A homeless alcoholic nicknamed Ricky Ricardo, swigs cheap vodka by day at his favorite corner in Washington Heights, then calls an ambulance to chauffeur him to the hospital for a free meal and a warm place to sleep, courtesy of taxpayers who fund his Medicaid benefits. For a chronic caller like Alardo -- who phones 911 four or five times a week -- the annual medical bill can be as high as $300,000. Over 13 years, the length of time he has been abusing the emergency room, he has cost the medical system an estimated $3.9 million.
In Midtown, another bum, Robert, has faked emergencies to get food and shelter in ERs about 40 or 50 times in the past three years -- and taxpayers pick up his tab, too. Ricky and Robert are among the dozens of "frequent fliers" who clog the 911 system, tie up city ambulances, crowd emergency rooms and burn through Medicaid money. An ambulance ride alone can run as much as $800, and an ER visit can cost, conservatively, $400 a pop, according to estimates from medical experts.
City officials don't track frequent fliers or the costs associated with their transport and hospital care, but anecdotal numbers from ER and EMS workers suggest there are dozens throughout the city. "We have a system that is extremely dysfunctional. We have no place to put these people," an EMS medic said.
A paramedic working downtown said some frequent fliers think they'll get faster treatment if they arrive at an ER by ambulance, rather than walk in. "They know what to say to our call takers," he said. Or they'll tell a bystander, "Oh, I have chest pains," the medic said. Alardo, 53, phones 911 so regularly, medics know which calls are likely his. "When Ricky passes on, I'll probably even go to his funeral," said one medic who works in Washington Heights. "I've seen him almost every day for the last 13 years."
An inebriated Alardo lauded the medics last week, saying they "treat me like a king." A few hours later, he called for an ambulance to pick him up on Bennett Avenue. He went into the hospital at about 4 p.m. and slept for hours.
His fellow frequent flier Robert said he has called 911 as many as 50 times since becoming homeless three years ago. He said he would tell the 911 operator he had chest pains or was suicidal. But, he confessed last week, "I'm not really suicidal." Robert, 40, said he was looking for a place to sleep, get a meal and get the medications he takes for depression. He said he stopped his 911 habit after an ambulance driver "chewed him out." "I haven't called an ambulance for about a month," Robert said.
By law, EMS workers cannot refuse to treat or transport any patient. And ERs have to at least evaluate and stabilize homeless patients. The drain on the city's strapped medical system is huge. Medicaid reimbursements don't come close to covering the costs of frequent-flier visits. Medicaid pays just $175 for a basic ER visit and only $186 for the cost of an $800 advanced-care ambulance.
At a minimum, ERs give vitamins, showers, hot food and a bed to their homeless patients. But those who come in with underlying medical conditions require X-rays, cardiograms and medicines that can push the cost of an ER visit well above the average $400. "They take space. They take nursing resources. They're a drain on the staff's energy level and emotions," said Dr. Jeffrey Brenner, of Camden, NJ, who has studied the issue. "They're costing the system in both direct and hidden ways."
Brenner's research found Medicaid paid $46 million for the top 1 percent of Camden's frequent fliers, or 1,035 patients, during a five-year period. A pilot program at Bellevue Hospital has cut ER visits by 67 percent among "high-cost" Medicaid patients by finding them their own doctors, housing and even cellphones to keep in touch with their doctors, according to a recent report by the United Hospital Fund. But it will be hard to break the habit of vagrants who view the ER as their personal retreat. "It's not always easy to pick up these guys and take them in," one medic said. "But our policy is: 'You call, we haul.' We have no other choice."
'Rationing' is GOP weapon against health reform
In political combat, there are few more potent weapons than a single word or a catchy phrase that can be used to target a proposal and drive it into the ground. For Republicans, "rationing" could be that poison-tipped arrow for the Democratic-led health care bill, much as "amnesty" was the club with which conservatives beat President Bush's attempt at immigration reform into a bloody pulp in 2007.
"Governments ration care to control costs, and we've got stories from other countries where disabled children wait up to two years for wheelchairs. We've got a story that we found: a 76-year-old retiree pulled out their own teeth," said Rep. Dave Camp, Michigan Republican and the ranking member on the House Ways and Means Committee. "Government rationing is a scary proposition," he said.
Sen. John Cornyn of Texas, chairman of the National Republican Senatorial Committee, echoed this point during a conference call Wednesday, warning that the government could get into the business of rationing health care, deciding how much Americans can get or can spend on it and denying people health care that exceeds some rationed amount. "The rationing problem is very real in all this and I think that as the American people learn more and more about the proposals as we are now being allowed more time for them to engage on this issue, they are very, very much concerned," he said.
But Democrats say the insurance companies are already rationing care and that the reforms they want would cover all those who are being denied coverage under the current system, as well as keep down costs through an intensive focus on which medical procedures and products deliver care most effectively.
Republicans say that under a government-run system, which they argue will result from the proposed option to buy insurance from the government, cost will come to be the dominant factor that defines "efficient care," and thus Americans will be denied care with no recourse.
House Democrats plan to introduce their health care overhaul measure Monday and consider amendments later in the week. On Sunday's talk shows, there was disagreement on whether Congress will finish work on the bill before adjourning for the August recess.
Sen. Judd Gregg, New Hampshire Republican, said on CNN that meeting the deadline was "highly unlikely" because the Senate Finance Committee had not completed a draft. Sen. Jon Kyl of Arizona, the Senate Republican whip, said flatly there was "no chance."
Why Britain should fear American health care reform
Tucked away in a piece about possible end runs around NICE, the health care rationing body, is something of a scary paragraph:
Pharmaceutical companies are reluctant to launch new drugs in the UK at low cost because 25% of the global market is influenced by the UK price.
No, not that one sentence, although it helps explain why this next one is scary:
It comes at a time when other countries are actively considering setting up equivalents to Nice. First among them, and most important for the pharmaceutical industry, is the US. President Obama is known to be interested in some sort of cost-effectiveness scrutiny of medicines, which is bitterly opposed by the industry.
What all too few seem to understand is that medical innovation is hugely driven by what happens in the US market. The only market that is largely free from price controls. We can see from the first sentence that price controls do indeed retard innovation but of course there is no outcry about this for we don't normally see it. Who does take note of cures that aren't invented, aren't launched, because price controls mean there is no profit in their being so?
The great release from this problem for European health care systems has been that the US market, by far the largest in the world, is not subject to such price controls. Thus 300 million of the richest people on the planet underwrite, through the prices they pay for new treatments, the developments that we get years later as prices drop.
If the US does indeed bring in some form of NICE equivalent, some form of price rationing, then medical innovation will fall....no, not cease completely, simply there will be less of it than there would otherwise have been. Thus people who could or might have been cured will not be and they will die.
Reform of the US system might still be worthwhile, something like NICE might even still make sense: but don't anyone believe that such changes will be costless, they will indeed cost lives.
NHS 'obsession with breastfeeding is putting bottle-fed babies at risk'
Thousands of mothers who bottle feed are accidentally putting their babies' health at risk, says a study. They were found to be using too much formula milk powder and timing feeds wrongly. Frequent overfeeding can put babies at risk of long-term obesity and conditions associated with it, such as heart disease.
The problem is blamed on the Health Service's obsession with breastfeeding. It is accused of failing to provide enough information to new mothers on the alternatives. Cambridge University experts reviewed studies involving more than 13,000 mothers. They found that many mothers felt guilty or thought they were a failure for bottle feeding, while many were angry about not being able to breastfeed.
Others thought midwives were more interested in helping breastfeeding mothers than those who used bottles. Ministers are keen to get more mothers to breastfeed because of mounting evidence that it improves children's immunity to disease and helps brain development. It is also thought to reduce a mother's chance of heart attack.
The research, published in the Archives of Disease in Childhood journal, involved 23 studies. The authors found that some NHS midwives mistakenly thought they were forbidden from giving advice to bottle-feeding mothers, even after the baby was born. 'When women do not get information from healthcare professionals, they are reliant on friends and family, and incorrect practices are likely to be handed down from one generation to the next,' the researchers said.
They found that many mothers mistakenly put too much formula powder with the water. 'In addition to the short-term issues of hygiene and safety, it is possible that errors in the measurement and over concentration of bottle feeds may contribute to overfeeding, rapid infancy weight gain and later obesity,' they said.
The World Health Organisation code on infant feeding says only limited information on bottle feeding should be given before the baby is born - and after birth, instruction on bottle feeding should be given only after the mother has decided against breastfeeding. The study also noted that parents often changed the brand of formula they used if their baby was regurgitating it, in the belief the child might have a food intolerance. However 'it was possible that the reason for this symptom may not have been intolerance but overfeeding', the researchers said. 'There was a risk that infants would wrongly be labelled as having an intrinsic abnormality with longterm consequences to their health.'
An Infant Feeding Survey from 2005 showed that while 78 per cent of mothers in England initiate breastfeeding, only 45 per cent of babies were exclusively breastfed aged one week, dropping to less than 1 per cent when they were six months. The authors said that while it was known that breast milk is best for baby, mothers who choose to bottle-feed or who have failed with breastfeeding should be supported. They added: 'Inadequate information and support for mothers who decide to bottle feed may put the health of their babies at risk.'