Frequent Fliers of the Washington Heights

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The United States spends 16 percent of GDP on health care—the OECD average is 8.9—and there is a broad consensus amongst Democrats and Republicans that the current system needs to be drastically overhauled and coverage expanded. The New York Post talks to amateur health care policy expert Ricky Alardo, who enages in weekly inspections of Manhattan hospitals, on why health care costs are so high. His answer? Popov.

Ricky Alardo, a homeless alcoholic nicknamed Ricky Ricardo, swigs cheap vodka by day at his favorite corner in Washington Heights, then calls an ambulance to chauffeur him to the hospital for a free meal and a warm place to sleep, courtesy of taxpayers who fund his Medicaid benefits.

For a chronic caller like Alardo—who phones 911 four or five times a week—the annual medical bill can be as high as $300,000. Over 13 years, the length of time he has been abusing the emergency room, he has cost the medical system an estimated $3.9 million.

In Midtown, another bum, Robert, has faked emergencies to get food and shelter in ERs about 40 or 50 times in the past three years—and taxpayers pick up his tab, too. Ricky and Robert are among the dozens of "frequent fliers" who clog the 911 system, tie up city ambulances, crowd emergency rooms and burn through Medicaid money. An ambulance ride alone can run as much as $800, and an ER visit can cost, conservatively, $400 a pop, according to estimates from medical experts…

"They take space. They take nursing resources. They're a drain on the staff's energy level and emotions," said Dr. Jeffrey Brenner, of Camden, NJ, who has studied the issue. "They're costing the system in both direct and hidden ways." Brenner's research found Medicaid paid $46 million for the top 1 percent of Camden's frequent fliers, or 1,035 patients, during a five-year period.

A pilot program at Bellevue Hospital has cut ER visits by 67 percent among "high-cost" Medicaid patients by finding them their own doctors, housing and even cellphones to keep in touch with their doctors, according to a recent report by the United Hospital Fund.

It is only a matter of time, I suppose, before governments target the makers of fine products like Bankers Club and Kentucky Gentleman to "recover health care costs" associated with Ricky Alardo's illness. Also, for Europeans planning a visit to Manhattan, you might want to consider doing an end run around those expensive, rundown midtown hotels by getting loaded and decamping to this full service establishment in the West Village.

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  1. If you drink popov you deserve what ever happens to you, but really, dude couldn’t afford McCormicks?

  2. The free rider problem is contributing to the tragedy of the commons!

  3. Dude, bum is not the preferred nomenclature. Hobo, please.

  4. An ambulance ride alone can run as much as $800,

    That would only be a one-time cost if the EMTs “accidently” forgot to secure the gurney, and “accidently” forgot to shut the back door of the ambulance, and of course, “accidently” took the sharp on ramp turn at about 70 mph.

  5. I can absolutely, positively confirm that frequent fliers like this are a massive burden on the healthcare system. The know the welfare system, and they play it like a fucking Stradivarius.

    The Bellevue program sounds interesting, but I wonder how long it will sustain those kinds of numbers, and what the net savings is after you load in all the “new” welfare costs for housing, etc.

    Plus, in many communities, you will have a hell of a time finding doctors to take any Medicaid patient, much less a problem patient like this crew, who are famously hard to deal with and wasteful of the clinic’s time and resources.

  6. I too can confirm this to be a major problem in American Healthcare. Emergency rooms are extended social service agencies.

    Also, while I can’t speak for every community, I can tell you that there is pretty much no such thing as a ‘drunk tank’. Any talk of a ‘drunk tank’ is a manifestation of hollywood– a throwback to a simpler time, small towns, cops who ‘know everyone’. If the cops find a drunk man, unconscious on the street, he’s taken to the E.R., period.

  7. To quote the Godess Nancy: “just say no!”

  8. Seattle put their chronically homeless inebriates (hereinafter, “hobos”) in “permanent supportive housing” and saved a bunch of money, at least so it appears from the recent JAMA article about their experience (link to Reuters article, not the original study – I have a draft copy of that if anyone cares to see that I’ll upload to drop.io).

    It may be cheaper to let them drink themselves to death on the streets, but most people have ethical qualms about that approach. Aesthetically, they’re a disaster. Not enough cops to watch them all the time.

    And then you have San Francisco, where they spend $186 million annually and have built north of 4,500 housing units for close to 4,500 hobos, and by day they are still out on the streets panhandling and making a nuisance of themselves.

    Is this problem absolutely intractable or can significant progress be made? I suspect housing and zoning restrictions are one of the first places to look, but even then, mentally ill drunks used to be institutionalized. Is that the only answer?

  9. Whats wrong with a Boy Who Cried Wolf Law. After the second non-emergency call, no one will ever respond again.

  10. I disagree. A hobo is usually an itinerant worker, traveling from place to place in search of employment. This guy is a bum.

  11. WHY DO LIBERTARIANS HATE THE HOMELESS BLARG

  12. “Dude, bum is not the preferred nomenclature. Hobo, please.”

    Hobo is derived from the term “Hoe Boy” used in reference to the groups of migrant workers carrying hoes and searching for work after returning from war.

    Bums are must definitely not hobos.

  13. mentally ill drunks used to be institutionalized. Is that the only answer?

    The same persuasion that demanded that we open the doors of the institutions are now reversing themselves and saying, “Well, maybe”. Apparently, the bad old days weren’t as bad as we thought and some are talking about finding a way to institutionalize people against their will again. But with better controls… or something.

  14. Now would be a good time to remember that the Patients’ Choice Act reforms Medicaid and turns it into a “debit card” style program which lets you shop around for medical care and actually get to see the cost. And if you spend over a certain amount I think you have to start paying out of pocket. So it should help with the “frequent flier” problem, in addition to all the other good things the bill does. Call your Congressman!

    Amazing that it saves money to give a homeless man a free cell phone to call the doctor. Wow.

  15. It’s interesting you mentioned Kentucky Gentleman and Banker’s Club, but why didn’t anyone think of Gordon’s and Congress? If we’re thinking of cheap liquor, let’s get it right, ya know?

  16. Your source of all things BumWine:

    http://www.bumwine.com/

  17. I may have to buy the “Trodden no more” shirt.

    http://www.bumwine.com/bumwine/shirt/gadsden.html

  18. I think the politically correct term is “urban outdoorsman”… 🙂

  19. Seattle put their chronically homeless inebriates (hereinafter, “hobos”)

    Dammit, I had “bums” in there and switched to “hobos.” I thought John-David was a legit referee. It’s like the time a kid in tee ball told me I had been called out at second base, so I stepped off the bag to walk back to the dugout, and then the fucker tagged me out.

  20. An ambulance ride alone can run as much as $800, and an ER visit can cost, conservatively, $400 a pop,

    How is it that a ride to the hospital costs more than the the ER visit?

  21. I used to work in a hospital scheduling visiting nurses. It seemed like SOP to automatically write orders for homecare visits when they discharged the homeless. Which was sort of a dumb idea, since they don’t have, like, a home for the nurse to visit, plus they rarely met the criteria for being technically “homebound.”

    So we’d spend inordinate amounts of time doing our due diligence/documenting how we’d tried to contact these fine folks, who coulda been getting (cheaper, natch) outpatient care if they wanted/needed.

    Then, when these same guys visited the ER again in a month or so, the whole process started again.

  22. Dude, bum is not the preferred nomenclature. Hobo, please.

    Being called a bum is better than being called a sucker which we are and Alardo has every right to snicker at us for picking up the tab.

    Looks like we are going to be doing a lot more of that in the future, my fellow Juicy Pops.

  23. “I would hope that a drunken Latino man with the richness of his experiences would more often than not reach a better conclusion than a sober white male who hasn’t lived that life.”

  24. So it should help with the “frequent flier” problem, in addition to all the other good things the bill does.

    It won’t do a damn thing about frequent fliers. They have no assets, so they don’t care about whether their care is covered.

    The hospitals are required by a federal law to take them in, give them medical exams, provide any emergency care they need, and not discharge them until they are stabilized, regardless of ability to pay.

  25. Give them a large dose of morphine upon arrival. Go to sleep in the ER, wake up in Tijuana. I’m guessing most of them don’t have documents to get back across the border.

    Yeah, this is heartless, inhumane, and cheap cost-effective. Look for it to be a part of our new national healthcare plan.

  26. This is nothing. You should see the unpaid hospital bills for psych patients who don’t want to be in the hospital. The patients want to leave, but the doctors won’t let them. The doctors keep them locked up at a cost of $2,000 to $3,000 per night. A hotel in Manhattan costs less than a tenth of that.

  27. At some point, for society to function properly, we have to look around at the worthless fucks and just let em die.

  28. Anyone who offs Ricky Retardo should be regarded as an American hero.

  29. I guess “hobo” was a weak choice for my lame Big Lebowski riff.

  30. BunkerBill

    Your link goes to a story about a fairly routine case of medical error which happens regardless of who is paying the bills.

    There are plenty of legitimate socialized medicine but stories like this aren’t among them, any more than isolated anecdotes about some limey loser pulling his own teeth.

    As another H&R guy might say, you cannot prove that this baby’s death had anything to do with socialized medicine.

    And the limey guy could have gone to a private dentist and paid to have his teeth pulled.

  31. There are plenty of legitimate [criticisms of] socialized medicine

  32. The existence of Kentucky Gentleman embarrasses me as a Kentuckian.

  33. OK, Abner, if the opponents of socialized medicine can’t use anecdotes, then its supporters can’t either.

    Fair?

  34. R C Dean,

    Anecdotes often work fine. The problem is that the link BunkerBill furnished tells us nothing about socialized medicine per se. It was about a simple straightforward medical error which as I said happen everywhere regardless of who is paying the bills. There’s some shyster advertising on the radio here almost everyday telling us how many people die every year here in the good old USA. I’m sure he’s lying but it’s still a big number I’ll warrant.

    And a H&R poster furnished a parallel to the story of the limey guy with the toothaches in a story of a little kid who died in Maryland because the families Medicaid had been cut off and an abscessed tooth wasn’t extracted in time.

    In both cases the victims had access to private dentistry and could have had all the worked they’d wanted done for a fee. In the Maryland case the fee was $80. Such is the culture of dependence in some parts of society that family and friends can’t even be bothered to raise eighty dollars to save the life of a child. But somehow it your fault and mine, not theirs.

    But still the story offers us nothing either way to argue for or against socialized medicine. And neither does the one about the limey. And what ever Reason writer used it the other day needs to stop using it.

    But yes, youre quite right every time a National/Universal (whatever, where someone else is expected to pay your medical bills) Health plan advocate uses an anecdote that doesn’t work (and most of theirs don’t) they should be called on it.

    Example, in Sicko Michael Moore told the sad tale of some poor guy who cut two fingertips off with a power saw and had no insurance. He raised the $12K needed to sew one back on but couldn’t raise the $65K need for the other> This was offered as proof of the need for a national healthplan but I’d be willing to bet there’s no place in the world with socialized medicine that wouldn’t have said “well, we can do that one but not the other.” That’s speculation on my part but I’d be shocked if it wasn’t true. I don’t try to prove anything by way of the story and neither should Moore.

    I really spent way more time on that than it was worth.

    But this is a serious topic and it deserves a lot better reasoned arguments than grrr..stupid eurotrash…socialized medicine…grr…stupid canadians…grr

  35. “There’s some shyster advertising on the radio here almost everyday telling us how many people die every year here in the good old USA [due to medical accidents].

    Stupid unfinished sentences.

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