A little whine. . .

So last night, the phone rings - caller ID is no help - and I pick it up because when Kevin may be calling from another country code, my staunch never-pick-up-an-unknown-call rule is relaxed. It's a guy who assures me he isn't selling anything, and would I please take a few minutes to answer a few brief questions. I figure what the hell, I must have been feeling particularly nice - so I played my best 'informed political consumer' for a few minutes. What got me all riled up were the questions raised in my own mind by his questions - especially those about the cost of healthcare.

He asked what I thought to be the primary cause of rising healthcare costs in the US. I took a deep breath, bit my tongue, and chose one of the responses his script provided me. And I fumed inside. Because while it may not be the single biggest cause, the rampant abuse of the healthcare delivery system that I see every day is one of the roots. It works like this:

When I have a headache, I reach for the tylenol. Or if it's a real dome-pounder, maybe the Excedrin. It would never even cross my mind to go to the Emergency Room for a shot of demerol and phenergan, at a cost of, oh, I'd guess $400, by the time I was done paying the hospital's portion and the doctor's portion (these figures are purely estimated). Or let's say my kid has the sniffles. Being a rational person, if I decide to seek care [which I rarely actually do, as an ER nurse I tend to favor the 'suck it up' philosophy], I'll take the kid to the pediatrician, and belly up to the $25 copay as opposed to the $100 copay the ER would be.
But the reality is that rational people like you and me are the minority. Some of those rational people have insurance, and some don't - that's just a fact of life.

The real problem lies in two other groups that make up a huge percentage of my hospital's patient population. First, there are the people on Medicaid, whose sense of entitlement helps them ignore the fact that a pregnancy test that would cost them 5 bucks at the drugstore, costs the taxpayers $125 (this isn't a made-up figure) when we do it at the hospital. Quote from an actual patient, when I boldly pointed this out one day: "Oh, that's okay, I have Medicaid, so it's free for me." Arrrrrgh.

And then there are the people who have no intention of ever paying their bill, those folks who know that we can't turn them away even if they owe us thousands for unpaid care and frivolous visits. So for them, it's no biggie to show up at the ER for the sniffles either, and oh yeah, while I'm here, I hurt my knee two weeks ago so can you please give me some Percocet...

So while we continue to provide care of the highest standard for every person that comes through our doors, because the law and what's left of our consciences say we have to, the hospital's expenditures keep growing in relation to income. And this is happening everywhere. That, my friends, is what I see driving up healthcare costs. And the bummer of it is... folks like me, who are out there on the frontlines with smiles on our faces, see our workloads, patient loads, and stress increasing. But not our salaries.

There, I feel better. Thanks for listening.