The Irrational Rationing Of Health Care

emergency_room_And the waiting begins

Three years ago I had a mild stroke and was admitted to an LA County hospital emergency room. The only place to park my bod was in the waiting room. Initially there wasn’t a single chair available. Finally, someone got up and I grabbed it, exhausted. I turned and looked down the hallway towards the actual ER. It was lined with gurneys on either side occupied by patients in various states of disrepair, reminding me of a movie about a train crash with dozens of injured passengers stacked up waiting to be triaged.

A couple of hours later someone walked me to a holding area full of more patients, each lying on a gurney occupying just enough curtained space that someone could walk between them. But there was still no available gurneys and I was given a folding chair next to a big sink. Feeling the need to put my feet up, I looked around and found an empty cleaning bucket, turned it over and used it as a foot stool. While sitting there trying to calculate what percentage of my visual field was now missing, a nurse came in with a full bed pan and dumped in the sink right behind me, apologizing profusely. I shrugged it off, told her not to worry about it.

I was reminded of this charming little encounter with what passes for medical care in this country as I was reading an op-ed my an emergency room physician in today’s LA Times titled:

Where’s the big healthcare emergency? In the ER

The deteriorating condition of the system and its patients cries out for reform.
By Dr. Brian Johnston

The paramedics bring in a 47-year-old laborer, a father of four, with untreated high blood pressure, dying of a cerebral hemorrhage. A woman in her 40s enters the ER complaining of feeling “lousy,” unaware that her blood pressure is extremely high and that her kidneys are destroyed. She goes on dialysis and disability. An elderly widow is brought in severely dehydrated and comatose, with a blood sugar level over 800.  Medi-Cal had switched her to a “share of cost” program, which forced her to choose between paying her rent, or taking her medicine.  She’d chosen to pay the rent.

These are all patients I have seen in my ER in recent weeks. I have practiced emergency medicine in Los Angeles for 36 years and have witnessed a steady decline in system capacity as hospitals, county clinics and ERs have closed, even as our population has grown. People needing treatment arrive in far worse condition than before. Larger numbers of uninsured people and those whose managed-care facilities limit their access now come to the ER, which is the only option left to them. We see people suffering from preventable complications of treatable diseases. ERs are so crowded that patients aren’t seen as quickly as they should be, and some even leave before they’re seen by a physician…

Remember that next time you see some loon at a town hall meeting yelling about how “Obamacare” would result in the rationing of medical services and cost more than maintaining the status quo.


  1. Avatar mary b


    I just went to the website to sign up. For some reason, I think I did once before. I am very limited health wise, so I hope they can find me something to do. The three things they had listed won’t work for me as I am losing my hearing. It’s very hard for me to hear unless someone speaks very clearly and sometimes loud. If you know about hearing loss, it all depends on tone, bass, etc., in order to hear or understand the words.
    But good news! I just heard from Vocational Rehab yesterday and after being put on a frozen wait list for the last 5 years, they think they may be able to help me get hearing aids!! Isn’t that great!

  2. Avatar mary b

    Change is so overdue, the current clusterphuque so broken, that only dramatic and replete change will come close to fixing it. 77% of us know this; will we stand unified this time? We ALL better hope so.”

    You know, I have written to more than a few times to ask what we can do to help with the Reform. I’ve always clicked the little box that says something like “would like an answer”. For some reason, they never write back. I think we need an organized effort, something like during the campaign. I am of limited resources and no money but I have a lot of time I could spend helping out.
    Do you know of anything that I might be able to help out with reform? I have been forwarding messages and articles. It doesn’t seem to be doing much good. I cannot believe that Obama would blow this! But then every time that I think he may have, I remember that he is not only intelligent but he also has street smarts. Hopefully, he’s holding his cards close as he obviously can’t even trust some W.H. aides.

  3. Avatar mary b

    Hey Guys and Gals,

    The reason that I was asking about Insurance was because about a year ago I fell down a couple of steps and broke my heel bone and a couple of other bones in my foot. It was very painful and I had to drive myself to the hospital. (Standard transmission, too)
    Of course, I didn’t tell them that or they wouldn’t have given me anything for the pain.
    I am uninsured. There were two other people in the E.R. waiting, and it was obvious that they were getting pissed off over the wait time. After about 5 hours, or maybe longer, they brought me in to see the Doc. They X-Ray ed it and told me it was broken. DUH!
    Then, instead of a cast or a boot, they put a plastic splint on it that went up to my knee. I have no idea why I had a splint that went all the way up to my knee. They then wrapped a bunch of ace bandages around it and gave me crutches. The nurse was a real bitch. I told them I could not use crutches as I have two disk problems, one of which is herniated. I also have nerve damage in my neck. I asked for something else, maybe a cane. They’re supposed to be the professionals, they should have figured it out. The nurse just mumbled something bitchy and said “crutches” even though I told her I could not use them. I only saw the Doc when he came in the room to tell me what was broken so I couldn’t tell him of my other injuries. He seemed alright.
    So, as a result, I had to walk without crutches, a cane, whatever. They gave me 5 vicodin and told me to see an orthopedic. Yeah, like that was gonna happen without insurance.
    So, there you go. My long story short, thanks to the Bush Administrations claim that the E.R. will help those without insurance. What a freakin joke!
    This is a prime example why we need a STRONG Public Option! That, and because when I go to the Doc once a month, my scripts cost me $799/month for 4 (FOUR) scripts. And every month, the price goes up a little more.

    1. Thanks for sharing your story, Mary b.
      “He seemed alright” … the Doc was the one who decided to splint your heel instead of coughing up a boot, which is more expensive than a few ace bandages. What bullshit. The real tragedy is, millions— millions of Americans don’t even have access to this kind of bullshit care. Change is so overdue, the current clusterphuque so broken, that only dramatic and replete change will come close to fixing it. 77% of us know this; will we stand unified this time? We ALL better hope so.

  4. I am. I couldnt find the right F-button to similute smearing Monkey Feces on the screen so that I could truly express the level of deep seated utter despair and frustration I have with the Dumb Fucks who are so fucking greedy that they cannot unclench their assholes for just one second and let the rest of us have a chance at a decent life. 🙁

  5. You can have insurance and that doesn’t make a difference getting into an ER. Often you are forced to go to an ER because it takes week to see your Primary Care Physician–by then you are either well or near death. I have sat, as an insured person in good standing with their policy for 12 hours at a time in ERs and I don’t live in California, I wont say where, but I will say that my state is not nearly so populated as all that. The ERs get mad at you, if it’s not whatever constitutes a real emergency, but patients are often left in the dark about what that means. Or you could be in a precarious state where a non-Emergency could change, and you are not sure. No doctor or nurses to ask, all you have left is the ER.

    Most doctors have bank hours anyhow, so who do you turn to? The docs cannot complain about the rise in Alt Health Care practices, or in the use of the internet, because thats all the new working poor have left, even with an insurance policy and a Primary Care Doc.

    Rationed Care? Wouldnt the Medical System have to be organized in order to calculate Rationing?

    What we have is 50 goddamn Monkeys fucking one greasy football. That is the state of medical care. The looney Scabs showing up for Lobbyests are just the cherry on that particular shit sundae.

  6. Avatar mary b


    I hope that everything turned out well for you in the end. It is a disgrace the way people are treated in E.R.’s and else where all over the Country. Unless of course, you’re in Congress.

    I have a bunch of horror stories I could tell you. They are too numerous to list. But of all my permanent disabilities, only one could not have been avoided. Most of them, if I had had Primary Care, preventable medical, I wouldn’t be waiting for my Social Security Disability now. I would still be a productive member of society.

    If Health Care does not pass with a strong public option, then nothing will change except Insurance Company Profits. They will get higher.

    By the way, did you have Insurance during that time? Just curious to see how big the gap is between being insured and not.

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