In The ER, Unhealthy Premium On Insurance Data

The classic image of the emergency room is ingrained in our minds: A critically ill patient is rushed in and a medical team quickly surrounds the gurney. Through heroic measures, the patient is snatched from the throes of death.

It does happen that way. But health economist Philip Musgrove encountered something quite different one afternoon. He explains in this excerpt from an essay in the journal Health Affairs.

As a general rule, criminal situations aside, I believe you shouldn't threaten one person's life to save another's. But the only time I'm sure I saved someone from death, that's exactly what I had to do.

One afternoon, I saw a workman come out of a house and try to climb into his van. He couldn't do it. In fact, he couldn't speak and barely could breathe. He appeared to be having a heart attack right there. I ran to him, grabbed his keys and hauled him into his van.

I drove straight to the emergency entrance of a major hospital. I half-walked, half-dragged him into the waiting room.

I told a young receptionist, "I think he's dying ... probably having a heart attack."

She pulled out a paper form and started asking questions: "What's his name? Social Security number? Does he have insurance?"

It seemed possible that he might die, right then, while she rattled off her list of questions. She couldn't seem to understand what "emergency" meant. Never before or since that afternoon have I felt like seriously threatening another person physically. But I had to try something extreme.

So I leaned over her and said, loudly enough for everyone in the waiting room to hear, "Lady, if you let him die, you're going to be the second person to die in this emergency room this afternoon!"

She jumped up and ran through swinging doors. Immediately, two attendants rushed out and loaded the man onto a gurney. By this time, he was turning blue. How was this emergency room incident even possible? A prestigious academic hospital hadn't gotten a receptionist to understand what an emergency is. Behind that hospital was a health care system without an effective, electronic way to locate records of a person's medical facts. And with scores of insurers and millions of uninsured people, every emergency patient is a potential economic drain whose costs no doctor, clinic or hospital wants to absorb.

The sick workman didn't die. Several days later, he called me.

He said the problem hadn't been a heart attack. He'd undergone lung surgery recently, and some of the stitches had ripped loose. When I found him by his van, he was literally drowning as his lungs filled with fluid.

The hospital was able to pull him through. But if he'd collapsed without anyone seeing, he wouldn't have made it.

And it turned out that, yes, he had insurance.

Health economist Philip Musgrove is an editor at the journal Health Affairs.


