I have been treated to the best health care the world has to offer -- that is right here in the United States. I don't think there is one thing wrong with the American health care system. It is working just fine, just dandy.
– Rush Limbaugh
Limbaugh is quoted after a visit to a Hawaiian hospital that admitted him with severe chest pains... But presumably before he received his EOB from the insurance company.
Drawing conclusions about a system, based on anecdotal experience, is always hazardous, especially when the person doing the drawing is a wealthy celebrity blinkered by ideology.
He does not detail the treatment that was so dandy or whether it actually resolved a medical problem other than transient pain. Most important, he does not say — and probably doesn't know — how much it cost.
My own experience with medicine in the islands is limited, but possibly relevant. In 2003, I accompanied someone experiencing severe abdominal pain to a Maui ER. I'll spare you the details, except to say the problem was likely a ruptured ovarian cyst that was going to resolve itself and apparently did by the time the dose of pain killers wore off. A CT scan and ultrasound revealed nothing — just as in Rush's case — and a laproscopy offered after the patient felt ready to leave was turned down.
However, the patient spent most of the day on a gurney in the ER — without a pillow (they were out of pillows) — for continuing "observation," which meant "lie here by yourself until we can find the specialist to come back and take another look at you."
The charges for this visit, which did not involve an ambulance, room or medical intervention other than fluids, meds and the diagnostic tests, came to $14,000. Fortunately, the costs were picked up by insurance, but because they were out-of-network for the Minnesota-based policy, Medica (and its policy-holders) paid a higher portion of the bill.
The care was "best" if best means borderline over-provision of services with no adverse outcome. (We'll guess Rush got a pillow.)
Ironically, because Hawaii has an employer mandate and a relatively high number of people with health insurance, its hospital emergency rooms don't provide the level of indigent and outpatient care that burden costs at mainland hospitals.
Most Hawaiians see their regular doctor, use fewer health care services and are admitted to hospitals 26 percent less than the United States average. The ERs can deal with true emergencies, like chest pain, abdominal pain and surf-slammed tourists. In 2007, the state had 34 percent lower ER outpatient visits than the national average.
Other states tried employer-mandated care only to repeal the efforts after employers threatened to move across state lines. Hawaii’s isolation forestalled such threats, and its paternalistic plantation history made employer-provided care an easy fit.
There are perils in drawing conclusions about how a national health care system would work based on one isolated state's experiences — and liberals and conservatives will find the lessons they're looking for.
One thing you already knew, though. Rush Limbaugh isn't telling you the whole story.
