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Frequent Flyers

When I was in medical school in the late sixties, the veteran’s hospital would always start to fill up when fall came around and the temperatures were dropping.

Why does this happen? Maybe people are sicker this time of year, and some of that is true of course, but the following paragraph written by Sabrina Tavernise in the New York Times on March 22, 2015 about a person in Hennepin County, located in Minnesota, pretty much explains partly what is happening.

MINNEAPOLIS — Jerome Pate, a homeless alcoholic, went to the emergency room when he was cold. He went when he needed a safe place to sleep. He went when he was hungry, or drunk, or suicidal.

“I’d go sometimes just to have a place to be,” he said.

Mr. Pate made 17 emergency room visits in just four months last year, a costly spree that landed him in the middle of an experiment to reinvent health care for the hardest-to-help patients in Hennepin County.

More than 11 million Americans have joined the Medicaid rolls since the major provisions of the Affordable Care Act went into effect, and health officials are searching for ways to contain the costs of caring for them. Some of the most expensive patients have medical conditions that are costly no matter what, but a significant share of them — so-called super utilizers like Mr. Pate — rack up costs for many reasons and perhaps some avoidable ones. As noted above the combination of poverty, homelessness, mental illness, addiction and past trauma require complex solutions.

At the University of Nebraska in the late sixties, we medical students were not that politically correct. I don’t think that term was even around then. The people like the patient described above were called “frequent flyers.” Another phrase used was, “they have a positive suitcase sign.” It meant they were all packed expecting to stay.

We as a society face immense medical costs when we do not take care of the disadvantaged people in our country. As Ms. Tavernise points out, many of these people are homeless, mentally impaired, poverty stricken and have medical issues requiring sophisticated levels of long term care. It is up to all of us to address these trying societal problems.

The above article also stated, “We do not mind cutting off the gangrenous leg of a frostbitten diabetic but it is expecting a lot from all of us to be expected to buy a pair of winter boots for the person to prevent this complication”.

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