I had finished my shopping a few days ago and was sitting in the store’s entrance foyer talking on my cell phone. A few feet from me was a table of free samples: packs of Advil, Tylenol, and some of the other painkillers that are handy to have around. As I talked, I watched this woman walk up and take ALL of the Tylenol samples: the stack of two pill packs she stuffed into her pocketbook must have been an inch thick. As the blogger Happy Hospitalist (One of the best medical bloggers I’ve seen, he’s worth your time!) would say, in her world, FREE = MORE.
I’m sorry, ma’am, but FREE does not equal MORE. Here’s a good example: In a six year period, nine patients accounted for 2,678 Emergency Department visits, for a total cost of over three million dollars. Anyone want to guess who paid that three million? Probably not those nine people.
Emergency Departments are becoming more and more overworked. EMTLA (The Emergency Medical Treatment and Active Labor Act) laws state that if you present with an emergency condition you have to be treated, with no thought to your ability to pay (There are provisions and exceptions, but that is the general meaning of the law.) Show up at the door marked EMERGENCY! and the doctor will see you, no questions. Come one, come all, because FREE=MORE.
It’s so bad that Emergency Departments are trying to figure ways to cut “Preventable Visits” – Emergency Department visits that could be treated just as well somewhere else – a clinic or a “regular” doctor’s office.
One thing that an Emergency Department can do is to shut down and convert the space into an Urgent Care Center. An Urgent Care Center may be big enough to handle the cases that an ED can, but they don’t have to: EMTLA does not apply to Urgent Care Centers. So they can question you on your ability to pay, and they can (and do) refuse treatment. And thanks to FREE=MORE, a community loses its first line of defense against trauma and sudden onset illness.
This is why we can’t have nice things.