St. Vincent's: first of many?

New York magazine reports that although the closure of giant St. Vincent's hospital earlier this year shocked New Yorkers, the pain isn't over yet -- because the majority of the city's hospitals teeter on the edge of financial collapse. With 2% profit margins considered enviable, and losses the norm for most institutions, the city's hospitals leave the article's author searching for the why. What's killing the city's hospitals?

The author does identify some reasons specific to New York: the stranglehold that unions have on hospital labor drives up costs, the high percentage of uninsured and Medicaid- or Medicare-insured patients, the older buildings that many hospitals are forced to maintain.

But what he doesn't say is how all of these things tie together with the pressures that hospitals nationwide are facing: It's government intervention, stupid.

If hospitals weren't forced by city government to deal with unions, they could contract privately with workers willing to accept lower wages than unions demand. If the government didn't insure the poor and seniors, and if hospitals weren't forced to accept all comers (in NYC, it's not just emergency departments that have to do this; according to the article, the nonprofit status of the city's hospitals subjects them to a complex web of regulations forcing them to accept patients regardless of ability to pay), hospitals could choose to deal with patients who can pay (and accept charity patients voluntarily, if they could afford to do so). If New York weren't landmarked to death, with a ridiculous number of historical committees, neighborhood groups, and bureaucrats to please if you so much as want to change the windows on your townhouse, hospitals could build newer facilities when it makes financial sense for them to do so.

All this, on top of the pressures that hospitals all over the country face -- emergency rooms that can't turn away patients, even those who are clearly faking an illness to get a free bed for the night and who will never pay a red cent for the expensive medical care they receive; malpractice lawsuits that force enormous, often undeserved, payouts; private insurers (who would likely play a much smaller role in a fully free market) driving down reimbursement rates -- and it's no wonder New York's hospitals are in the toilet.

Add ObamaCare to the mix, and there will be even more patients clamoring for care, straining a system already at the brink of collapse.

I was fortunate, four days ago, to have a New York City hospital to go to when I had a medical emergency. I certainly hope I don't have one again for the rest of my life. Unless we turn toward a free market in health care, who knows what will be there the next time?

Lessons learned from the ER

Wow, it's been a while since I've posted! Chalk it up to training for the Chicago Marathon, which I improbably ran in 4:22:35, taking six minutes off my personal record despite temperatures in the high 80s for the last several miles of the race. (If the forecast had said it was going to be that hot, I probably would not have run the race, so perhaps not knowing was better, as I would have missed out on bettering my PR!)

Unfortunately, although I was able to run 26.2 in such brutal conditions and seemed fine, if exhausted, afterward, as it turns out there were some lingering aftereffects.

On Thursday and Friday I had a pretty bad stomachache, which I attribute to the fried chicken I had for lunch on Thursday. Due to said stomachache, I did not eat much on Friday at all, and although I did drink water, I probably didn't drink enough for having run such a dehydrating marathon just a few days before. On Friday afternoon my nausea got fairly uncomfortable, so I decided to go home instead of joining friends for Objectivist happy hour.

On the subway, I really started to feel like caca. It was a crowded train and there was nowhere to sit down, so I just resolved to stick it out and put myself to bed with a glass of water the minute I got home.

Except I didn't make it home. All of a sudden I saw white lights. I remember thinking something that was complete nonsense (I can't remember what it was, just that it didn't make any damn sense) and the next thing I knew I was on the floor of the subway car. The train doors opened -- fortunately, I had fainted just as the subway had arrived at a station stop -- and some kind strangers helped me out of the train and onto a bench, where I spent the next woozy several minutes answering questions of the strangers and the paramedics they summoned. One of the strangers called my husband for me (there was no cellular reception in the station, so he stepped outside to do this) as I waited for an ambulance to arrive.

I was taken to the Brooklyn Hospital Center ER, where my husband (who arrived shortly after I did) and I spent the next six hours. The medical staff gave me IV hydration, some drugs for the nausea, an EKG, and a chest X-ray; this being an ER, I waited hours between tests. (Not that I fault Brooklyn Hospital Center, for reasons to be stated below.) I was so ready to leave by the end of it! The resident who had been seeing me finally told me that it was probably just dehydration, but that I should follow up with a cardiologist, and that I was free to go once I finished at least half of another IV bag. (My husband says it was a bit of a relief to see me watching the IV bag with obvious impatience, because it was better to see me bored and restless than fatigued and out of it, as I had been for the first few hours we were in the ER.)

End of story: Please don't worry about me, I am doing fine (and I don't intend to stop running marathons, as I have run three of them before with no such issues), although I do have a fat lip from where I hit the floor of the subway car when I passed out.

End of story, beginning of thoughts about story:

• Objectivism is perfectly compatible with kindness to strangers. I know a lot of people who, if they heard this story, would respond with, "See? Those strangers were nice to you. Doesn't your philosophy mean that you'd just keep on walking if you saw someone pass out on the subway? That's horrible!" Not true. Objectivists recognize that other people can be a huge value -- and sometimes, the benevolent attitude that results from that realization means that helping a stranger is more valuable than whatever it is you would have been doing with those few minutes of your life. If a stranger near me were in an emergency situation, and there were little or no risk to me, of course I would offer whatever help I could. (Example: I would certainly call paramedics if I saw someone having a medical emergency, and wait until help arrived; I would not, however, jump into a lake to save a drowning man, knowing that my own swimming skills are not great and that I would likely imperil my own life without saving his.) I want to live in a world where, in the rare case that I cannot help myself -- like when I lose consciousness on a subway train -- someone will help me. So I ought to help create that kind of world, by helping out when I see an emergency.
• This does not mean I owe health care to every Tom, Dick, and Harry. A coworker once challenged me, "You mean if you saw a guy having a heart attack on the street in front of you, you wouldn't help him?" when I said I was against universal health care. Well, just because I would help the man having a heart attack doesn't mean I need to help everybody else pay for health care that they can't or won't pay for themselves. Helping strangers comes out of a sense of benevolence, not one of duty. I'd do it out of the selfish recognition that self-sufficient people -- myself included -- are, in rare emergencies, not able to help themselves, and that I selfishly want to help such people, knowing that the cost to me is almost nothing and the benefit of living in a world where people show kindness to strangers in emergencies is great. This is not the case for my being taxed to pay for health care for retirees who can afford to take Florida vacations because Medicare pays for their doctor visits, or "poor" Americans who claim they can't afford health care but they can pay for a cell phone. The cost to me is great (just the Medicare tax my employer and I pay on my salary, let alone all the other entitlements I pay for, could have made a nice chunk for my husband's and my down payment fund), and the benefit to me is zero (because I'm not interested in living in a world where the able and the frugal are constantly forced to prop up the unable and the spendthrifts).
• EMTALA needs to go. Right now. For those who don't know, EMTALA (the Emergency Medical Treatment and Labor Act) is a law that forces ERs to treat anyone who comes near them, meaning that plenty of people who "can't afford" to see a doctor use the ER when they get the sniffles, and others who just want a warm bed for the night will make up symptoms, knowing the ER can't kick them out until they've run a bunch of tests, which takes hours. The patient in the bed next to me was like this; I heard him arguing with the doctor on duty that he felt like he was going to have another seizure (she told him there was no evidence that he'd even had one in the first place, and that Medicaid would not cover his stay there, so he'd have to be discharged) and that if he were out on the street that night and had a seizure, it would be on her head. It was so obvious that the guy was making up a story to get a free bed for the night. With patients like these clogging emergency rooms, driving up wait times for patients who truly are in emergency situations and making it harder for doctors to get paid, is it any wonder hospitals are closing their emergency departments and more and more doctors are choosing to leave emergency medicine? Check out the M.D.O.D. blog for story after story of doctors forced to serve deadbeats, getting fed up with the mess, and quitting. I want to live in a world where emergency care is available if I need it -- and I am willing to pay for it. EMTALA has got to go -- because EMTALA destroys that world.