Young Ben Ehrenreich — a lefty true-believer, like his author-mother Barbara — wrote an opinion piece for the Los Angeles Times earlier this month about getting his girlfriend’s broken ankle set gratis, via the emergency room at L.A. County-USC Medical Center. I wish he’d told us what he thought the experience should have been like, rather than giving us his slice-of-life account of how it was — because what struck me were the similarities between my experiences as an insured patient at the excellent L.A. private hospital Cedars-Sinai and Ehrenreich’s uninsured girlfriend’s at County-USC.
For instance: Five hours until they got from the ER to the gurney… Me, too! But that was as a fully insured patient at Cedars in October, wheeled out of hospital radiology and into the ER for intense tumor pain that couldn’t be controlled. How long does Ehrenreich think an uninsured patient should wait? How much should they pay? And why can’t they just pay a reasonable amount at a walk-in urgent-care clinic for a simple procedure like a broken ankle? For that matter, why don’t they have insurance in the first place? Maybe it’s unaffordable for some. Maybe it’s unaffordable for Ehrenreich’s girlfriend, but I’d sure like to hear why.
It’s amazing what people don’t know about these kinds of things. A friend with no health insurance, for instance, recently said confidently she’d “go into hospice” if she got cancer like me. But hospice isn’t for the uninsured; hospice is for cancer patients with no treatments left. Until then, it’s: Hello, County-USC emergency room! Not only do I wonder what that’s like, but even more, I wonder what true-believers like Ehrenreich think it should be like.
How bad is it at County-USC? I’m sure there aren’t any dark rooms there to lie down in before you begin your treatments, like those I enjoy in Beverly Hills at my private doctor’s radiology practice. It all makes a big difference when it comes to controlling pain, believe me. Not that uninsured patients should feel entitled to such amenities, but the bloody sheets around the gurneys at County-USC, as described by Ben Ehrenreich in his op-ed, are out of order. He does have a point there.
Ben Ehrenreich may know something more about medical care than most do. It turns out that he had an emergency procedure of his own, an appendectomy, a few months ago, which he described on his mother’s blog. Although insured via Blue Cross, Ben is now complaining that the hospital is overcharging him. But nowhere in his letter of complaint to the hospital director does he make clear if this overcharge is what the hospital sent to Blue Cross. I suspect that what Blue Cross is willing to pay via its negotiated rate is markedly different. My three recent hospital stays at Cedars — all at a cost of around $50-$60,000 for what I guess we should call the “rack rate” — were actually under $20,000 according to what Blue Cross is willing to let the hospital charge. So there’s no way to tell from young Ehrenreich’s lament what he’s really expected to pay — or what he thinks the labor charge should be, for instance, for delivering those cheap saline flushes Ehrenreich complains he was overcharged for. Does he think the nurses should work for free? Or maybe just at reduced rates?
The ER horror stories I’ve read about lately have all focused on how long patients have waited on ER gurneys, sometimes in the corridor, before being admitted to the actual hospital. But I was actually extremely grateful once I got to that stage in October, because the ER nurses gave me oxygen and a much stronger painkiller than the radiology department kept on hand. And at least on the gurney I could lie down. Unlike Ben Ehrenreich, I really have no complaint about my hours spent on that ER gurney. It was a five-star hotel compared to the ER waiting room.
I can’t help thinking that there must have been some way to avoid that whole ER situation, but from everyone I’ve talked to, there really wasn’t. Maybe Fridays are particularly bad, so that even outpatient procedures shouldn’t be scheduled for those days, just in case anything goes wrong. And I do think more attention should have been paid to the fact that I’m quite opiate-tolerant at this point. Maybe if they’d given me stronger painkillers to begin with in radiology the whole unpleasant episode could have been avoided. And maybe the emergency room is just not the most enjoyable part of the medical-treatment experience, which is tough luck if you don’t have insurance.