Healthcare-What Could Have Happened

 

The following was passed on by one of our members prior to the GOP’s latest attempt at repealing the ACA and enacting an ever changing program of their own.  Even though nothing has passed, it may reappear and everyone should be aware of how this would have effected our ERs. This article is written by Kellen Squire, an emergency department nurse from Barboursville, VA, running for the Virginia House of Delegates in the 58th District of Central Virginia this fall.

“Now we have the vaguest outline available for the Senate’s version of Trumpcare, it pretty much confirms that it’s as bad as we thought it was. Long story short- cut as much care as possible to enable funding of huge tax cuts, with amazingly interesting corporate handouts to boot. Some of it would be hilarious if it weren’t so tragic- like the “party of personal responsibility” trading the “No Free Rider” amendment that forced everyone to pay at least a little, with a $50b handout to insurance companies– and on top of that, they get to completely deduct executive salaries that’re greater than $500k. What a deal! I’m glad we have a master negotiator for a President!

Now, even that explanation is a little nebulous, since huge tax cuts and deductions don’t mean much to a lot of people, and the magnitude of $50b is hard to imagine. It’s like winning the lottery. You know it’s a thing, but it’s hard to comprehend what that means in your life.

Since I’m an emergency department nurse running for the Virginia House of Delegates this fall, I thought I’d sit down and illustrate exactly what that means, in a way you can take back to your friends and family. Be it your MAGA-hatted uncle, your politically uninvolved friend, etcetera; just to help bring home just how this reckless and incredibly ill-conceived bill is going to affect them personally, even if they have great insurance and good primary care provider- that means Trumpcare is gonna ruin someone else’s day, not theirs.

Bzzzt! Oooh, I’m sorry, that’s not correct. We all get to wade waist-deep in this upcoming scheisse-fest. And to help explain how, we’re going to use the emergency room as an example, since the ER is one of the few places in medicine where everyone (regardless of class, creed, color, religion, economics, etc) is likely to go at some point. It’s also the one place that everyone truly starts out as equal- or, at the very least, as close to it as possible.

In fact, in my ER, in fact, we’re not even allowed to take payment information until you’ve seen a doctor. This is because of a law signed by notorious socialist Ronald Reagan in 1985 that codified into law anyone seeking medical treatment would get it, period. End of story. It’s probably been the biggest unfunded mandate of all time, but a necessary one… unless you’re just peachy keen with people dying in the streets.

So! Trumpcare passes, and becomes the law of the land. Since we just denied millions of people health insurance, making them unable to get reliable primary care and preventative services, congratulations to all my brothers and sisters in emergency services! You just became the primary provider of healthcare services for upwards of ten to twenty percent of the entire country! And that’s not just the nurses and doctors in the ER, but firefighters, EMS, and even law enforcement- they have to deal with it a hell of a lot more than you’d think, and they are absolutely included in our umbrella of emergency services, and will have to deal with this fallout.

But that’s okay; you’ve got great insurance. So you’ve got no problem! But, oh no! Your nine-year old daughter falls off her bike at 5:45pm on a Friday afternoon and slices a three-inch laceration into her chin that’s bleeding profusely. Your family doc is done for the day, so guess where you have to go? Ahh, yes, the ER!

Do you like Disney World? Great! Because it’ll be just like that, minus all the rides and attractions. Yup, just a giant bill and lots of waiting. And waiting is what you’ll do, because all of the people I mentioned before, the ones Trumpcare has forced into the ER- they’ve been waiting ahead of you for several hours already! Get comfortable in that shoulder-to-shoulder waiting room.

Ahh, but you’ve patient consoled your daughter for several hours, and finally get back to a room. Great! Well, lacerations are time consuming to deal with, so expect the provider to put it off to last, after they finish (necessarily!) with any patients that are having acute problems and may decompensate while they’re doing the suturing. And that’s IF they don’t decide to consult with Plastics, since this is a facial laceration and doing it poorly will result in a scar that’d make Harry Potter jealous.

And if they do a Plastics consult, that cash-register noise you just heard was the hospital billing department, who are grinning and rubbing their hands together in excitement. Since the Republicans decided to repeal the “personal responsibility”, “no free rider” act from Obamacare that stipulated everyone had to have health insurance, lest their income tax refund be penalized, the hospital has to make up the money from folks who either can’t; or, yes, even refuse to pay! I know you’ll share the hilarity of Republicans being so reflexive on having to destroy anything associated with Barack Obama they’ll even destroy their own party’s platform when you get your bill in the mail!

Ahh, you say, whatever- I can maybe handle that, and you’re just trying to scare me… if anything was really wrong, or if I called an ambulance, I’d still get straight back into the ER, seen quickly. This ain’t a third-world country.

Well, let me tell you about that! Because, unfortunately, I’ve got bad news for you; your mom just slipped and broke her hip! This is depressingly common, ground-level falls are one of the most common morbidities among folks over 65. Luckily, though, you were there with her to see it happen, so you could call 911 immediately. In just a few short minutes, that rescue squad will show up at your door!

Ooooh, but small problem. The local volunteer rescue squad has another empty building call. See, the county you live in relied heavily on their volunteer crews before Trumpcare was passed, but now that it’s the law of the land? They worked them so hard they burned them out! And since they couldn’t reimburse them training, meal, or uniform costs, the state, in a last ditch effort to get more volunteers, kneecapped all training and certification requirements for EMTs (THIS IS NOT A JOKE, THIS ACTUALLY HAPPENED IN VIRGINIA). But we managed to take all of these well-meaning, community minded volunteers and burn them out by asking them to do a full-time job for no money, no training, and no support.

So, the call goes to a paid crew of firefighters and EMTs. Now, unfortunately, that paid crew may have to range over an area of a couple hundred square miles. So it might take ’em awhile to get there! Hip fractures are notoriously painful, so do your best to keep your mom comfortable while the ambulance is on the way.

Almost a couple hours after you called 911, finally! You arrive in the ER, and go straight back to a room to get seen. Oooh- wait. Nope. No, you’re going to triage. Yes, yes, I know; your mom broke her hip, but have you seen the ER today? There are six other ambulances in queue when you pulled in. Why don’t we see if your mom can sit in a wheelchair for a little bit, or possibly a hall bed or triage bed, if they’ve got one available.

Then you’ll get to see the maestro for the entire department- the triage nurse! Though she or he is overworked and inundated, they know precisely what your mom is going through, and are gonna do their best to put an IV in her, and then grab one of the docs and beg them to give her something for pain- ibuprofen, or maybe toradol if they’re lucky. If they know it’s going to be a long wait, though, she might be lucky enough to get a shot of dilaudid, and since she’s been in pain so long, it’s going to take a hefty dose to quiet it.

And on that note, congratulations! Along with her broken hip, she’s also acquired an opiate dependency! That’s right, most narcotic addictions start in exactly this fashion- it’s not “junkies” who’re getting hooked on painkillers, it’s normal folks like you and I. And not only that, but you’d be stunned to find out the average age of a new onset narcotic addiction isn’t in the teens… or twenties… or thirties… or even forties! Nope, in fact, older Americans are one of the most at-risk groups! Oooh, and remember, too, those “junkies” weren’t always so- they started out “normal” too, and now your mom is well on her way to joining them!

When your mom is finally seen, she’ll get more pain meds, x-rayed, et cetera, but then she’ll at least get to a hospital inpatient room, and be able to relax, right? Oof. Sorry about that. If she doesn’t need surgery emergently, she’ll be boarding in the Emergency Department, because the inpatient beds are all full. Possibly for days, in fact; but don’t worry! Even though the ER staff is incredibly overworked, they’ll do their level best to provide for your mom.

In fact, the nurses, techs, EMTs, and doctors will burn themselves right the frick out trying to take care of your mom. Her nurse will skip lunch, skip breaks, even ignore a screaming bladder, just to make sure that hip fracture pain stays quieted (along with the other four to seven patients she or he is looking after). That nurse’ll work twelve or sixteen hours straight (“Can you just stay for an extra four? We’re so backed up, and had two call-outs. Please!”) because they know people need help, are suffering. And as a consequence, that nurse will also be hard at work exhausting themselves emotionally and physically, destroying personal relationships, ruining their home life, all because they’re not willing to let your mom be the one to suffer for this Trumpcare nonsense, anymore than she already has.

And we nurses aren’t alone in that; EMTs are. And police officers. And firefighters. We’re not going to ask for help for us; hell, no! We’re going to keep shouldering these loads for the people who need our help. Why, we had a firefighter in our community not long ago that attempted to commit suicide rather than have to ask anyone else for help. Asking other people for help when there are so many that need YOUR help is a deadly sin in emergency services, much to my incredible dismay. I’ve seen people turn to drugs, become addicted to narcotics, just to take the edge off to get them through another day. It’s okay, see- they don’t have a problem, they’re just trying to make it to another day of helping people. A percocet here or there isn’t going to hurt, right?

There’s a point when hard work and perseverance in the face of incredible odds isn’t enough to hold the line. This is what Republican legislators are counting on to bail them out on this POS bill. They’re counting on the heroes that live among us to save their asses- give them cover from having to actually govern. Give them the cover they need to pass this massive tax cut for the rich, at the expense of all the rest of us.

They’ll tip their hat to my brothers and sisters in emergency services, broken and battered, and say “Hah, without you guys the Democrats’ worst prognostications would’ve totally come true! Thanks! Oh, and sorry; can’t approve that .5% tax increase on cigarettes. I know it would’ve paid for all your training and equipment, but I got lobbyists to answer to. See ya!”

And we’ll just take it; nod and keep working. Because we don’t complain. We just work; work until we can’t do it any longer.”