v4/letter/f/ce7236/32.png) [@Frylock](https://boards.straightdope.com/u/Frylock)\ **Post date:** [January 16, 2007, 3:30pm UTC](https://boards.straightdope.com/t/american-hospitals-let-the-uninsured-die/388173/20 "2007-01-16T15:30:31Z")
[QUOTE=Sapo] And then there was the famous case of the uninsured patient who was admitted for head trauma, had part of the skull removed as part of emergency care and then the doctors wouldn’t put the removed piece of skull back until they could secure payment. This took months. Let try and find a cite since I know I will get an earful if I don’t. ok, here it is: > **[BBC NEWS | Health | "I lived without part of my skull"](http://news.bbc.co.uk/2/hi/health/3706631.stm)** > > A young US woman lived "without half her skull" for four months while awaiting a health insurance decision. [/QUOTE] Oh. My. God. I would _never_ have believed that if not for the BBC cite. It just makes. No sense. I don’t have the words. Anyone know if there’s a basis for maybe a lawsuit or something likely to exist in this case? -FrL- [Next page](https://boards.straightdope.com/t/american-hospitals-let-the-uninsured-die/388173.md?page=2)