Free Healthcare

[Elizabeth502]

Why should I not bring them up? If we are talking health care costs and solutions, they lie smack, dab in the center of the problem.

But you speak throughout CAF discussions on this issue, as if they are the central or only problem. They are not. Hospitals have become bankrupt and closed because of non-chronoically ill patients using the ER for acute or even ordinary care, and, en masse, not paying bills for which they never carried insurance.

There are multiple central issues in healthcare costs in this country, all of which together result in enormous patient cost, because that’s the way insurance works.

~physician malpractice insurance
~fraud – in billing, in pharmaceuticals, and more
~shrinking sizes of insurance pools, due to patients opting out of coverage, increasingly.
~lack of availability of really efficient routine care, which is what most people need and seek.
~lack of availability of stand-alone hospital/catastrophic insurance, which would be affordable if virtually universal
~less accessibility to preventive services for those with chronic conditions, due to shrinking percentages of Primary Care physicians (and their need to pay off medical debt, pay high overhead costs of individual offices, etc.)

and much more. Those are just some of the main contributing problems.

 

[seekerz]

But you speak throughout CAF discussions on this issue, as if they are the central or only problem. They are not. Hospitals have become bankrupt and closed because of non-chronoically ill patients using the ER for acute or even ordinary care, and, en masse, not paying bills for which they never carried insurance.

There are multiple central issues in healthcare costs in this country, all of which together result in enormous patient cost, because that’s the way insurance works.

~physician malpractice insurance
~fraud – in billing, in pharmaceuticals, and more
~shrinking sizes of insurance pools, due to patients opting out of coverage, increasingly.
~lack of availability of really efficient routine care, which is what most people need and seek.
~lack of availability of stand-alone hospital/catastrophic insurance, which would be affordable if virtually universal
~less accessibility to preventive services for those with chronic conditions, due to shrinking percentages of Primary Care physicians (and their need to pay off medical debt, pay high overhead costs of individual offices, etc.)

and much more. Those are just some of the main contributing problems.

The are by no means the ONLY aspect of the problem, but there is no point in addressing coverage without considering the chronically ill. From the pharmaceutical industry, to the hospital business and private practice, they are what keeps the medicine wheel turning - they are where the costs are concentrated.

 

[TheRealJuliane]

But you speak throughout CAF discussions on this issue, as if they are the central or only problem. They are not. Hospitals have become bankrupt and closed because of non-chronoically ill patients using the ER for acute or even ordinary care, and, en masse, not paying bills for which they never carried insurance.

There are multiple central issues in healthcare costs in this country, all of which together result in enormous patient cost, because that’s the way insurance works.

~physician malpractice insurance
~fraud – in billing, in pharmaceuticals, and more
~shrinking sizes of insurance pools, due to patients opting out of coverage, increasingly.
~lack of availability of really efficient routine care, which is what most people need and seek.
~lack of availability of stand-alone hospital/catastrophic insurance, which would be affordable if virtually universal
~less accessibility to preventive services for those with chronic conditions, due to shrinking percentages of Primary Care physicians (and their need to pay off medical debt, pay high overhead costs of individual offices, etc.)

and much more. Those are just some of the main contributing problems.

Two other huge factors:

Hospitals being forced to care for everyone including those without means to pay. I am not saying it is humane to allow people to suffer; it is not. But ERs are not the place for the uninsured to go when they have a cold, and that is what happens, and the hospitals are not allowed, by federal law, to turn them away. That takes resources from patients who need them.

People here illegally who do not pay into the state and local taxes, but who use the services as if they did. Sales tax does not cover their use of hospitals and other medical facilities.

Demographics are being shown to politicians every day. Mexicans and other illegals have more babies than do Anglo American citizens. More babies = more voters. But to entice those voters, handouts are needed - thus, “free health care.” Politicians are not stupid.

 

[Elizabeth502]

The are by no means the ONLY aspect of the problem, but there is no point in addressing coverage without considering the chronically ill.

True. I’m just pointing out that I, and several others, have not refused to consider the chronically ill, and many of us have addressed this issue in discussions of alternative proposals.

From the pharmaceutical industry, to the hospital business and private practice, they are what keeps the medicine wheel turning - they are where the costs are concentrated.

(1) Pharmaceuticals include a fair amount of fraud & excess, not just legitimate prescriptions & doses.

(2) Private practice M.D.'s are not affordable for an awful lot of people, including those with chronic conditions, because of exorbitant costs. And as for routine (& preventative) care, fifteen years ago when my children (now just barely grown) were little, a single private, non-specialist pediatric visit for well care was like $200. (Not in Beverly Hills.) I shudder to think what it is now. My current private endrocinologist is expensive. Etc.

(3) “The hospital business” is not just about the chronically ill. Why do you keep insisting that it is? The hospital business includes emergencies, as well as irresponsible ER use. It includes an awulf lot of surgeries & treatments for non-chronic acute conditions, especially those which require monitoring or advanced supervision not available in a surgery center. (And there are also not enough of the latter.)

 

[seekerz]

Two other huge factors:

Hospitals being forced to care for everyone including those without means to pay. I am not saying it is humane to allow people to suffer; it is not. But ERs are not the place for the uninsured to go when they have a cold, and that is what happens, and the hospitals are not allowed, by federal law, to turn them away. That takes resources from patients who need them.

People here illegally who do not pay into the state and local taxes, but who use the services as if they did. Sales tax does not cover their use of hospitals and other medical facilities.

Demographics are being shown to politicians every day. Mexicans and other illegals have more babies than do Anglo American citizens. More babies = more voters. But to entice those voters, handouts are needed - thus, “free health care.” Politicians are not stupid.

ER overuse is part of the problem of costs and is also part of the problem of coverage. Under-insured and uninsured people may have no other access to health care; in addition, many people are not well educated as to what is an emergency and what is not.

I’m curious though, as to how you would envisage hospitals turning people away? Who would decide what is simply a cold and what is a cold with an asthma attack or pneumonia? The receptionist? Practically speaking, someone with medical training would have to see them anyway; so I don’t see how allowing hospitals to turn away the uninsured would solve anything.

Contrary to popular belief, those with inadequate or no coverage are not simply (or even mainly) illegal aliens but include very many, hardworking, minimum wage earners - not to mention the long-term unemployed/underemployed.

 

[seekerz]

True. I’m just pointing out that I, and several others, have not refused to consider the chronically ill, and many of us have addressed this issue in discussions of alternative proposals.

(1) Pharmaceuticals include a fair amount of fraud & excess, not just legitimate prescriptions & doses.

(2) Private practice M.D.'s are not affordable for an awful lot of people, including those with chronic conditions, because of exorbitant costs. And as for routine (& preventative) care, fifteen years ago when my children (now just barely grown) were little, a single private, non-specialist pediatric visit for well care was like $200. (Not in Beverly Hills.) I shudder to think what it is now. My current private endrocinologist is expensive. Etc.

(3) “The hospital business” is not just about the chronically ill. Why do you keep insisting that it is? The hospital business includes emergencies, as well as irresponsible ER use. It includes an awulf lot of surgeries & treatments for non-chronic acute conditions, especially those which require monitoring or advanced supervision not available in a surgery center. (And there are also not enough of the latter.)

The point I’m trying to make, but probably failing to enunciate properly, is that chronic conditions underlie the majority of expensive patient interventions in our health system. From the ER to the ICU, what brings people in? It’s strokes, from poorly controlled blood pressure, heart attacks from blood vessel disease, complications from poorly controlled or longstanding diabetes, gallbladder disease from obesity and high choleterol, etc.

Not only that, one type of chronic disease feeds the other and many people - particularly those past middle age - have more than one. So yes, it might be an acute illness that lands someone in the ICU, but other than injuries and infections, the main underlying cause of that acute event, is chronic disease. Which is why the ACA stresses prevention and primary care to the extent that it does.

 

[Jeanne_S]

Or it’s basic economics (I find it a good practice to at least initially, attribute the best - rather than the worst motives - to people).

Part of what drives the increase in health costs are the earnings of providers. By virtue of their specialized knowledge, they can - if they choose - try to match the services they render or recommend, to the income they seek for themselves (Kind of the same way lawyers’ honesty is what determines how many hours they bill us for).

A bigger part of what drives up health care costs is malpractice insurance Also,the over testing,due to the medical community being so afraid of lawsuits,insurance companies demanding a lot of these tests, the use of pharmaceuticals,God forbid,anyone try to actually get to the root of their health th issues by applying naturopathic modalities,nooooo,better to be on drugs,which only masks these s ymptoms,often times creating other issues…what a headache

 

[seekerz]

A bigger part of what drives up health care costs is malpractice insurance Also,the over testing,due to the medical community being so afraid of lawsuits,insurance companies demanding a lot of these tests, the use of pharmaceuticals,God forbid,anyone try to actually get to the root of their health th issues by applying naturopathic modalities,nooooo,better to be on drugs,which only masks these s ymptoms,often times creating other issues…what a headache

The dilemmas and weaknesses of our medical system are many and discussing them could take us the rest of our time on earth, but at some point, action becomes necessary.

I do agree that modern medicine tends to turn too quickly to drugs rather than to commonsense lifestyle measures that cost nothing, however if you are referring to the ‘natural remedy’ industry I trust them even less than the pharmaceutical industry, which at least is required to produce some research on effectiveness, safety and product integrity.

Not sure I agree with you about malpractice being a bigger contributor. I live in a state with malpractice caps and see no evidence of less tests being ordered because of less fear of what a lawsuit can do to practitioners financially.

On principle, I do think that once people have risks explained to them beforehand and freely consent to interventions, they should not be able to sue for anything more than the cost of treating complications - unless there was gross negligence at play.

 

[Jeanne_S]

I would like to see natural medicine accepted by the insurance companies as an adjunct to western style medicine. Western medicine doesn’t really focus on nutrition the way it should insofar as treating disease.For example,my husband(64 yrs old.) always active,non smoker.However since his late thirties has been on cholestrol meds and blood pressure meds. No amount of exercise,or eating well,changed his cholestrol numbers .In March he and I started seeing a natruopathic dr. He put him on an eating plan and a few supplements. His latest readings,totoal cholestrol164,bad totoal 94! His blood pressure is normal and he is titrating off hid BPmeds! Even his internist is thriled

 

[TheRealJuliane]

ER overuse is part of the problem of costs and is also part of the problem of coverage. Under-insured and uninsured people may have no other access to health care; in addition, many people are not well educated as to what is an emergency and what is not.

I’m curious though, as to how you would envisage hospitals turning people away? Who would decide what is simply a cold and what is a cold with an asthma attack or pneumonia? The receptionist? Practically speaking, someone with medical training would have to see them anyway; so I don’t see how allowing hospitals to turn away the uninsured would solve anything.

Contrary to popular belief, those with inadequate or no coverage are not simply (or even mainly) illegal aliens but include very many, hardworking, minimum wage earners - not to mention the long-term unemployed/underemployed.

Oddly enough, before that legislation was enacted, people went to the doctor if they had a cold! Imagine that! Once you make it easy for people to go to the ER (won’t be turned away), guess where they are going to go…

 

[seekerz]

Oddly enough, before that legislation was enacted, people went to the doctor if they had a cold! Imagine that! Once you make it easy for people to go to the ER (won’t be turned away), guess where they are going to go…

Which legislation are you referring to?

People go mainly because they have no access to non-emergent care, or the access they have is too expensive. Have you been to an ER recently? Can’t imagine many ppl putting up with the aggravation without some equally aggravating reason…

 

[Elizabeth502]

Which legislation are you referring to?

People go mainly because they have no access to non-emergent care, or the access they have is too expensive. Have you been to an ER recently? Can’t imagine many ppl putting up with the aggravation without some equally aggravating reason…

Frankly, judging from your composite comments about Emergency Care, it appears that some of us are perhaps more inttimately acquainted with the population base using ER’s as routine care. Yes, ER’s are aggravating. But not nearly as aggravating (to the people irresponsibly using them) as the high cost of premiums. Occasionally putting up with a dysfunctional waiting room & socially dysfunctional patients is minor compared to regularly putting up with the highway robbery & high-ceiling deductibles which pass for “insurance.”

(I’m covered, and I have never – when not covered – used ER’s irresponsibly; I respect doctors & nurses far too much for that. However, I’m an excellent observer of The Pattern, and I’ve overheard plenty, in and out of ER’s, to understand the popularity of such a choice, and the population segments it most appeals to.)

Yes, others go because they truly are indigent and should have qualified for Medicaid, but for some reason do not. (In my region, Medicaid is a racket.) But that population does not nearly represent the majority of ER users in some locations.

 

[Nimzovik]

Oh, we’re back to envy again? Doctors also have a much larger student debt load than the average person as well as malpractice insurance. What would you do, pay doctors the same as janitors? Do you think just anyone should be able to perform surgery? Yes, we reward doctors for their skills. The ones who perform complicated surgery, we pay the most. Family practice doctors don’t earn millions of dollars. And whose business is it if anyone’s house is large, or not? There will always be someone with more money than you, and someone with less money. How about if you pay attention to your own life instead of coveting someone else’s life?

Whoa!.. Slow down. In California the state managed Health Care system in regard to Developmental Centers, the nurses are members of the dubious,IMHO, SEIU union. IMHO these uh…-]politcally blackmailed and coerced/-] negotiated Nurses salaries and benefits have indeed contributed to skyroceting Helath Care costs. And yes- in said systems I do indeed think Doctors are overpaid.

‘Coveting’,‘envying’, is not the issue.

 

[Dawnia]

Emergency rooms can turn away anyone who does not require emergency services. The law spells out some of the conditions not considered emergencies and some have been determined by court cases. They do have to have someone evaluate whether or not it’s an emergency, though.

“Any patient who “comes to the emergency department” requesting “examination or treatment for a medical condition” must be provided with “an appropriate medical screening examination” to determine if he is suffering from an “emergency medical condition”. If he is, then the hospital is obligated to either provide him with treatment until he is stable or to transfer him to another hospital in conformance with the statute’s directives.”

emtala.com/?vm=r

 

[Elizabeth502]

Emergency rooms can turn away anyone who does not require emergency services. The law spells out some of the conditions not considered emergencies and some have been determined by court cases. They do have to have someone evaluate whether or not it’s an emergency, though.

emtala.com/?vm=r

That may be on the books, but it is not followed where I live, nor where many other people live. Conditions, for example, urgent enough not to indicate an advance doctor’s appt, but not “emergency,” are nevertheless treated in ER’s. Perhaps the individual hospital policy overrides the statutes; I don’t know. I’m just telling you how it works, and it works not as people expect. That’s why in several posts elsewhere I have advocated adjoining clinics & hospitals where possible, so that such an option (including sending an uncritically-ill patient home) is realistic.

 

[Seeker1961]

That may be on the books, but it is not followed where I live, nor where many other people live. Conditions, for example, urgent enough not to indicate an advance doctor’s appt, but not “emergency,” are nevertheless treated in ER’s. Perhaps the individual hospital policy overrides the statutes; I don’t know. I’m just telling you how it works, and it works not as people expect. That’s why in several posts elsewhere I have advocated adjoining clinics & hospitals where possible, so that such an option (including sending an uncritically-ill patient home) is realistic.

My aunt was an ER nurse for 35 years, and her hospital did have that rule on the books-but the MD’s and nurses that actually ran that ER knew that the people coming with the child with an earache had nowhere else to go. This was a mostly middle class suburb, and MD visits were upwards of $50 to $100 and there were no low cost clinics. The people that worked at low wage jobs with bad or no insurance coverage weren’t on anybody’s radar until they had to wait at too long of a line at the supermarket. A low cost clinic would have been great-but nobody wanted to pay for it or have it in their neighborhood.

Now-those people will be able to get coverage they can afford to pay for and actually does something and visit MD’s instead of high cost ER’s. Whatever happens with ACA-I hope we keep the part that helps them.

 

[Dawnia]

That may be on the books, but it is not followed where I live, nor where many other people live. Conditions, for example, urgent enough not to indicate an advance doctor’s appt, but not “emergency,” are nevertheless treated in ER’s. Perhaps the individual hospital policy overrides the statutes; I don’t know. I’m just telling you how it works, and it works not as people expect. That’s why in several posts elsewhere I have advocated adjoining clinics & hospitals where possible, so that such an option (including sending an uncritically-ill patient home) is realistic.

Hospital policy can go above and beyond the law. But the point is that hospitals aren’t REQUIRED by law to treat those patients. If they are loosing money due to treating people they aren’t required to treat, it is of their own making. Some are claiming that everyone needs insurance because of all the deadbeats treated in the ER and that is disingenuous. Insurance isn’t likely to stem the use of the ER, because the population that uses the ER for routine care are the ones that don’t have access to insurance anyway.

The idea of a 24 hr clinic to take in the non-emergency cases is a good one. It would serve the uninsured/underinsured population, save money & free up the ER for true emergencies.

 

[seekerz]

Frankly, judging from your composite comments about Emergency Care, it appears that some of us are perhaps more inttimately acquainted with the population base using ER’s as routine care. Yes, ER’s are aggravating. But not nearly as aggravating (to the people irresponsibly using them) as the high cost of premiums. Occasionally putting up with a dysfunctional waiting room & socially dysfunctional patients is minor compared to regularly putting up with the highway robbery & high-ceiling deductibles which pass for “insurance.”

(I’m covered, and I have never – when not covered – used ER’s irresponsibly; I respect doctors & nurses far too much for that. However, I’m an excellent observer of The Pattern, and I’ve overheard plenty, in and out of ER’s, to understand the popularity of such a choice, and the population segments it most appeals to.)

Yes, others go because they truly are indigent and should have qualified for Medicaid, but for some reason do not. (In my region, Medicaid is a racket.) But that population does not nearly represent the majority of ER users in some locations.

I’m not claiming that it’s only the indigent who misuse ERs. The under-insured (meaning minimum wage-earners) do it too - to avoid deductibles. Many people use the ER to get ‘free’ care which contributes to health costs for the rest of us. Maybe it’s just the places I’ve lived - but I’ve most often seen people come in who’ve neglected their health until the problem could no longer be ignored, than I’ve seen people who come in for very minor concerns.

 

[Dawnia]

My aunt was an ER nurse for 35 years, and her hospital did have that rule on the books-but the MD’s and nurses that actually ran that ER knew that the people coming with the child with an earache had nowhere else to go. This was a mostly middle class suburb, and MD visits were upwards of $50 to $100 and there were no low cost clinics. The people that worked at low wage jobs with bad or no insurance coverage weren’t on anybody’s radar until they had to wait at too long of a line at the supermarket. A low cost clinic would have been great-but nobody wanted to pay for it or have it in their neighborhood.

Now-those people will be able to get coverage they can afford to pay for and actually does something and visit MD’s instead of high cost ER’s. Whatever happens with ACA-I hope we keep the part that helps them.

I wouldn’t count on those people being able to afford insurance. The people that can’t afford a $50 - $100 trip to the doc aren’t going to be able to afford $500-$1000 per month for insurance premiums. But they get subsidized… Yes, on their taxes at the end of the year. They still have to come up with the fees upfront to get that subsidy.

 

[seekerz]

Emergency rooms can turn away anyone who does not require emergency services. The law spells out some of the conditions not considered emergencies and some have been determined by court cases. They do have to have someone evaluate whether or not it’s an emergency, though.

emtala.com/?vm=r

That’s right. Someone still has to see them. OTOH, some insurance companies have a line, staffed by (I think) a registered nurse, who can listen to what the problem is and advise the person on whether or not it can wait. IMO, all ERs should have such a phone line - at the front door.