HEALTH REFORM: A Day in the Life in an Emergency Room

A day in a real hospital ER has as much drama, triumph, and heartbreak as any  TV show. USA Today chronicled 24 hours at the University of Virginia Medical Center in Charlottesville, VA. They asked everyone -- patients, doctors and nurses, concerned family members, housekeeping staff -- to share their experiences with the health care system, and what they think about changing it. USA Today writes,

Their experiences and observations underscore why changing the health care system has proved so hard for presidents and policymakers: the complexity of the system, the pressure from chronic diseases, the shortfall in preventive care, the high costs, the competing demands -- and the life-or-death stakes.

Everyone agrees they want to preserve the quality and technological advances of American medicine...Beyond that, though, the consensus frays.

And the interviews the reporters conducted suggested that a lot of the misinformation spread about health reform this summer had gotten through.

Few of those interviewed in the ER have much idea of even the broad outlines of what's being considered in the House and Senate. In a sobering sign for Obama and congressional Democrats, what has broken through more clearly are warnings from opponents that congressional action is likely to raise their taxes, limit their choices, increase their waiting times and lead to "socialized medicine."

While 14-month-old Clara recovered in a hospital bed from a possible seizure, her mother, Tyler McNeely told USA Today the care her daughter received was great, and she worries that things might get worse if the health system changes.

University of Virginia freshmen Leilani Herzog and her mother Susan sought treatment at the ER for Leilani's sudden severe rash. They have an HMO back home in California, but can't yet access her "guest care" at a Virginia HMO. They "appreciate the savings," in their plan back home, but don't like the quality of care.

Last year, Susan diagnosed Leilani's sinus infection (which required surgery) by herself over the internet, she told USA Today. Susan wants low-income families to have health coverage, but worries a government-run plan would limit her choices, and raise her taxes. From the account in the newspaper, she did not seem to realize that health reform is not a "government-run plan." If the public option survives, it will be just that, an option.

Four in ten Americans visited the ER in past year, either for treatment or accompanying someone who needed treatment, reports USA Today. In just 24 hours, 197 patients came through the UVA Medical Center ER, surpassing the 59 bed capacity in the ER from about afternoon until midnight. Nurses like Judith Miller are used to working 12 to 16 hour shifts to deal with the short-staffing and the constant influx of patients. Miller told USA Today she was concerned health reform wouldn't save money, and wanted health professionals, not politicians, to have a greater say in legislation.

The ER treats everyone, regardless of ability to pay. "We cannot close. We cannot turn away. Whatever comes through that door, we have to care for," said nurse Jonathan Bartels. Dr. Robert O'Connor told USA Today he wishes the government would realize how strapped the hospital is for resources. The state of Virginia reimburses UVA Medical Center $70 million for uncompensated care, $10 million short of the actual cost.

When the uninsured and underinsured get sick, they often have no where else to go but the emergency room. Because they cannot afford to pay for treatment out of pocket, many wait until they become seriously ill before seeking treatment.

Robert Bowers, 22, is a landscaper who cannot get insurance through his job, and cannot afford $400 per month for individual coverage. He came into the ER for the first time in two years because of swelling in his jaw. The last time he saw a doctor he was in an emergency room seeking treatment for an ear infection, he told USA Today. What could be a simple prescription for antibiotics becomes costly and inefficient in an ER. Overcrowding forces patients to wait hours for care that is,  typically, more expensive.Overcrowding is exacerbated by patients who have insurance, but can't get into their doctors as quickly as they want or need. 

June Logan is a housekeeper in the UVA Medical Center. Logan told USA Today she lost her job and was uninsured before she came to work at the hospital, making it difficult for her to afford the medication she needed after her heart attack. She is relieved she once again has insurance -- not just for her own health, but for her invalid son, who is bed bound and needs frequent medical treatment.

Logan says she has hopes the changes to the health care system will improve the lives of people less fortunate than her. "I think they should push this new health care reform. There are so many people who come through here with no insurance. It can be overwhelming. They have no choice.

The emergency room is a great microcosm of the health care debate in general. The health care professionals in the ER do the best they can for their patients but are held back by limited resources. The ER gives amazing care that helps patients and saves lives, but at the same time, care is overly expensive and inefficiently delivered. Patients and doctors are dissatisfied with the current health care system, but are nervous about the consequences of change. Change is scary, of course, but the cost of doing nothing on health reform is scarier.  Any doubts? One look around the emergency room should convince you.