Uninsured patients

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Comfortably Numb: How Psychiatry Is Medicating a Nation Charles Barber See book keywords and concepts

Prices of the best-selling drugs routinely go up at two to three times the rate of inflation. uninsured patients in the United States pay more for drugs than people who are insured, who have the large FIMOs to bargain for them. The United States is unique among Western countries in that it does not limit drug costs in some way.27 Big Pharma has the largest lobbying contingent in the country— there are more drug lobbyists than members of Congress28—which has helped create an extraordinarily regulation-friendly environment for the industry.

Why Michael Moore's SiCKO is a health care documentary every American must see Mike Adams, the Health Ranger See article keywords and concepts

Why are hospitals literally dumping uninsured patients on the street, abandoning the sick to protect profits while our politicians actually negotiate on behalf of Big Pharma to make sure Americans keep paying the highest prices in the world for medications? (Click here to see our CounterThink cartoon on President Bush's price negotiations with drug companies.) What's wrong with America's health care system? SiCKO is a must-see documentary SiCKO creator Michael Moore answers that all-important question in his best documentary yet.

Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer Shannon Brownlee See book keywords and concepts

The big losers are psychiatric wards, which are magnets for poor, uninsured patients suffering from debilitating mental illness and substance abuse problems that require lengthy, expensive treatment. Medical departments, which care for patients with infectious diseases like pneumonia and chronic diseases like heart failure, are routinely in the red. The emergency departments at many hospitals break even only if they're lucky, in large measure because while their reimbursements are high, so are their costs, and many of the patients they see are uninsured.

Meanwhile, more than a hundred emergency rooms around the country have closed in the past decade, victims in part of rising rates of uninsured patients appearing at their doors. At hospitals that have kept their emergency doors open, administrators have not been eager to add the additional ER beds that are often so desperately needed, because that would mean caring for more uninsured (and unprofitable) patients. Many cities now face a shortfall of emergency services, and hospitals routinely divert ambulances because their emergency departments are completely full.

Critical Condition: How Health Care in America Became Big Business Donald L. Barlett and James B. Steele See book keywords and concepts

He spent the next three months burning up the Los Angeles freeways, driving some 8,000 miles to speak to groups, to gather information from patients who had received oversized bills, and to collect data comparing hospital bills of uninsured patients with those submitted for the same procedures on insured patients. In June 2001, Forbes issued his first report documenting that southern California hospitals were billing self-paying uninsured Latinos almost five times the amount they were charging HMOs.

After a hospital visit, uninsured patients are stunned by the size of their bills. They have little warning it's going to be that large. When they were sick, they weren't focused on money; they were just trying to get well. Before the initial shock wears off, hospitals often follow up by offering a "discount" for the treatment. For example, if a patient pays in full within a specified period, such as sixty or ninety days, the hospital may offer to "discount" the bill by knocking $20,000 off a $60,000 total.

Health Care Meltdown: Confronting The Myths and Fixing Our Failing System Bob LeBow, M.D., M.P.H. See book keywords and concepts

Those are the uninsured patients who (a) come in but aren't seen because they lack the $200 they're asked to plunk down at the front desk, or (b) don't even bother to come in because they don't have the cash in hand and have too much pride to be rebuffed by the receptionist. The physicians—as well as other health care professionals— should be much easier to convince to tear down the windmills. In fact, many professional organizations have been actively coming up with proposals for universal coverage, some of them quite progressive (beyond such narrow solutions as MS As).

Not-for-profit hospitals should have every reason to support NHI since they would no longer have to write off their services to uninsured patients as uncompensated care. The Lords of Medicine The physicians are a mixed bag. A large number of physicians of all specialties (especially primary care doctors and psychiatrists) actually support single-payer universal coverage. Physicians for a National Health Program (PNHP), an organization started in 1987 to promote single-payer national health insurance, has over 9000 members.

And they are ix learning to accept the type of rationing endured by my uninsured patients: health care that is delayed or skipped altogether. As we approach another crossroads for our American health care system, I fear that more and more Americans will suffer unnecessary pain and illness, as well as increasing humiliation. I am passionate on the issues because my passion is rekindled on a daily basis as I struggle with my patients to jump through unnecessary and wasteful hoops to meet their health care needs. I have tried to remain objective in what I describe.

On the other hand, the uninsured patients want as little done as possible. "Please, doc, no lab tests today. I can't afford them." But it's amazing what "catch-up" medical work gets done when someone gets health insurance or turns 65 and qualifies for Medicare. Suddenly the gallbladder that's been acting up off and on for eight years is taken out, the diagnostic tests for angina are done. Perhaps most frustrating for me as a physician are the chronic disease patients who won't return for needed follow-ups because they can't afford the visits.

All hospitals, however, should welcome change that would help cover the costs of the uninsured patients they currently care for anyway. I remember when a small group of people (including myself) from an organization that was then called the Idaho Citizens' Network put together a single-payer universal coverage health care reform bill for Idaho in 1991. We even managed to get an Idaho state senator to sponsor it and introduce the plan, called "IdaHealth," as legislation. A few people still kid me about how the bill failed in the Senate by a vote of 42-0.

The Medical Racket Martin L. Cross See book keywords and concepts

The director of medicine at the time, Mark Singer, remembers that the Columbia brass focused on the case of three uninsured patients who had been sent to a special heart unit for treatment, chastising them for admitting such patients, who were called "self pays." "My father owned and operated a millinery factory in the garment district," Mr. Singer says, "and I never witnessed such an extent of demeaning, debasing, and devaluing behavior in the tough street environment as I personally experienced then." Forcing Out site Poor Patient His ire is morally correct.

Oxymorons: The Myth of a U.S. Health Care System J.D. Kleinke See book keywords and concepts

The other four uninsured patients were not emergencies at all: two had minor infections and needed antibiotics, one needed more of the diabetes medication she had gotten in the ER last month, and one was a fidgety young woman who reported excruciating back pain and knew exactly which narcotic would take care of it. Dr. Agnello crumpled onto the threadbare couch in the residents' lounge, weary from a twelve-hour noisy blur of patients, nurses, and telephone calls. He would miss basketball practice again.

For too many uninsured patients, a hospital's legal mandate to provide charity care is consummated only retroactively, after its efforts at collection—some of them ferocious and all of them practiced by both for-profit and not-for-profit hospitals—fail. For many, the so-called charity care budget is really a bad debt budget, dressed up for state and federal tax auditors. The horrors of this situation percolate in U.S. bankruptcy data: of the 1.2 million American families who filed for bankruptcy in 1999,500,000 reported medical problems.

In addition, using University Hospital's emergency room for their primary care guarantees uninsured patients the poorest possible continuity of care. The same Consumer Reports article notes that "a person in the midst of a seizure gets treatment for the seizure but no investigation to determine the cause. A child in the middle of an asthma attack may be treated with medicine that opens the air passages but won't get medications to prevent future attacks.

Physicians who were presented scenarios with insured patients recommended service for 72% of patients, and physicians who were presented scenarios with uninsured patients recommended the same services for 67% of patients" (Mort, 1996, p. 783). Most of the clinical ramifications of these findings may be benign. If so, then these data serve only to underscore the central problem with third-party health insurance payments—namely, the availability of coverage stimulates demand for medically marginal medical services. Would that this represented the entirety of the case.

Your Doctor is Not In: Healthy skepticism about national health care Jane M. Orient, M.D. See book keywords and concepts

This was a response to the alleged tendency of private hospitals to do a "wallet biopsy" (to see if the patient had insurance) and "dump" uninsured patients on the county hospital, whether or not the patient might be harmed by a delay in treatment. It is morally outrageous to delay treatment of a seriously ill or injured patient in order to determine his insurance coverage—or to deny life-saving treatment if there is no insurance.

Health Care Meltdown: Confronting The Myths and Fixing Our Failing System Bob LeBow, M.D., M.P.H. See book keywords and concepts

Other clinics are not always so lucky, and their uninsured patients must often fend for themselves in paying for these tests. As clinicians, we can order a test; e.g., a chest X-ray to be done at the hospital, but then the patient must come up with the cash to pay for it as well as the separate bill they'll get from the radiologists for reading the X-rays. A Patchwork of Arrangements to Get Care When it comes to diagnostic procedures, the situation gets much more difficult for both the clinician and the patient.

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