Health care and poverty in the US: the system is crazy.

True story here. I live in the US, and am poor. Starting about a week ago, I started feeling very ill. As I can’t afford any medical care, I just tried to ignore it and hoped it would go away. However, on Wednesday I was so weak and in such pain I hauled myself to the ER of the nearest hospital. From what I understand about the laws in my state, hospitals can’t refuse medical care in emergency cases even if you can’t pay. And as I was in such great pain and not medically trained, there is no way I could self-evaluate my medical status, so this could be called an emergency.

After I arrived, the doctors thought it might be serious and admitted me. They put me on a saline drip and an EKG, and ran a lot of blood tests. After a while, a doctor came in and explained the situation. According to the tests my electrolyte levels were WAY off, and the conclusion was that I was suffering from acute renal failure. :frowning: And stated they wanted to admit me as an inpatient to treat this. I then explained that I couldn’t afford medical care, and asked if there was something they could just give me for the pain and go home where I could pray I got better? Not only is money an issue, but because of certain aspects of my real life situation I can’t just check into a hospital and have others tend to handling these other real life matters for me. I then asked the doctor if I refused further treatment what are the odds something seriously bad happening to me, like death? His response was that while I could legally refuse care, the odds of me dying were “very high”. No functioning kidneys falls into the medical category of “SERIOUSLY bad.” As I was in extreme pain, I just responded to the effect “check me in, and be quick about fixing whatever is wrong”.

After about 12 hours, the doctors informed me that medical tests seemed to indicate I might also have experienced a heart attack (the exact term the doctor used.) Oh joy! What they wanted to do is invasive surgey with some sort of scope to look at my heart, with the possibility that if they did find I had a heart attack possible surgery for that. I refused, commenting that my real life situation was such that I couldn’t be in the hospital that long. I just wanted them to deal with the renal failure issue, and gamble that the tests about my heart were wrong because my blood chemistry was shot to hell.

Apparently they found my case interesting. At one point a couple doctors and about 8 residents (this is a teaching hospital) were in the room asking me all sorts of questions. I guess it must be that not every day a middle aged guy with no history of kidney problems walks in the door with acute renal failure with no obvious explanation. Thus I was a good example case for the residents.

After about 24 hours I was feeling just a little better and asked if it would be OK if I left? The response was that I was still in bad shape and unstable, and this was medically inadvisable. :frowning: I decided to stay one more day.

At the end of the next day, while still not feeling great was much better. They said that while I was stable enough I could leave, they advised against it. I checked out, and they gave me a list of specific dos and don’ts. It turned out that my early attempts at self-treatment made things much worse. I just thought it was likely a virus or such, and didn’t realize my kidneys had failed. What I did wouldn’t have likely been bad if I had been in general good health. However, what I did was quite inadvisable as I had acute kidney failure.

What is so crazy is that while unless I am in really bad shape I couldn’t even get basic health care (like a physical to check out blood pressure, etc.), when things get really bad they are wanting to treat me for things I didn’t even come in for. Not only surgical examination of my heart, but even possible heart surgery if that showed I had a heart attack??? I just wanted to get well enough to be able to walk around rather than in such severe pain I couldn’t. Bizarre.

For those in the US surprised I got as much care as I did, I suspect it had to do with the luck I stumbled into a teaching hospital. The doctors couldn’t very well have given me the usual treatment I’d expect in the US. That being get me stable enough to walk out the door, hand me a few Tylenol #3s, and be told “best of luck, dude.” Hey, I even got in the mail yesterday something from the social worker at the hospital. If I go to the local welfare office and apply for Medicaid (which I already know I can’t qualify for), as my income is less than 140% the US Federal Povert Guidelines, I qualify for free care per the “Community Financial Aid Policy.” Dunno if this care would be much good (as in I might be able to qualify for a physical, but if I had high blood pressure I couldn’t afford the drugs to treat it), but I appear to qualify for something. Whatever this hospital is offering looks suspiciously like a “we are looking for guinea pigs to train our residents” program. However, this isn’t necessarily all bad. Residents have all kinds of motivation NOT to want me to die on them. Screwing up and killing patients doesn’t help toward being certified as a doctor. :wink: I wish I had the presence of mind at the time to get the business card of one woman resident I talked to. She seemed to think that she would be able to qualify me for at least basic medical examinations at the college med school clinic.

Such is life, possible death, and medical care in the US. :frowning:

Aren’t you a hop, skip and jump away from Canada?
Sure I feel bad about your situation, but what do you want me to do about it?

Hmm, all those who maybe criticise the idea, or the philosophy, or even the (occasional weakness )reality of socialised healthcare, perhaps they should try out a measure of chronic illness and poverty mixed together.

The problem with any Medicaire type funding, is that the line, or standards on who pays, who is eligable, and by which methods you measure this, means that there is always a danger of anomolies and poverty traps.

You cannnot get people to take out medical insurance if the rules on Medicaire funding are such that almost everyone qualifies, else there wouldn’t be enough incentive to do so.

So you end up with those who are too poor to be ill and just rich enough not to qualify.

The people who then suffer most from this tend not to have the same political clout, apathy maybe, as those who have vested interests in maintaining the current system.

This is why I vote for the lefties. And, one of the main reasons I voted for Clinton the first time. The righties tend to “back-load” (terminology?) their social services. The fact that you can’t get basic preventive care for free as an impoverished person translates into huge medical emergencies, which then get paid for. This does make very little sense. Especially since the people lacking medical coverage are the very same able-bodied working adults whom the righties expect to carry the majority of the nation’s labor on their backs.

It kind of reminds me of the tendencies of a conservative government to slash funding for foster care and mental health for kids, then hurry up to supply more money for prisons, instead of working for prevention in the first place.

One thing I’ve realized as a person who has lacked health care coverage for the majority of my adult life (thank God, I don’t lack it now.) is that many doctors take payments, and there are clinics out there (you have to really search) which take sliding fee scale payments based on your income. Even when you have to pay some sort of bill for your preventive care, as long as you make any sort of payment per month you’re pretty much good to go. This doesn’t even begin to address the problem of taking time off of wage-paid jobs to sit potentially several hours at a clinic, nor the quality of care that you would receive. But there are some ways around the system even in a nation that doesn’t give a shit about its poor, stopgap measures though they may be. Please try to get to that clinic if you can. Even if you have to call the hospital and investigate whom the resident might be and if you can’t find her, try to find another person that can tell you how to get in at the clinic. Good luck with everything.

Okay, I’m out of here. I just realized this is Great Debates.

runs and hides

OMG.

OK-first off, the teaching hospitals are not here to trawl for poor and indigent pts to “practice” on. The poor are not guinea pigs–although it may feel like that at times.

You are walking around in ARF and want a few Tylenol with codeines? wth?
Tylenol #3 will do nothing for acute reanal failure, trust me. ARF is not something that is treated with “take 2 aspirins and call me in the morning.”

Sounds to me like they either found some off lab work that indicated an MI (heart attack) or you had an EKG that showed some changes in the heart rhythm that could mean an MI.

the fact that they wanted to check you out and help you get better is a bad thing? Wth?

Most(all hospitals) lose money with people in your circumstances-unless there is outright fraud of some kind going on.

I deal with pts like you every single day I am at work. We treat them as civilly and as well as anyone else. As a nurse, I never ask if someone is able to pay for my care. It’s not an issue.

What did you expect? bouncers at the door, saying “nope, you can’t pay; get the hell out?”

I can’t decide if I am more amazed at the OP’s leaving AMA for something potentially very serious (and it IS serious) or his own amazement that he actually got concerned, focused care.

Color me clueless. Now I’m off to work.

I sincerely hope that IF you start feeling bad again, that 1. you do not wait until it is as bad as it was this time and 2. that you allow the docs and nurses to care for you.

It ain’t like I, or many others, can just hop, skip and jump over to Canada and have Canada provide free medical care. As for what can you do about it, you could become politically active and support medical care reform in the US.

Clinton was the only ray of hope for decent medical care in the US in recent memory. The biggest thing I have against him is he threw in the towel. He had the right idea.

I didn’t mean that as a slam against the teaching hospital in question. I’d rather be a “guinea pig” than have no medical care at all. And as I pointed out in my OP, they’d actually be motivated to provide decent care. Residents get graded on how well their patients do. If I keel over dead in the hospital and it turns out this happened because the resident didn’t follow correct medical procedure, I should think this might be an impediment for that resident’s future medical career.

I agree. Whatever went wrong with me was to deal with the ARF I had but didn’t know about was that I had to self medicate with ibuprofen for the general pain, and calcium carbonate (“Tums”) because the stress was causing lots of stomach acid production. Ordinarily calcium carbonate is about as safe as drugs get. I looked up the LD50 and it is astronomical. However, in the case of ARF (which it didn’t even occur to me was the problem, and I couldn’t get a proper medical diagnosis), because of the lack of properly functioning kidneys this shot my electrolyte levels to hell. And apparently in cases of kidney problems, ibuprofen is very poor choice. According to the discharge orders, I am not to take any NSAID for the next 30 days.

This is my guess. In particular, I got the sense that it showed in the lab work. Is there some sort of blood test than can show a possible MI?

I didn’t mean to slam the hospital, but instead the US health care system in general. Unquestionably, they will lose money on me.

I never got the idea from them they were inclined to say “nope, you can’t pay; get the hell out.” In fact quite the reverse. I was the one who brought up the inability to pay, and asked if there was anything they could just give me for the pain, and I’d be out of there. They were the ones who were trying to keep me around. If I had left the matter to them, I’d likely still be in the hospital. Particularly as they wanted to treat me as a cardiac patient, including possible surgery. In fact if it weren’t for them, by now I’d likely be dead. I was just too weak and in too much pain to keep arguing about leaving, and gave in and said I’ll stay another night. I was hoping to be in and out the same day. The doctor was quite blunt when I asked what my odds would be if I left right now, and was basically told most likely very soon dead without functioning kidneys.

What is AMA in this context? I didn’t leave until after 2 days when the tests indicated that my kidney functioning was returning to normal. After getting over the shock and horror of being told I had accute renal failure (how could something like that happen to me?), I realized that I’d be a goner if I left before they got my kidneys to work again. Fortunately my kidneys did recover. If I ever do have to be hospitalized more than 2 days or so, it would be time to cash in my chips as I’d have no life to go back to after leaving the hospital. :frowning:

Again, my beef isn’t with the hospital, but the system in general. I do in fact intend to apply for Medicaid where I know I will get denied and submit this financial aid form the hospital social worker sent me. Had I been able to see a doctor before I needed to go to the ER, likely I never would have needed to go to the ER.

I had no choice but to wait as long as I did. I had no access to medical care short of the point where it would require emergency treatment. Early on I thought it was probably just some minor virus, etc. and would go away. Only when it got to the stage that I could barely move or even lie down without extreme pain did it become obvious it was some sort of emergency.

And I didn’t leave before the doctors and nurses were able to get the ARF issue under control. My tendency was to want to, but I was persuaded to stay. As for the possible heart attack issue, that is a matter of real life circumstances force me to have to defer treatment. I need to work to pay rent, bills etc. If tomorrow universal health care became reality in the US, and would pay any and all medical bills, it still would do no good if I needed heart surgery or such. If I can’t work, I wouldn’t have the money to otherwise survive. In this specific case, even though I didn’t come in complaing about any heart problems, and the hospital knew I couldn’t pay, they were wanting to examine me as a heart patient. They even mentioned the possibility of surgery. If the hospital had their way, their idea was to treat the ARF and get that under control, at which time they were going to send me off to whatever part of the hospital deals with cardiac patients, where I would have been admitted there for further treatment. (This is a large regional hospital which treats pretty much everything. They even have 2 MRIs, they only MRIs in the area I know about.)

For me, any medical care is an extreme luxury. Only to be considered if absolutely necessary. If I am in so much pain I can’t work, then it becomes necessary. Which is why I stayed the absolute minimum time in the hospital to deal with the ARF issue. With ARF, the hospital can’t hand me some pills and show me the door so I can go off to work. Instead, I had to wait while they treated me and kept running tests and could tell me when I was well enough to dash out the door and go to work.

Hospitals lose money on 90% of their patients (insured and uninsured combined). They make money on the remaining 10%, and that profit is used to run the whole hospital.

If you need help, they won’t turn you away; they’ll save your life and work out the money later. In this case, it looks like they’re trying to get you qualified for Medicaid/Medicare. If, as you believe, you won’t qualify, many hospitals have something that permits them to provide indigent/low-income care. (They get funding from the state and other sources, or in some cases, simply provide it as part of their corporate mandate.) I suspect that is the “Community Financial Aid Policy” you refer to. In some cases, it acts like a medical insurance plan, in that you get the same care as you would if you were insured, and you also pay steeply discounted amounts (or nothing), just as you would if you were insured.

If I were you, I would be all over that like white on rice. Call and get more information, because that plan could really help you out until we get universal healthcare. :frowning: (That’s me, holding my breath.) Seriously, though, find out, because no one wants you to go through again what you just went through.

I’m a little confused as to what the debate, or even rant is here.

It sounds like you went in to the hospital, got treated competantly and effectively (and despite your objections).
I do agree with the bit about not being able to be treated except in emergency situations, though.

Also, to address this:

All medical professionals are motivated to provide decent care. Some are under various constraints, but if they truly don’t give a damn about you then they’ve gone into the wrong field, and it has nothing to do with whether he or she is a resident, intern, nurse, doctor, or whatever.

Not following correct procedure can get anyone in hot water, not just residents. And, to double check on residents, orders have to be signed by higher-ups to make sure they’re doing their job as they’re supposed to.

But, to sum up, med students want to help you because helping you is the job they signed up for (and paid through the nose to get). There will always be bad apples in any bunch, but that has nothing to do with desire to get good grades. I highly doubt most residents go home thinking, “gee, I just killed a man today, I hope I don’t have to take Open Heart Surgery 101 a second time!”

Also, here’s hoping you don’t have to spend three days in a hospital. I find it strange that if you truly had an extreme emergency and were laid up for a week you’d really be in as dire straits as you say. If you don’t mind my asking, what are you doing for a living at the moment?

To others: is that a common situation? I’m basically unemployed now, but I’ve never had a job where the prospect of leaving a hospital in critical condition was preferential to not being at work the next day with a damed good excuse.

I know for a fact in this state I don’t qualify for Medicaid, as I have tried in the past. That would require disability. This “Community Financial Aid Policy” I refer to is some sort of indigent/low-income care program. I have no idea how it is funded. Likely mostly through some sort of governmental block aid programs. The benefit for the hospital is that likely it means they would at least get some funding for any care they give me. Otherwise they end up having to eat the bills if I just have to keep ending up in the ER. Which in this specific case likely will be substantial, and could have been much higher. Remember I checked out earlier than they wanted me to. After getting the ARF under control, they wanted to shoot me over to cardiac care for cardiac evaluation and treatment. The cost of that would likely have been hideous. From the gist I got, if I apply quickly for this “Community Financial Aid Policy” and am approved, it will retroactively cover the costs of treatment for this ARF emergency room visit.

Had I been able to get some care before this got to the emergency stage, things would have been much cheaper. There was several days where I was feeling ill I could have gone in for treatment which might have avoided the need for me ever to end up in the ER. Overall medical costs tend to be much cheaper if some care can be provided before it gets to the stage where it is an actual emergency.

(Standard disclaimer: I’m not your doctor, you’re not my patient, and I am not licensed to practice medicine in your state.)

I cannot express to you how important it is that you follow up on this. It’s the only way to make sure that your issues have resolved and the best way to make sure it doesn’t happen again. At least in our clinic (also a resident clinic), we don’t bill for an office visit for a hospital follow-up, though you’d be billed for any labs that ensue.

I don’t know what it is about your situation that makes it impossible for you to be away for more than a day or two, even in a serious situation like this one, but it would probably be wise to start making plans so that it will be possible. Knowing no more than I do about your story, I’d have to say that the likelihood that you’ll have to go back to the hospital in the next five years or so is pretty high, and it might not be something you can safely ignore.

Also remember that if you need meds to treat, say, high blood pressure, there are ways to get them. Some of the best BP meds are the cheapest–$8/month cheap. Other more expensive ones have patient programs that you’d probably qualify for. Don’t let anything go untreated until you’ve checked out all the options.

Though I’m obviously biased, I’d say that people who are admitted to the medicine teaching service in our hospital get better care than they would on the average hospitalist service. For one thing, we’re far more likely to be up to date with the data and the treatment options. For another, you have more people working on the case, which leaves less of a chance of anything being missed. You also have, at least in our case, a brilliant academic attending clinician at the head of the team, making sure everything is done right. We’re certainly no more overworked than a lot of the hospitalists in our system. We probably won’t be as efficient as a private doc, though.

Read the subject line of this thread for a topic to debate. In particular, the part about for many the only care available being emergency care can be debated in terms of efficiency. Not to mention ethically.

My criticism isn’t about the medical professionals I encountered here, but the system in general. The latter is a political one, and not about specific doctors, interns, nurses, etc. A lot of why the US doesn’t have universal health care is that the financially well off don’t want to pay for the medical bills of the poor. Just let the poor who are ill die and decrease the surplus population. Of course in reality it often doesn’t work that way. The poor often don’t die off quickly enough, and end up generating lots of costs getting emergency treatment. Those costs end up getting eaten by someone, and those someones aren’t the poor. Under the current system the well off end up paying either through higher medical insurance costs, or higher taxes.

I’ll be honest enough to answer. At this moment, in the food service industry for not much more than mimimum wage. :frowning: And I assure you, many of my co-workers would be in similar dire straights if they had to be laid up for a week. The exceptions are those who are supported mostly by others (kids living with their parents), or a few who are retired and just work there for some extra money. Along with those who are on welfare with Medicaid, ADC etc. Those are the lucky buggers. The government pays all their medical bills, and they can still collect a welfare check if they end up in the hospital for a week. As for me, when told by the hospital staff that tests indicated I had a heart attack and they wanted to check me out for that, I had to tell them “thanks for the offer, but I must leave quickly so I can go to work. If it really was a heart attack, I’ll just have to cross my fingers and hope I don’t have another one.”

From what I remember being told in the hopsital (in my condition my memory may not have been optimal), and the paperwork I received, if I apply at the welfare office and the apply for the community financial aid policy at the hospital, I could get:

#1) Basic office visits.
#2) Lab work. #1 would be useless without this other than in trivial cases.
#3) At least some inpatient hospital services. Of course for ER care, already they legally can’t deny this. However, it might cover things like EKGs, etc. In fact as they already diagnosed me with an apparent previous heart attack, they probably already would be wanting to do a cardiac evaluation.

If possible, such plans would be desirable. Dunno if it is possible though. My main priority at the moment would be to take steps to avoid needing hospitalization. In this specific case I had been feeling rather ill for several days before I ended up in the ER. Had I been able to see a doctor before then, odds are high I’d never have ended up in the ER. An ounce of prevention and all that.

This community financial aid policy might cover basic medicines. The idea seems to be to avoid people needing to end up in the ER for easily treatable medical problems. It would be far more efficient for them to pay $8 a month for a blood pressure medicine then me ending up in the ER with a stroke. I don’t know about the current welfare programs in my state, but they used to have one that covered office visits through the county health department which also included medications. And IIRC also some lab tests. (It’s hard for a doctor to prescribe medications without being able to do lab tests to diagnose illnesses.) But no hospitilization. For me, the county health department for practical purposes is too far away to routinely get to. However, this hospital (which is conveniently located for me) offers office visits as part of the financial aid program. (Which tends to make sense as they are a teaching hospital, and they couldn’t effectively teach without actual patients to treat.) If the state program also will cover medicines and such as ordered by doctors at the teaching hospital, between the 2 I would be covered.

As you advised, I should check out all the options.

Not sure I understand this reasoning; what will happen to your “real life situation” if you die? Won’t others end up handling them for you anyway?

Yes. There is an enzyme that they can test for that shows if the heart muscle is suffering or has recently suffered damage. I don’t know how long the enzyme shows up in the blood.

My husband recently had an incident with greatly elevated heart rate and he started to show that enzyme, so it’s not a guarantee that you had a heart attack, just that you had some damage to the heart muscle.

I am not a doctor! This is what I’ve gleaned from my husband’s experiences.

His 1994 MI is also visible (to experts) on EKGs.

Whether he’s close to Canada is irrelevant. There are residency requirements in each province before you can qualify for medicare. If you’re not a legal resident, you have to pay.

Medicare is a social service, funded out of our taxes. If you don’t live here and pay taxes, why should we provide free medical care?

Hit “submit” instead of preview. Meant to add that I’m sorry for your situation, rfgdxm. My post was directed to the suggestion that you could solve your problem by travelling to Canada, not to sound unwelcoming.

If I die, at that point I would have no real life matters to worry about at all. I’d be beyond all worries. :wink: I don’t believe in an afterlife, and wouldn’t be able to worry about things because I had forever ceased to exist.

I am just sitting here stunned that someone would rather go home and pray than recieve medical care from compentent professionals.

That being said ** rfgdxm ** does have a (possibly) valid point here. His illness perhaps could have been something caught with a 30 minute exam. Instead he ran up a two day hospital bill and plus whatever extra medical care he (stupidly) refused. Countries with socialized medicine consistantly outperform the U.S. in providing health care and do it at a lower cost. I guess I just don’t understand the objection to socialized medicine. We have numerous examples of something that works better than what we have. Why not switch?