Let Sleeping Old Men...Sleep

It is true that medical care, especially emergency medical care, is expensive. Although I don't know much about how much things cost, the rule of thumb I use to help potential patients estimate the cost of being seen in the ER is "at least $300 just to walk in the door."

Part of this is a facility's charge (the cost of maintaining the space and equipment of an ER and staffing it with nurses, aides, etc.) and another part is the professional fee of the physician. Invariably, people complain about their bills.

I am often asked by friends and acquaintances why their ER bill was so high. More times than not, of course, they came to the ER with a trivial complaint about a pain or injury that was not life-threatening but merely inconvenient and annoying. They easily could have seen their primary doctor, but they didn't want to wait a few weeks, days, sometimes even hours, to have their problem addressed.

"Don't you realize," I answer them, "that you came to the ER with a sore throat, but we have to maintain the equipment and training and skills to resuscitate you if your heart and lungs stop! Pharyngitis sounds like it should have a cheap fix, but you came to a place where we can literally bring you back to life if you die!" That has to be worth something.

This happens all the time. The extreme happened yesterday.

The ambulance ($300 right there!) was called out at 0710 to an unconscious patient at a local assisted living facility. The patient was a 89 year old man with a cardiac and diabetes history. Upon arrival he was pale and somnolent, but responsive to verbal stimuli. Blood sugar was normal, there was no external injuries, and he had no complaint of pain. After a couple of cups of coffee, he was alert, interactive, and managed to feed himself breakfast.

Diagnosis: Drowsiness, possibly related to abnormal sleep pattern.
Cost to Medicare: probably in the $500-$600 range.
Cost of a McDonald's Egg McMuffin Meal* with coffee: $3.29.

Clearly it is not emergency care which is expensive; emergency care for non-emergency conditions is expensive.

Let sleeping old men sleep. It's cheaper.


* Of course I do not endorse fast food as a healthy alternative.