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Cake day: July 4th, 2023

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  • 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.


  • 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