Why American Civilization Will Fail: Arizona Medicare Woman Spends $2700 of Taxpayer Money To Get Laxative

We will never balance the budget, and I can prove it with one story.

Ronnie, we'll call her, is a 75-year-old woman in fair health who last week had outpatient surgery to fix an umbilical hernia.  The wall of her tummy thinned and in 45 minutes the surgeon fixed it, spatted her on the butt, figuratively, and sent her home.  Pretty routine.

Or was it?  It took Ronnie an extra three hours to get out of post-operative care because her oxygen level kept dropping, and the anesthesiologist was heard wishing she had "oxygen available at home."  She has never needed it at home.  Did it drop because she was just sleepy from the drugs, or because she wasn't handling the whole thing as well as they hoped?
Here's a hint.  Ronnie threw up twice on the 20-minute drive home.  Just liquid and she felt better quickly.  But a sign of vulnerability.  How do we care for medical vulnerability and not break the bank?  The Tea Party would just chop off care.  It may come to that.

They told Ronnie a nurse would come by to tend to her dressing a couple of days after surgery, but no one came.  She was in good spirits and seemed to be in good shape, but wouldn't take off her own bandage or take a shower with it on.  A friend helped with the bandage and the stitching looked fine and Ronnie got clean.
Ronnie's about 75 pounds overweight, and hadn't moved her bowels in four days after surgery, in spite of taking a laxative and eating prunes.  Like a huge percentage of women, and men, too, over 50, she is constitutionally allergic to all but the most minor of exercise, one of the main reasons she has some problem with constipation in the first place.  And doesn't sleep well.  Now she's got surgery interfering with her bowels, too.  She called the surgeon's office to ask where the home nurse visit was and what to do about pooping, but says she didn't get help.  Claims she called multiple times.  Even talked to a nurse once.  No help.
Suddenly, feeling left alone without help, the next day she up and called 911 and went to the emergency room to get a stronger laxative, and have somebody medical look at her incision.  I'm assuming Medicare will be billed maybe $3000 for this episode and it will have to pay some fraction of that to the ambulance company, and the ER.  Half?

That's the story that spells the doom of our system.  Where was the home visit nurse?  Where was the surgeon's office when Ronnie called complaining the laxative wasn't working?  Where was Ronnie's ability to ride it out a bit and let things move along and be okay?  She has some tendency to jerk and jump at minor problems.  Then she'll calm back down, then she will get worried again.  She herself used the phrase, "I refuse to live a fear-based life," but the only thing that sent her to the ambulance was fear.  And/or feeling left alone a little too long.  When she jerked the 911 button, nobody came on the line to do a 30-second "medical necessity review" of Ronnie's proposed use of the emergency system for an obvious nonemergency.  A patient representative might have done the trick.  She needed a home visit nurse and a strong laxative and incurred the system (she's on Medicaid as well as Medicare) an extra fee of some thousands to get them.

This one case shows why conservatives don't believe in socialism, or if it doesn't, it could.  Yet Ronnie needed help.  She needed to call her surgeon once an hour until she got it.  She called twice and gave up.  Maybe we need an on-call nurse practitioner or physician's assistant who can do spot home visits to spare the ambulance and the ER.  Ronnie spent 7 hours in the ER, a dead giveaway she didn't really need emergency care.  Maybe her Medicare plan, which will pick up the tab,