A former chair of orthopedics says that he fell out with Brier because he wanted to give priority in the waiting rooms to patients who paid out of pocket or who had full insurance: "People who pay for health care don't want to sit in a room with fifty people. They want to be seen in a timely manner. I think that's very reasonable."

Speaking as a person with medical insurance: traditional standards of triage will be fine, thank you.

I have my own experience to relate, on the topic of "multiculturalism" in hospitals- but this one has to do with hospital staff, not patients. Before he passed away a couple of years ago, my late father was an emergency patient at Fairfax Inova hospital. Nearly everyone involved with his patient care there was either "nonwhite" and/or a first gen. immigrant- the doctors, nurses, medical techs, patient aides, cleaning staff. Both the care my father received and the helpfulness of the staff toward my family was excellent. With one exception- there was a nurse who was very brusque and impatient with up. She was a home-grown American, and her surname was Ger-well, lets just say she probably partook of my own partial ethnic heritage. (Such matters of identity are typically both elusive and defiant of rational explanation, no?)

But maybe she was just having a bad day...

I realize that in the article, the way that the "multiculturalism" business plays out regarding the patients at Maimonides is entirely different, with aspects that act as obstacles and tend to lead to predicaments. But my experience- and others, in other environments- bears out the notion that most the problems mentioned in the article associated with "multiculturalism" have more to do with factors such as indigence, lack of language and communication skills, and the well-known tendencies of elderly people to be increasingly set in their ways, than with multicultural interaction per se.

One more thing: notwithstanding my sympathetic stance toward many libertarian ideas, including economic proposals- this country needs single payer health care, at a reasonably comprehensive standard. It's practical good sense. The "health insurance companies" are cross-invested all over the place. They'll cope.

Many commenters here have focused on the perceived and actual roles of professional nurses. Well part of the problem is that nurses and nursing issues receive zero reportage throughout all of healthcare coverage. (If you doubt that, check for yourself: on any healthcare story or health website, search for the terms, nurse or nursing.)

I blog about nursing issues (did it full time on the blog, Universal Health) and find myself slipping into old habits on my current blog called Home of the Brave (link at my name). In fact, today I took the Wall Street Journal to task for its creative fiction about nursing during this recession.

Please read and learn about the facts behind the stereotypes and the public image of nurses and nursing. It ain't at all what you think (unless you are a nurse and know first hand).

http://universalhealth.wordpress.com

They are very valuable professionals with four-year degrees who NEED the expertise of highly-skilled doctors and surgeons who go through the grueling work of med school, residency, and specialties, who in turn are valuable professionals who need the skills of nurses to execute large portions of the actual hands-on care.

Part of the problem is this notion that nurses do all the work and get no respect, when in fact nurses and doctors are an effective division of labor, with one half specializing in diagnostics and depth of knowledge in a specific area, and the other half specializing in treatment and carrying out medical instructions. Recognizing the respective strengths on both sides of the fence would go a long way to getting rid of a lot of the acrimony. All we'd have without doctors and surgeons is palliative care, and without nurses we couldn't have a functional medical system.

There's talk here about all the different people who have done their jobs, and I say bless 'em all. Appreciate 'em all. Respect 'em all.

Because they're not always on the same side, but they still hang in there in an impossible situation.

This is also one reason I am very behind Universal Health Care. To be able to make sure our medical professionals have more time to treat, less paperwork to face, more chance to do preventive care, and less dilemmas forced on them by a bad system, the better.

These dedicated men and women are about as close as we get to saints in this world.

I spent my first several years after business school working with teams of nurses in hospitals around the country who, through excellent performance in their clinical roles, had been promoted to management positions. It was my job to help them gain some of the MBA-type skills -- budgeting, process mapping, etc. -- that their new positions required. When I started with a new team, I'd tell them that no one would EVER have expected me, with business training, to come lead a hospital unit and "just figure out" the clinical side -- but they were being asked to do something equally unreasonable in assuming management roles (often for multimillion-dollar annual budgets, and staffs well over 100 FTEs).

I left that work entirely humbled by the magnitude of the problems facing healthcare in the US -- and by the magnitude of the spirits of the nurses for whom I had the honor of working. In several years of working with hospital executives since then, I've been saddened by the mediocrity and lack of vision in so many administrations. If U.S. hospitals are to survive and thrive, it will be due to the great clinicians and gifted leaders so often produced by the nursing profession.

PEOPLE WHO PAY out of their own pockets should actually be given priority for treatment over those who don't, or who have medical insurance.

So since I didn't have ready access to $20,000 for a hospital stay and, imaging studies, lab work, and 24-hour drug dispensing, I should have been left to probably die while the dude with cash moved to the head of the line?

And they should be given a discount for paying in cash.

That is almost always the case. Most medical facilities offer a self-pay discount for that very reason.