Edwards wants a socialist state

[Embar Angylwrath]

But you're talking about cutting off ER services to patients regardless of their means to pay based on 'lifestyle choices'.

Or do you believe that ER services should only be cut off to the poor?

Are you saying that people should get a free ride in the health care system, regardless of lifestlye choices?

[Harlowe]

That sounds pretty cold. I hope you aren't serious, because what kind of ethics is that...that'd you actually want to deny people emergency medical treatment based on their inability to pay?

I thought I had a bit of a bootstrap mentality, but that crosses the line morally to me. Though I'd like to see even more welfare reform (ideally charities should be the place to seek hand-outs unless you have children), to me, providing emergency medical treatment is just the humane thing to do. We're not a poor country; we should offer a modicum of temporary assistance to people. Hell we do it for corporations every day.

To let someone suffer like an animal in a wealthy country, especially when they could be suffering from mental illness, is just unconscionable.

[Embar Angylwrath]

Harlowe - Are you under the impression that most ER visits are of an emergency nature?

[Partha]

Actually, according to the CDC, half of all visits to the ER are characterized as needing to be seen in less than an hour - sounds fairly urgent to me.

http://www.cdc.gov/nchs/data/ad/ad358.pdf

categorized immediacy into five groups: emergent (less than 15 minutes), urgent (15–60 minutes), semiurgent (1–2 hours), nonurgent (2–24 hours), and ‘‘unknown or no triage.’’ As shown in figure 5, 15 percent of ED visits were classified as emergent, 35 percent were urgent, 20 percent were semiurgent, 13 percent were nonurgent, and for 17 percent, the hospital staff recorded this item as ‘‘unknown or no triage.’

Some other highlights:

About 6.6 percent (SE = 0.3) of all injury-related visits were alcohol related. Alcohol-related visits were assessed using the alcohol checkbox and alcohol-related reason for visit, cause of injury, and diagnosis items on the Patient Record form.

Self-inflicted injuries resulted in 438,000 ED visits (1.1 percent), with poisoning being the most frequent cause (0.8 percent). Approximately 1.7 million ED visits were for adverse effects of medical treatment and represented 4.2 percent of injury-or poisoning-related ED visits. This included adverse drug reactions and complications from surgical and medical procedures.

So much for Embar's fact free factoids.

[Rsak]

So the source for our statistics is the forms filled out by the patient or someone who brought the patient in.

For some reason the words of Dr. House are screaming in my head... "Everyone Lies!"

[Partha]

And you have statistics to counter what the CDC says? No?

Have you turned into Embar?

[Kulaf]

Well if you look at the charts on page 4 what it seems to show is that for the younger segment of the population ER vists over the last 10 years has remain relativle stable......and the usage increase you are seeing is in the older segment of the population no doubt due to the baby boomers all sliding up the scale. Not sure what you are trying to show with this data.

[Partha]

Well, Embar is theorizing (a nice word to avoid saying "pulling things from his ass") that drug and alcohol related ER visits are a large portion of ER visits, and as 'lifestyle choices', poor people who visit for those reasons should be disallowed to visit ERs. The data I quoted points out that his first point isn't true (big shock there). Unless, of course, we add in your factoid about seniors visiting the ER much more frequently and Embar now advances the idea that Granny and Granpaw Meth'Addict are, in fact, responsible for all those ER costs.

[Rsak]

Why did you ever think I was trying to counter the CDC report? I just thought it was comical that the cause of the ER visit is decided by the patient not the doctor.

[Partha]

Where did you get that, exactly?

[Embar Angylwrath]

You're twisting data, Partha. You cite alcohol related INJURIES, and paint it as those are the only alcohol related visits to the ER.

http://www.cdc.gov/alcohol/quickstats/general_info.htm

Over 4 million alcohol related visits to ERs in 2003, out of 114 million, about 3.5% of total ER visits. Add to that the drug related visits.

http://www.samhsa.gov/newsroom/advisori ... 35521.aspx

DAWN estimates that 27 percent of emergency room visits were related to the use of alcohol in combination with another drug.

[Partha]

That sentence is misleading - they're talking about 27% of the total 'drug misuse' stat, not of total ER visits. Earlier in the report, they state:

Of the 1.4 million emergency room visits associated with drug misuse or abuse recorded by DAWN in 2005, 31 percent involved illicit drugs only and 27 percent involved pharmaceuticals only. An additional 36 percent involved combinations of illicit drugs, alcohol, and/or pharmaceuticals. Overall, there were 108 million emergency room visits in U.S. hospitals during the year.

Further, as the data points out, many 'drug-related' ER visits were in regard to pharmaceuticals that were prescribed for legitimate medical uses. Sorry if I distinguish between Grandpa accidentally taking extra meds with a 25 year old smoking crystal meth, even if they don't really.

[Embar Angylwrath]

That sentence is misleading - they're talking about 27% of the total 'drug misuse' stat, not of total ER visits. Earlier in the report, they state:

Of the 1.4 million emergency room visits associated with drug misuse or abuse recorded by DAWN in 2005, 31 percent involved illicit drugs only and 27 percent involved pharmaceuticals only. An additional 36 percent involved combinations of illicit drugs, alcohol, and/or pharmaceuticals. Overall, there were 108 million emergency room visits in U.S. hospitals during the year.

Further, as the data points out, many 'drug-related' ER visits were in regard to pharmaceuticals that were prescribed for legitimate medical uses. Sorry if I distinguish between Grandpa accidentally taking extra meds with a 25 year old smoking crystal meth, even if they don't really.

Ok, lets agree on the numbers first. Would say that this report indicates 1.4 million ER visits out of a total od 108 million were associated with drug/alcohol misuse/abuse?

[Harlowe]

I'm thinking more about the poor and homeless individuals that don't have health insurance and don't seek medical care until their problems reach the point of needing to go into an ER. Would you want to turn them away because you are presuming they've made poor lifestyle choices because they also drink or abuse drugs? Embar do you seriously think all the homeless folks are actually sane individuals? I think the amount of mental illness in the homeless is staggering. If people have mental health issues, they aren't exactly making "lifestyle choices" as in - gee, I want to be a lazy drunk living in a box and peeing in a jar.

I just think it's sad that these people are written off by half of society as "lazy", when they are mentally ill. If you've ever done volunteer work at soup kitchens or meals on wheels, you don't see a lot of people taking advantage of "the system" and just being lazy.

Though I'm not about to have them come live in my house, so maybe I'm a hypocrite - but I don't mind tax dollars paying for those folks getting some emergency care. It's just the decent thing to do.

[Ddrak]

I think it costs society more to provide ER than it does to provide non-emergency care to these people - in more ways than just money as well. If you're waiting for the homeless/destitute to get to emergency stage before treating them then you're really not being very efficient about things.

Dd

[Partha]

Though I'm not about to have them come live in my house, so maybe I'm a hypocrite - but I don't mind tax dollars paying for those folks getting some emergency care. It's just the decent thing to do.

You're not a hypocrite - after all, it's highly unlikely you're skilled at treating mental patients. You put your money into someplace where people who ARE can do that work.

Ok, lets agree on the numbers first. Would say that this report indicates 1.4 million ER visits out of a total od 108 million were associated with drug/alcohol misuse/abuse?

Sure! Now you can agree with me that you were pulling numbers out of your ass before, and were wrong.

And if you'd cut off drug/alcohol admissions to ERs, which overbuden our healthcare system because of personal lifestyle choices, you'd see ER visits drop by 30%. I don't care what anyone chooses to put in their body. I DO care when I'm asked to pay for the consequences of their lifestyle.

See, THIS is why debating you is practically pointless - you go fact free into EVERY argument. I only do it because I care.

[Rsak]

Alcohol-related visits were assessed using the alcohol checkbox and alcohol-related reason for visit, cause of injury, and diagnosis items on the Patient Record form.

[Partha]

Alcohol-related visits—Although there is a separate item on the Patient Record form to indicate whether the visit was alcohol related, sometimes an alcohol-related reason for visit is specified or an alcohol-related diagnosis is rendered without the alcohol item being checked. Using the checkbox alone provides an estimate of about 2,535,000 visits (2.2 percent, SE = 0.1) related to the use of alcohol by the patient or another person or both (data not shown). The alcohol checkbox was marked ‘‘unknown’’ or left blank for 11.8 percent of visits. Using data from the checkbox, any alcohol-related reasons for visit, any alcohol-related external causes of injury, and any alcohol-related diagnoses produced an estimate of 4,003,000 visits (3.5 percent, SE = 0.2).

So, even under the expanded definition which includes spaces left blank in the report, you're still coming up with less than 4% of all ER visits being alcohol related. Where are you going to get the data to support Embar that says that ~38 million ER visits involved drugs?

[Embar Angylwrath]

I'm thinking more about the poor and homeless individuals that don't have health insurance and don't seek medical care until their problems reach the point of needing to go into an ER. Would you want to turn them away because you are presuming they've made poor lifestyle choices because they also drink or abuse drugs? Embar do you seriously think all the homeless folks are actually sane individuals? I think the amount of mental illness in the homeless is staggering. If people have mental health issues, they aren't exactly making "lifestyle choices" as in - gee, I want to be a lazy drunk living in a box and peeing in a jar.

I just think it's sad that these people are written off by half of society as "lazy", when they are mentally ill. If you've ever done volunteer work at soup kitchens or meals on wheels, you don't see a lot of people taking advantage of "the system" and just being lazy.

Though I'm not about to have them come live in my house, so maybe I'm a hypocrite - but I don't mind tax dollars paying for those folks getting some emergency care. It's just the decent thing to do.

I said nothing about turning away people with mental illness. Personally, I find the treatment of the mentally ill in this country abhorrent. To me, they are just as disabled (for work purposes) as someone who is injured in a car accident, and I feel they should be part of the "safety-net" health care system. As an aside, when Reagan, as Gov of California, closed most of the mental health assisted living centers, that's when I couldn't be a Republican anymore.

Society does have an obligation to those who are damaged beyond repair, or at least beyond our ability to repair. We have an obligation to meet their basic needs of food, shelter and clothing, and to keep them reasonably safe from harm. My issue is with the people who choose to immerse themselves in a life of self-destruction, and then ask the rest of society to pay for the consequences of it.

[Rsak]

Why are you convinced that I am trying to prove you wrong or support Embar... Let me repeat that I find it comical that the statistics are generated by the patients rather then the doctors. That is all.