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Obviously this is anecdotal, but the vast majority of the patients that I take care of in the outpatient setting are on Medicaid, like 99%.
Yes of course they come in for "unnecessary visits" (not sure exactly what that means), but so do people who have copays that are $25. But in general the patients that I take care of on Medicaid are certainly in general wonderful people who are grateful and not demanding a MRI and the most expensive med they saw in a tv ad. When I explain that xyz isn't indicated if they do ask for a MRI after 1 day of back pain then the vast majority of patients understand and follow my recommendations.
Of course there are patients who are "super-utlizers" but that is not the vast majority of the population. And the patients that I see that are in those situations usually have a variety of socioeconomic complications...homelessness, substance use, domestic violence, etc that complicate the picture, therefore more supports in general would likely improve society overall for people in those situations.
So no, I don't think making healthcare affordable to ALL is a doom and gloom situation in regards to patients wanting everything, right here and right now. People in general don't enjoy sitting in the ED for 8 hours.
Your faith in humanity is more than mine.
There are tons of studies to show, without a doubt, that copays and deductibles (even small ones) reduce healthcare utilization in proportion to what the patient is paying. Just like any other good, the higher the direct price, the lower the demand.
If we have zero price- demand is going to be sky-high. Now it’s true that raising the price reduces BOTH appropriate and inappropriate care indiscriminately which is not an ideal outcome. It’s a blunt tool.
Therefore, the only way to regulate infinite demand (in a zero direct price scenario) is to harshly ration and triage care through a set of rules that cannot be second-guessed and cannot be influenced by either defensive medicine or consummerism , which is how most other nations with “universal healthcare” do it. If we decide to do this then the American people deserve to know EXACTLY how it will be done before voting for it.