Frustrated

So we are all aware of the folks who come to the ER for three hots and a cot, maybe some percocet, a new pair of socks, if they are lucky a pair of hospital pants. I am frequently asked to provide rides home to folks who lack the foresight to determine how they might get home once they take the ride in the ambulance for whatever non-emergent complaint they might have. The ER can become a haven for the homeless, the abused, and the otherwise non-coping folks of the city. Many have state aid, recently there are more who don't and won't qualify.

We no longer have free prescription assistance at the hospital, the new health program in the state can't be enrolled in unless you haven't had insurance for over six months, which really doesn't make a whole hell of a lot of sense. In order to qualify for medicaid you have to be incredibly poor, you also often have to be on disability.

Which brings me to another issue. Why is it that those who have had asthma since they were a child but are on medication and it is well controlled get social security disability and medicaid but my mother who had a shoulder injury which left her unable to play the piano which was her life's work, had a hip replacement, and is nearing 65 can't get it because she is not disabled enough. She can't lift her arm at this point above her waist. She still tries to teach but it's pretty hard and discouraging. She doesn't qualify for health insurance because of her pre-existing conditions, she makes too much money for Medicaid because she is actually trying to work for a living. Our health system is broken.

People with state entitlements use the ED as primary care and yell at staff when they aren't seen immediately, don't get lunch while waiting to be seen for a sore throat, and also want a free ride home because when they called the ambulance for their sore throat it didn't occur to them they wouldn't have a ride home. People without state entitlements also use the ED as primary care because they won't be required to pay. They will also frequently get free socks, free lunch, and maybe some free clothes along with free medical care because they will ignore the bills and collection ageny letters that will inevitably come.

There are clinics that operate on a sliding fee scale, or if you are too poor, will care for you for almost nothing, will help you sign up for state programs and help you with meds. There is also a free mobile care clinic that provides meds for chronic conditions for free, will provide care for free.

But it's easier although less pleasant to take a free ride to an emergency department, wait for several hours, abuse the staff, not follow up, be non-compliant, and possibly end up in more dire straits because of it.

The system is broken and nobody want to take responsibility for it.