A headline on the front page of today’s Arizona Daily Star caught my attention: a man died while waiting over 8 hours in the emergency room. It was shocking but inevitable. Emergency room care is so bad here in Tucson that I can’t believe it took this long for it to happen. At least now everyone is talking about it, and that’s important.

My wife recently went to the ER with severe chest pains that looked and felt like a heart attack (it wasn’t, in the end). I knew we could be there a long time, based on some of our past experiences, so I packed food, water, and books for her. But the experience was even worse than my lowered expectations: she spent 24 hours in the ER, on the gurney they wheeled her in on. She was never admitted to a bed in the hospital itself because there simply wasn’t any room. Other patients spent the night in gurneys out in the hallway, between janitor buckets. The whole place looked like some kind of natural disaster had happened. It was a wretched experience, for everyone.

There’s more to rant about, too, like the way that once you enter the system, you can’t continue to take care of yourself: if you have prescription medicines, the doctors on staff must administer them. Makes sense, if a doctor is available. If not, then you are soon in a more dangerous situation than you were at home, and that’s even assuming the MRSA doesn’t get you.

Neither of us blamed the staff: they were obviously working as hard and as fast as they could. The system was overwhelmed. But this was not out of the ordinary for an ER visit. For the last fifteen or more years it has gradually been getting worse. In our family, we put off, avoid, and dread every trip. Our dread is not misplaced: people are now literally dying in the waiting rooms.

The article has a good summary of what has led up to the current crisis:
• Extreme shortages of ER doctors, on-call specialists, nurses, and trauma centers;
• Increase in outpatient visits: 46% in Arizona, vs. 8% nationwide;
• Fully 50% of ER patients in Arizona come seeing primary care, not ER care, vs. a 14–17% rate nationwide;
• Managed care forces doctors to treat patients at lower-than-market prices, with higher-than-necessary accounting overhead;
• Short office hours for doctors, meaning that anyone having an urgent problem after 5 PM is sent to the ER;
• Aging boomers, adding extra pressure here in the Sun Belt where they come to retire;
• Increasing numbers of uninsured patients who come to the ER for everything because that’s the only place they can’t be turned away.

The article is generally clear-eyed and forceful, pointing out that although a 2006 task force appointed by our governor has identified some fixes, “a comprehensive solution will be complex and take years of effort, a strong political will, and no small amount of money. There is no easy fix.”

However, it dances around one major issue that is contributing to the problem of the uninsured: illegal immigrants. I do realize that for the purposes of analyzing the problem, a legal citizen without insurance is exactly the same burden on the health care system as an illegal immigrant without insurance. My point is that all of this immigration is unmanaged and increases the local population of patients who cannot contribute to the health care system as much as they require of it.

There was one quotation at the end that alluded to this issue, by Rep. Phil Lopes (D-Tucson). He was responding to the article’s reporting of families leaving Arizona because of this problem: “It is shocking to see a family run out of the state because they can’t get decent care—a fully insured family with social and economic status. That should not be happening.”

He’s right. He’s pointing out that those who are leaving are the ones who are supporting the health care system, the ones who have paid their dues, working within the system. If they leave, collapse accelerates.

I have a couple of doctors whose reputation as specialists is good enough that they do not need to accept managed-care contracts in order to find patients. They don’t accept any insurance at all; they charge “cash on the barrel-head” and leave it to me to file the paperwork. That’s a good thing; in fact, it’s the only thing that’s going to rescue health care. They need to be able to charge what their services are worth. I am appreciative of my medical plan, but it is kind of crazy to pay only $10 for an office visit with a doctor, less than lunch at a nice restaurant. That’s not proportional.

As far as providing a safety net of general medical care, I think that those who shout down discussion of socialized medicine need to realize that failure to provide it at some level has brought us to this crisis point. We are paying for everyone’s care anyhow, including the uninsured, including the illegal aliens. When a patient can’t pay, the hospital doesn’t prosecute or send them to debtor’s prison; they inflate the cost of care for everyone else.

I believe the government should set up and pay for clinics staffed by nurses who are indemnified at some level against malpractice, and allow them to provide general medical care for a nominal fee that is proportional to services rendered. Giving it away for free will make people abuse it, but something like a $25 fee to be seen immediately by a qualified nurse at any hour of the day or night makes a lot of sense, especially during spikes in public health demand, such as a flu epidemic.

In the meantime, if you come to Arizona…bring your own first-aid kit and prepare to rough it. Increasingly, there’s nowhere to go for help.