Shortly after the collapse of communism, in the depths of Russia’s post-1991 malaise, my father tumbled down an icy set of stairs in Moscow. He broke his wrist badly, and was taken to what might be called Moscow General.
His experience there made a great story, months later: Cats roamed the hospital’s operating rooms, put there on purpose to control the vermin. Drunks moaned on the stretchers lining the halls. His well-meaning doctors, lacking the proper resources or know-how, put a cast on him — but without putting any gauze underneath, so when it was taken off later, the hair on his arm went with it. At the time, this outrageous experience seemed like a classic example of Russia’s terrifying slide into the Third World. Today, it could happen in America.
Well, probably not the cats. But the National Academy of Science’s Institute of Medicine, the Congress-chartered agency that advises the government on medical matters, has just concluded a two-year review of emergency care in the United States, and here’s what it found: If you call an ambulance in the U.S., it may well be forced to reroute you to a more distant ER, often one with fewer resources, due to overcrowding. You may be further held up because many ambulances can’t effectively radio hospitals, since their communications equipment dates from the 1970s. If you go into cardiac arrest, the likelihood our emergency care system will save you varies wildly: In some cities, emergency responders save half of patients suffering from cardiac arrest; in others, they manage to save only 5 percent. Inside the ER, if it turns you need to be admitted to the hospital, you might spend two days or more waiting on a stretcher in the hallways — longer, probably, than some of those unfortunates my father saw lying in the halls during his eye-opening stay in Moscow General.
This won’t be a surprise to anyone who’s been to the ER recently. But the revelation that these horror stories aren’t the exception but the rule might be the one thing that could revive our discussion about our health care system and how it might be fixed.
Remember the fight over Hillarycare in the early ’90s? Opponents registered many complaints against the Clintons’ health care plan, but a major one — or perhaps the one that undergirded them all — was that our health care system wasn’t terminally ill. It’s notoriously hard to get the people of a generally prosperous country riled up about poverty; in the same way, arguments about skyrocketing drug prices and the prohibitive cost of routine doctor’s visits weren’t persuasive to many of the already-insured, who paid low premiums for drugs and were amply reimbursed for trips to the GP.
The sorry state of our emergency rooms is a direct result of the high number of uninsured, who go to the ER for complaints we’d take to a GP. But unlike access to insurance or prescription drugs, emergency care doesn’t discriminate. When you call an ambulance, the best insurance in the world can’t ensure that your ambulance won’t be diverted if the ER is overcrowded, that you’ll be seen quickly, that you’ll get the care you need. The Washington area recently learned this terrible lesson when, because of negligent emergency care, veteran New York Times reporter David Rosenbaum died before his time.
Over the past decade, the declining condition of American emergency rooms comes in and out of the news. In some cases, the coverage produces results — Los Angeles instituted a “trauma tax” to try and save its ERs — in others, the attention fades away. But the power a nationwide breakdown in emergency care has to frighten people — people who thought their health insurance could save their lives, but find instead that they may be lost due to others’ lack of it — may transform the next big health care debate. Policy hounds predict it’s soon to come. Let’s keep the heat on this story.
Eve Fairbanks is a reporter-researcher at The New Republic.
