In The ER, Unhealthy Premium On Insurance Data After rushing a stranger to the emergency room, health economist Philip Musgrove discovered that getting insurance information can trump getting emergency care.
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In The ER, Unhealthy Premium On Insurance Data

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In The ER, Unhealthy Premium On Insurance Data


Yes, but possibly the least relaxing place in a hospital is the emergency room. We get from TV the image of a desperately ill or wounded patient rushed in and quickly surrounded by an intense medical team frantically trying to save him. It does happen that way. Here's a story about when it didn't from a man whose job it is to analyze the system - health economist Philip Musgrove.

PHILIP MUSGROVE: As a general rule, criminal situations aside, I believe you shouldn't threaten one person's life to save another's. But the only time I'm sure I saved someone from death, that's exactly what I had to do.

One afternoon, I saw a workman come out of a house and try to climb into his van. He couldn't do it. In fact, he couldn't speak and barely could breathe. He appeared to be having a heart attack right there. I ran to him, grabbed his keys and hauled him into his van.

I drove straight to the emergency entrance of a major hospital. I half-walked, half-dragged him into the waiting room. I told a young receptionist, I think he's dying - probably having a heart attack. She pulled out a paper form and started asking questions that I couldn't answer. What's his name? Social Security number? Does he have insurance?

It seemed possible that he might die right then while she rattled off her list of questions. She couldn't seem to understand what emergency meant. Never before or since that afternoon have I felt like seriously threatening another person physically. But I had to try something extreme.

So I leaned over her and said loudly enough for everyone in the waiting room to hear: Lady, if you let him die, you're going to be the second person to die in this emergency room this afternoon.

She jumped up and ran through some swinging doors. Immediately, two attendants rushed out and loaded the man onto a gurney. By this time he was turning blue.

How was this emergency room incident even possible? A prestigious academic hospital hadn't gotten a receptionist to understand what an emergency is? Behind that hospital was a health care system without a quick, effective way to locate a person's medical records. And with scores of insurers and millions of uninsured people, every emergency patient is a potential economic drain and no doctor, clinic or hospital wants to absorb that.

Well, the sick workman didn't die. Several days later, he called me. He said the problem hadn't been a heart attack. He'd undergone lung surgery recently, and some of the stitches had ripped loose. When I found him by his van, he was literally drowning as his lungs filled with fluid.

The hospital was able to pull him through. But if he'd collapsed without anyone seeing, he wouldn't have made it. And it turned out that, yes, he had insurance. Not that that should be the crucial question.

MONTAGNE: Philip Musgrove is an editor at the journal Health Affairs. This essay is taken from a column in the journal called Narrative Matters. Read more in the health section at

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