News from VA, ER front bode ill for Obamacare

The whole health care issue comes down to one issue: Who pays?

One of the major selling points of the Affordable Care Act was that, by covering more people, we could reduce the number of people who resorted to expensive emergency room visits for otherwise routine medical care.

That isn't working out so far, according to a survey released today by the American College of Emergency Physicians.

A quarter of ER docs say their patient volume has remained the same and half say they are seeing more patients since Obamacare went into effect Jan. 1. Some 86 percent of them expect visits to rise over the next three years, although the survey didn't ask the doctors why.

The median ER charge was more than $1,200 for the most frequent outpatient diagnoses in a study of over 8,000 ER visits in 2006-08, according to a 2013 report funded in part by the National Institute of Health.

When ER patients can't pay for their medical care, hospitals pass the costs on in the form of higher charges to other patients.

But what happens when the government is footing the entire bill? And what happens when the agency providing the care, say the Veterans Administration, is given high standards to uphold while not being given the resources to accomplish those goals?

Like good bureaucrats everywhere, they cook the books. In the VA's case, the agency was tasked to see veterans within 14 days of desired appointment dates.

The solution? Simply take off-the-book appointments, and enter them in the official system when you know the patient can be seen in the 14-day window.

Magic! The goal is met, and higher-ups are none the wiser.

The system breaks down, however, when someone -- in this case, a scheduler with local ties -- refuses to go along with the charade.

Lisa Lee, a 1980 graduate of McCook High School, and another scheduler were transferred from the Fort Collins Veterans Affairs Clinic in March 2013 for refusing to hide the wait times between the desired appointment dates and actual dates. She was put on a two-week unpaid suspension after filing an internal grievance about the transfer and scheduling practices.

Lee, a former Navy reservist now on active duty in Hawaii, told the Fort Collins newspaper, The Coloradoan, that the initial transfer resulted in a cut in pay and an hour commute to Cheyenne, Wyo., rather than being able to bicycle to work in Fort Collins.

The Office of the Medical Inspector reported that before Lee and the othe scheduler were transferred, appointments were running from mid-60 to 70 percent within the desired dates. After their transfer, that number somehow improved to 90 percent.

The ER and VA situations are only the tip of the iceberg of problems that can result when political pressures and medical care collide.

Read the original story from The Coloradoan here.