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Hi, everybody. Stefan Molyneux from Freedomain here with Matt, who has some very interesting stories to talk about with regards to healthcare, hospitals, and so on.
Matt, how are you doing today?
I'm doing well, Stefan.
Thank you for having me on. It's my pleasure.
It's my pleasure. Now, what was it that prompted you to send in your letter here, and what do you most want to talk about?
Well, I've been wanting to talk to somebody about this for a long time.
It's been a Source of frustration for me really since I started working in a hospital emergency room and seeing the abuse of services, Medicaid in particular, not by doctors or nurses, but by patients.
And how long have you noticed this for?
Is it more recent? Has it been going on for a long time?
I've been working in two emergency rooms for about a year and a half now.
I've got a medical background.
I was a former army medic in the infantry and I have also worked in other hospitals.
That was quite a while ago.
I worked as a nursing assistant.
I've also worked as a medical assistant in doctor's offices.
And basically since the start of working in the two emergency rooms a year and a half ago, I've noticed it.
And I wouldn't say that it's gotten worse.
If anything, it's gotten a little bit better.
I'm assuming that's because more people are employed now and don't qualify for Medicaid.
And I'm thinking that possibly a lot of the people that would get employed aren't the type of people to abuse the system anyway.
So what was your first...
Do you remember the very first time that you noticed that there may be a problem?
What prompted that thought in your mind?
Well, it... Basically, it's a constant, but some things that stand out in my mind, we get patients that come in by ambulance quite often, and there's absolutely no reason for them to be coming in by ambulance.
Things like back pain or a stubbed toe, blisters.
I've heard I just haven't felt very well for the last couple of days.
Certainly no reason why these people couldn't get a ride or take a taxi or an Uber.
But instead, they opt to call an ambulance, and that's going to cost the American taxpayer hundreds of more dollars, if not thousands of more dollars, for that ride.
When we actually have rides available, state Medicaid usually provide for rides for people who can't get them.
They have to wait a long time for those rides quite often, meaning hours, not days.
But they're available.
But I think that for a lot of people, they would rather charge the American taxpayer than deal with a little bit of inconvenience.
But isn't it the case that on the receiving end, I don't know, do you call 911, do you call hospital?
On the receiving end, don't they say, what is the nature of your emergency?
And if it's like, I haven't felt well for the past couple of days, it'd be like, I'm sorry, that's not really an ambulance situation.
Isn't that their goal or training?
You know, you would think so, but state law prohibits that.
We can't turn away anybody, nor can the paramedics.
If they call you, they can advise you and they can say, well, you know, you could just take a taxi in or get a ride, but if the person says, no, I want to go by ambulance, they have no choice.
And when a person walks into the emergency room, even if, you know, I'd be one of the people that checks them in, they're going to tell me what's going on with them.
That's what I do. I check patients in.
I deal with their insurance. I get them to sign documents for consent, things like that.
And so I know exactly what their symptoms are when they come in.
And when they say, I just started vomiting an hour ago, and they're there in the emergency room, you can't say, well, you know, you can just go home and relax for a day or two and you should be fine.
We have to take them in.
And, of course, vomiting, you know, that's something we all do.
Typically, that's not something you're going to call an ambulance for, but we have people calling ambulances for it all the time.
Well, and I suppose there is this aspect that's in healthcare, and particularly in the U.S. healthcare system, which is air on the side of caution.
You know, you send some guy home because he's got fairly mild symptoms, and it turns out he's the one in a thousand or one in a million, where it's something more serious than, I guess, there's liability and all that other kind of stuff.
You're absolutely right, and that's certainly a concern, and I'm sure that our healthcare professionals think about that, but I don't really think that it's their choice.
Even if they think that somebody is there for nonsensical reasons, they can't really say anything.
Plus, we're looking at, we're in an emergency room, and of course, what's the definition of an emergency?
I guess that might be different to different people, but we have, just in the area surrounding our hospital, I think we have six urgent cares.
And what we'll also see a lot of is a patient will have the same symptoms for days, maybe weeks, and for some reason they decide at 9 o'clock or 10 o'clock or 1 in the morning that that's the time that they need to go see a doctor, even though they've had these symptoms for a week.
Instead of going to urgent care where the bill to the American taxpayer, assuming that the person is on Medicaid, will be substantially less, They opt to go into the emergency room where you're looking at a minimum, even if it's just a sore throat, you're looking at a minimum of $1,000 to the American taxpayer.
Whereas if they went to an urgent care, you'd be looking at about $300.
And at an urgent care, if they're not able to handle the situation, they'll send them right to the emergency room.
We get referrals every day, of course.
So these people are kind of skipping the line, going straight to the emergency room when they're not bleeding, when there's no broken bones.
And a big problem with that that I see isn't just the taxpayer money that's being poured down the drain.
It's that people that are legitimately at the emergency room because they genuinely have an emergency end up waiting because we have a limited number of rooms and a limited number of hallway beds.
And once those rooms get filled up, then anybody else who comes in afterwards has to wait because we can't just kick somebody out even if they're there for a sore throat.
The nurse can't go in and say, sorry sir, you're going to have to go back into the lobby because we have a more severe patient.
Those patients end up waiting in the waiting room in severe pain a lot of times because we just don't have the space to put them anywhere where there's equipment where we can deal with them.
And unless it's something that's literally life-threatening, I mean we would of course have to move somebody if it was life-threatening, but if you're talking about a broken bone Where it's mainly pain that the patient is dealing with.
It's not life-threatening, but it's obviously very serious.
I can remember a young girl under 18, I think, was in our waiting room with a broken collarbone, and she just had to sit there because she got there right after this big rush.
And of course, some of the people in that rush were legitimate patients for an emergency room, but many, many, many.
I'd say, if I had to estimate, I would say, on average, About half of the people that come into the emergency room could have very easily gone to an urgent care or not gone to really seek medical treatment at all, some of the symptoms being very,
very minor. I mean, if you come into an emergency room for a blister on your foot, you know, I've had women take an ambulance to the emergency room to get a pregnancy test.
Nobody would argue that a pregnancy test is an emergency, but they do it.
And I've heard nurses make comments to patients before, such as, you know, you could go to a dollar store and get a pregnancy test for a dollar, and then the patient replies, I'm not paying for that because they're on Medicaid.
They won't even pay a dollar for a pregnancy test.
They would prefer to charge the taxpayer $1,000 for that pregnancy test.
Yeah, and I've got to imagine that...
It creates a fair amount of tension between the patients and the staff, because the waiting and the waiting, especially if you're in pain.
I think the only time I ever got very upset at a hospital staff was when I was undergoing chemo and I had a really Wicked, sore throat.
And I was told, you know, go to see emergency if you have that because you're immunocompromised.
And they said, well, you can't wait with everyone else because you're immunocompromised because of chemo.
So you have to go wait in some other area, right?
Some place that there weren't people.
And then they just forgot about me.
I mean, it was not good.
It's Canada, so it's not always ideal.
And I was sitting there just waiting and waiting, and I was swallowing broken glass.
And yeah, I finally went back, and they're like, oh, yeah.
Well, you know, out of sight, out of mind.
It's like, oh, that's not...
It's not really how healthcare is supposed to work.
But I've got to imagine as people are waiting and waiting, there's a lot of frustration.
People are in pain. It could be very well the worst day of their life they've had so far.
And like a friend of mine, he had his knee crunched in a judo tournament and he had to sit in a hallway for four hours before anyone could see him because it was just clogged.
And, you know, he was saying there were people there who were like, you know, my finger hurts stuff.
Yes. I mean, I've literally had people come in by ambulance just saying that they haven't felt very good in the last couple of days.
I can usually tell just when they walk through the door by their demeanor whether or not they should be there.
Now, I'm not going to judge that.
I can't make a decision, so it really doesn't matter what I think.
But when they come in with a smile on their face and they've got a pep in their step and they come straight to the front and they're They're not showing any signs of anything.
And they'll tell you something like, I've got a headache.
I've got a migraine. And I've had friends that have had migraine issues with their lives.
And I had friends that had migraines before there were treatments available for migraine.
And they just had to lock themselves in their room, turn the lights off, and deal with it for a day or so.
I've never known anybody who's suffered from a migraine who has any remote pep in their step or any kind of smile.
Right. Lock yourself in a dark room, and maybe if you throw up, you'll feel better.
Right, exactly. It took me a little while to understand.
My friend, he's a very smart guy.
You tend to think that things, especially when you're young, in my 20s when I had that friend, it's hard for me to understand.
Well, I don't see any symptoms, but you've got to take their word for it.
But when you see them and you see the look on their face and you see the sweat on their brow and you can tell that there's something going on.
But when somebody comes in smiling, you've kind of figured that they probably just don't want to go to work the next morning.
You know, something like that.
So the law, as far as I understand it, is no matter what, you can't turn anyone away.
Right. And isn't that one of the reasons why, let's say that you're an illegal alien in the United States, well, going to a doctor is kind of complicated because you've got to show a bunch of paperwork.
But if you go to ER, they can't ask for paperwork.
They have to provide health services to the best of their ability.
I mean, it's kind of a setup in a way.
And I think this is one of the drivers behind Obamacare, which was just trying to find some way to extend health insurance to people otherwise not covered.
Partly to facilitate immigration.
But you can't turn anyone away, right?
Right. We can't turn anybody away, even if it's something that clearly doesn't belong in an emergency room.
And yes, people know this.
And speaking of the illegal immigrants that come in, most of them actually don't have to deal with that because they've already been given coverage by the state.
They won't speak a word of English.
They'll come in, they'll have, say, a passport from El Salvador or Guatemala, and they have a state Medicaid card.
And that state Medicaid card is going to get them any medical treatment they want, for the most part.
I mean, there does have to be approvals.
If, say, you wanted to go in for some sort of surgery, doctors are going to have to approve that, and then the Medicaid system is going to have to approve that as well.
But if you're talking about coming into an emergency room, there's no approval necessary.
With or without coverage.
In fact, when people don't have coverage, well, even when they do, we are required to tell each and every patient that comes in that we have financial assistance available, and if we don't tell them that, that's something we can get in trouble for, and the hospital can get in trouble for.
Go ahead. So these illegal immigrants, they do the same thing that a lot of our American Medicaid patients do, and they They opt for the emergency room on a whim and they just bypass the urgent cares or we're making an appointment with a regular doctor because when they get Medicaid they also get assigned a primary care physician or nurse or physician's assistant and they usually don't bother with that.
They just head straight to the emergency room and then when we get these patients in that don't speak English then we have the added cost of Of hiring a medical translator.
You can't have just the translator.
You have to have somebody who's a medical terminologist and speaks both English and the language of the patient.
And so that, of course, is going to be a cost because we have to pay that translator.
We have an iPad on a wheeling stand that we can move around the emergency room.
But it takes so long.
Everything that I do with the patient has to be translated.
All the forms that we tell them about have to be translated.
The questions from the nurse have to be translated to the patient.
Then the patient's answer has to be translated back to the nurse.
And while we're doing all this, there's English-speaking American patients who are waiting behind them.
And it can take, I would say, probably take three or four times as long to deal with a non-English-speaking patient as it does to deal with an English-speaking patient for obvious reasons.
And we're not just talking English and Spanish, of course.
What is the variety of languages that you've had to try and deal with as a hospital worker?
It's almost exclusively Spanish.
We do get, I would say, Ukrainian and Russian folks in there.
Generally, though, they speak English, you just know that they're from these places because of their accents.
But another thing I see too is Is Medicare.
We see a lot of...
I see people that are clearly not from this country don't seem to have been here very long.
I could be wrong in some cases, and I would never say anything to anybody about it, but it appears that they haven't been here for very long considering their lack of English skills, and yet they have Medicare.
And sometimes that's even from disability as opposed to age.
And so I just see...
These millions of dollars getting pumped out from the taxpayer to these people that either don't belong in the United States, don't contribute to our system, or they haven't contributed very much and they're net takers, which I've heard you use that term, I think, on your show before.
And it's got to add up.
You know, eventually, as you've said and probably Anne Ryan has said, Eventually you run out of other people's money.
Oh yeah, that was Margaret Thatcher. So how, because there's so many people...
Outside the U.S. and even some people in the U.S. who don't really follow this whole process because there's this myth that if you enter into the United States illegally, you're living in the shadows, you're living in old abandoned cars, you're skulking through the subways, you barely can go and buy groceries and so on.
And I don't think people really understand just how many government resources are available for people in the country illegally.
Oh, so many.
And, you know, medical is just the perfect...
The perfect display of that.
They don't seem guilty at all when they come in.
I can't get upset with them.
They're human beings. If anybody thinks that I'm this horrible, awful person, why would I have gone into the medical field in the first place if I didn't like people?
I really do like people, and I have a great deal of empathy for these people when I see them face to face.
It's hard not to be nice to them.
They're typically pretty nice to me.
As hard as it may be to communicate with them, but they're all smiles and happy and I'm sure they're thrilled to be able to come in and take advantage of this wonderful medical care that they get, to be treated so well, to be able to come in and be seen so quickly if they're lucky enough to come in at the beginning of a rush and be one of the people that are creating that rush.
But, you know, they haven't contributed and it makes me particularly upset because My job is fairly low level, and that's nobody's fault but my own, but I make a little over $16 an hour.
I work as a per diem employee, so I'm not full-time.
I generally get a few, maybe two or three 10-hour days scheduled, and then I fill in when people call in sick or they decide they need more people on the schedule.
Then I also DJ. I've been a professional DJ for almost 15 years.
I actually make more money doing that most of the time.
If I were just to go buy my wages, my salary, my income, I should say, at the hospital, I would not qualify for Medicaid.
I only make about $150 to $200 a month too much to qualify for Medicaid.
Yet, if I wanted to get on the bronze plan of Obamacare, it would cost me over $600 a month, and my deductible would be over $10,000.
Prior to Obamacare, I could get coverage for less than $200 a month, and I would have a $20 deductible when I went into an urgent care.
These two things are related, of course, right?
So as I was pointing out, the Obamacare mandate was a way of extending healthcare benefits to people in the country illegally.
It was one portion of it, for sure.
And the idea that you could extend a bunch of fairly expensive healthcare, largely, I think, because it's significantly government-controlled and cartelled, but the idea that you could extend...
Health care to millions of more people who aren't paying a lot into the system without stiffing other people with the bill.
Well, I mean, it takes an extraordinarily economically illiterate population, and I think that's largely by design, to believe the idea that you're going to save, what was it, 25% or 30% on your premiums.
You just can't extend services to people who aren't paying very much for them without stiffing everyone who is with more of the bill.
Well, that's true. And with Medicaid, they don't pay a dime.
There's no... There's nothing to encourage people to be sensible about their healthcare, because they can just walk in and they're 100% covered, whereas somebody who's paying for their own insurance monthly, and probably these days quite a bit,
and it varies of course, and I get to see all this on people's insurance, but almost always they're going to have a co-pay, if not a co-insurance where they're going to get a bill later on.
Yet, if you're on Medicaid, there's not even a penny that you pay.
You will never have any cost whatsoever, so there's no deterrent to abuse the system because you can go in anytime you want, get that healthcare, not pay a dime, and nothing to deter you from using the absolute most expensive options available, just for your convenience.
And I've talked about other people that I work with.
Not everybody that I work with has the same attitude.
Some people are liberals that I work with.
And in fact, I expect to get a talking to when I go in to work Monday.
One of my co-workers was approached by a patient, actually the patient's boyfriend.
The patient had come in for a rash to the emergency room at 10 at night.
And a perfect example of why when you have this rash for the last two days, didn't you go to an urgent care yesterday or earlier today instead of the emergency room at 10 at night?
But she did. Everybody gets triaged when they come in and they get assigned a number that tells everybody else what their acuity is, how severe they are.
So if your acuity is low, even if you have a room already, you're probably going to wait behind people who are more severe.
So they had waited about an hour in the room and the boyfriend came out, approached my co-worker and said, you know, what's going on?
We spent an hour and we haven't seen anybody.
So my coworker said, you haven't even seen a nurse?
And she said, well, no, I've seen a nurse.
So she said, well, they should be in soon.
And then she walked over to where I was to basically complain and said, oh, my God, she says that she hadn't or he said that she hadn't seen anybody yet.
But in fact, they lied and they had seen somebody.
And we walked into a back room where nobody could hear us at that point.
And I said, well, you know, You should be used to this by now.
It's a Medicaid patient.
And she said, well, that doesn't matter.
You know, I said, well, I said, well, she said, well, maybe maybe she had to work today and it was and she couldn't go to work.
So she came to because I said something about her being here so late at night.
And so, well, maybe she had to work today.
And I'd already seen the person's chart, so I could see that it said unemployed, which is the vast majority of the people on Medicaid, it says unemployed.
And so she's like, well, that's messed up.
She used the F word for that.
That's messed up. I'm on Medicaid and I work.
I think, well, that's not the point.
She's not working. She could have gone into the urgent care today or yesterday and for $300 gotten seen.
And if the doctor there decided that they weren't equipped to deal with Whatever they suspected that her ailment was, they would have sent her to the emergency room.
But that should be the doctor's choice, not the patient's choice, unless it's an obvious emergency.
Right. Have you seen any correlation in sort of a big picture, or do you think that there is any correlation between the people who pay the least for their health care and their overall self-care regarding health?
Absolutely. Absolutely.
There's no doubt about it.
They're involved in the payment, paying for the service, even if it's just a little bit, then they have to think about it.
They have to think, do I want to spend that money at the emergency room, or do I want to spend less money at an urgent care?
And it's been discussed, I believe, here in my state about doing this, but their attitude is, we don't want to discourage anybody for any reason for ever going in to see a doctor.
But here I am, and I'll be honest with you, I'm in need of some healthcare.
I'm not a Medicaid kind of a person.
I don't want to be on Medicaid, but I feel like I could afford my own health insurance like I used to had Obama not come in and wrecked up the system, basically, and made everything so much more expensive.
It's not worth it for me.
I don't have $10,000 to put on top of $600 or $700 a month to pay for health insurance that I'm not going to be able to use unless I'm catastrophically ill.
And, you know, I'm getting to that age where I could be.
I'm almost your age, Stephen.
I just turned 49 years old.
And I did at one point, while I was in between jobs, I had Medicaid for a very brief time.
And during that time, I got pneumonia.
So it was helpful. But, you know, I went to an urgent care.
I didn't I didn't decide at 2 in the morning that I wanted to go to an emergency room because I had the symptoms for weeks.
I actually put it off.
I actually had to get the Medicaid to be treated.
I put it off for quite a while hoping that I would recover on my own, but my body wasn't able to do that so I ended up going into the urgent care and got an x-ray and was diagnosed with pneumonia and they gave me some antibiotics and those antibiotics actually worked at first.
And then I had a reoccurrence within two weeks.
And so they gave me some stronger antibiotics the next time I went back.
And then I was cured and feeling a lot better.
So it's not that I don't want people to ever have Medicaid.
I think it should be available for people when they're in between jobs.
But we have too many people, I think, that basically just live off of the state.
And they don't care.
Their attitudes...
In fact, I had a friend I used to work with at a previous job, a non-medical job, and she came into the hospital.
She'd been in there the day before for the same thing.
She came by ambulance twice for something that was not an emergency.
And the first time, I guess, we had fed her.
They had a nice hamburger from our grill that they had brought up for her.
And before she left that day, she came to me.
Of course, we had a friendly chat.
And then she said, you know, I got a really good hamburger yesterday.
Where's my free hamburger?
And I could shake my head and walk away.
It's like, you already got thousands of dollars worth of medical care for free, and now you want a hamburger.
Well, it's funny. Up here in Canada, I think, if I remember rightly, there was some sort of political movement to charge $5 for a doctor's visit.
Five dollars. Now that's five Canadian dollars.
It's like four bucks US or something like that, right?
And people just went insane.
What? Five dollars to go and see a doctor?
What are you crazy? It's like, that's half the price of a movie.
Less than half the price of a movie these days.
And most people seem to be able to afford a movie.
Five dollars. And people were just like, I have a right to infinite supplies of free stuff.
And of course, if everyone thinks...
That there's this massive universe of free stuff out there in the world, then of course you'd want...
It's like saying, well, you know, you can't have any oxygen today.
It's like, well, it's pretty ubiquitous and it's kind of free, so why won't you let me have any?
You're just mean. You're depriving me of oxygen.
But healthcare is not like oxygen.
Healthcare is in limited supply.
And it's important to keep the spirit or the enthusiasm, the morale of healthcare workers up.
And I'm not sure the system does a particularly great job of that.
I mean, I know there's a lot of doctors who want to quit.
I mean, you certainly seem somewhat dissatisfied with the profession from time to time.
I think you like helping people, but the system as a whole can really kind of grind people down after a while.
It can. You're so right.
That's a great point. When you're at an emergency room, you kind of signed up for it because you wanted to help people in emergency situations.
You didn't sign up for blisters.
That was somebody calling in to talk about their experiences in the ER, and I think it is a conversation, not just in America, but where there's fully socialized.
America's like 50% socialized, but where there's fully socialized healthcare, people are going to need to start having these discussions, and if everybody's taking More out of the system that they're putting in, the system can't last.
And the idea that we're going to give everyone free healthcare, and it's just going to continue going on forever, is creating a very cruel situation where people are not making the best choices about their healthcare because they are getting free stuff.
And then what happens is...
The free stuff runs out and people are in a very, very bad situation.
It's much, much worse to do this kind of system than to have the occasional person who's going to slip through the cracks, which is unpleasant and unfortunate, but it's better than everyone falling off a cliff.
So this is Stefan Molyneux for Free Domain Radio.
Thank you so much. Please help out the show at freedomainradio.com slash donate.
