As the Left marches towards single payer, how would universal Medicare affect EM compensation?

[EctopicFetus]

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The hospitals get sued all the time. In order to sue the federal govt as noted above they have to give you permission.

For those Americans who support this why wouldnt you create a charity and pay the premiums for some of the uninsured people?

I donate money to causes I think are important (more than enough to cover the premiums for a family of 4, and no im not mormon).

 

[miacomet]

Those caps are usually noneconomic only. And why do you think so few other states have made laws like that?

Suing the VA is super hard, same with IHS as you have to follow the Federal Torts Claims Act which has stricter rules the regular medical malpractice.

As for suing Kaiser... San Fernando Valley woman wins $28 million against Kaiser Permanente – Daily News

Class Action Lawsuit against Kaiser

And those are just the first 2 Google results

Absolutely true it's noneconomic. Who cares if the hospital gets sued? I'm not a hospital

Curious- who do you think should pay for economic damages when patients are injured (either by malpractice or not)?

 

[el_duderino]

The hospitals get sued all the time. In order to sue the federal govt as noted above they have to give you permission.

For those Americans who support this why wouldnt you create a charity and pay the premiums for some of the uninsured people?

I donate money to causes I think are important (more than enough to cover the premiums for a family of 4, and no im not mormon).

I hate the "well if you want social program x, why aren't you personally already doing that for some people by yourself?" argument. First of all, the charitable habits of any given person are none of your business. Beyond that, one of the points of the entire idea is that it will cost the same or less overall. The Koch-funded study said it would save $2 billion over 10 years. There's no reason a universal system would have to cost more to anyone than what we currently have.

 

[doctalaughs]

I hate the "well if you want social program x, why aren't you personally already doing that for some people by yourself?" argument. First of all, the charitable habits of any given person are none of your business. Beyond that, one of the points of the entire idea is that it will cost the same or less overall. The Koch-funded study said it would save $2 billion over 10 years. There's no reason a universal system would have to cost more to anyone than what we currently have.

It could be cheaper or similar costs.... but not without a major shift in CULTURE in the usa. You cant have your 1 million dollar cancer drugs and transplants for questionable benefit, your 60k/ year psoriasis drug, or grandma on thw vent in the ICU for weeks.

This would take major public expectation shifts AND retraining of a generation (or two) of US doctors. Completely ignoring whether is good or bad- Sorry- we don’t have the public will to impose those “death panels” yet.

 

[VA Hopeful Dr]

Absolutely true it's noneconomic. Who cares if the hospital gets sued? I'm not a hospital

Curious- who do you think should pay for economic damages when patients are injured (either by malpractice or not)?

No one?

It depends on if its a known but not really avoidable complication or actually a doctor screw up.

In the former, why should I/my insurance carrier/anyone other than maybe the patient's disability policy if they have one pay?

The latter case is what these lawsuits are designed to pick up, but they do a ****ty job of it.

 

[VA Hopeful Dr]

I hate the "well if you want social program x, why aren't you personally already doing that for some people by yourself?" argument. First of all, the charitable habits of any given person are none of your business. Beyond that, one of the points of the entire idea is that it will cost the same or less overall. The Koch-funded study said it would save $2 billion over 10 years. There's no reason a universal system would have to cost more to anyone than what we currently have.

But see, that's not true according to the study's author...

The Cost of 'Medicare-for-All' - FactCheck.org

 

[el_duderino]

It could be cheaper or similar costs.... but not without a major shift in CULTURE in the usa. You cant have your 1 million dollar cancer drugs and transplants for questionable benefit, your 60k/ year psoriasis drug, or grandma on thw vent in the ICU for weeks.

This would take major public expectation shifts AND retraining of a generation (or two) of US doctors. Completely ignoring whether is good or bad- Sorry- we don’t have the public will to impose those “death panels” yet.

Culture shifts can and do happen quickly. Look at how quickly gay marriage happened.

 

[miacomet]

No one?

It depends on if its a known but not really avoidable complication or actually a doctor screw up.

In the former, why should I/my insurance carrier/anyone other than maybe the patient's disability policy if they have one pay?

The latter case is what these lawsuits are designed to pick up, but they do a ****ty job of it.

Someone pays. If people are severely disabled and need ongoing care, someone will pay. Medicare, Medicaid, SSD, whatever. It's not like patients can pay. Disability doesn't pay for medical care, it pays for living expenses. It's not as though we turn people out on the street. NZ has a no-fault system. Other systems roll it into general societal benefits. But someone, and ultimately the taxpayer, pays. Are you truly suggesting that even if it's a known complication and no one is at fault, we just turn people out on the street? That they don't get care? Sounds like a death panel to me.

I agree the medmal issue is out of control. But I disagree that no one should or will pay. And I see the positives of a monetary-based system. In the UK, where it's hard to win a medmal case, docs are instead convicted, not infrequently, of manslaughter because the families demand something, and since they can't get money, they go for blood. Way worse, and it really ruins lives.

 

[doctalaughs]

Culture shifts can and do happen quickly. Look at how quickly gay marriage happened.

Gay marriage laws happened quickly. The cultural acceptance of gay marriage happened extremely slowly over probably 25-40 years. Obviously its still not totally accepted but the balance finally tipped.

Its a bad comparison because the US population is MORE entitled, respects its doctors LESS and is more litigious. They want everything in healthcare, they want it NOW and they want it “free.” They equate healthcare to drive-thru mcdonalds or amazon review mentality, and that is NOT the cultural shift we need to get to rationed medicare for all.

Seriously- in some other countries medical educaton is completely free, its nearly impossible to sue your doctor and patients literally carry their medical records around and wait in clinic all day to see a doctor (first come first serve; if you dont have your medical record to write in, too bad). And doctors write 1 line in the book instead of a novel about what actually happened and hand it back. Can you imagine the US population doing this? Can you imagine the clipboard nursing administrators and lawyers allowing this?

 

[hoot504]

Culture shifts can and do happen quickly. Look at how quickly gay marriage happened.

That's laughable. Not even remotely comparable.

 

[namethatsmell]

Should we privatize the police, fire department, and military? I'm not a bleeding heart, but I do have a tough time understanding how people can be OK with safety services like these being publicly funded but are against the premise of providing basic health care for everybody.

Roughly 15-20% of every health care dollar goes to admin bloat in our current setup. That's insane. Medicare runs with something like 1-2% overhead as I understand it. I'd be far happier to have my bloated insurance premiums (or their equivalent via a tax increase) go to government coffers than to the insurance CEO's multi-million dollar bonus and his shareholder leeches wallets while they make life more of a PITA for docs and patients.

 

[GeneralVeers]

Should we privatize the police, fire department, and military? I'm not a bleeding heart, but I do have a tough time understanding how people can be OK with safety services like these being publicly funded but are against the premise of providing basic health care for everybody.

That is because the one real purpose of having a government is to protect the rule of law and property rights. The public safety services fall under that. Healthcare is a completely separate entity.

 

[doctalaughs]

Should we privatize the police, fire department, and military? I'm not a bleeding heart, but I do have a tough time understanding how people can be OK with safety services like these being publicly funded but are against the premise of providing basic health care for everybody.

Roughly 15-20% of every health care dollar goes to admin bloat in our current setup. That's insane. Medicare runs with something like 1-2% overhead as I understand it. I'd be far happier to have my bloated insurance premiums (or their equivalent via a tax increase) go to government coffers than to the insurance CEO's multi-million dollar bonus and his shareholder leeches wallets while they make life more of a PITA for docs and patients.

The problem with your “non bleeding heart” argument is twofold. First, what is the definition of BASIC healthcare? And second, healthcare as we know it is not comparable with fire, police or even the milirary really.

BASIC healthcare is vaccines, possibly maternity and cheap, generic drugs. Basic healthcare is NOT what medicare provides -which tries to cover “modern medicine” that includes super-expensive meds and interventions. Where do you draw the line? Does basic healthcare cover a million-dollar cancer treatment which we deem “standard” care now? A transplant? A 100k pacemaker? After all, these can easily be considered “life saving” interventions. If the US public could openly admit this “basic” healthcare will be straight-up INFERIOR to a seeparate private system, and people on this system will NOT be given the same resources (even if they are dying), and it will be hard-capped at X dollars then maybe I could support that. Until then, it would be just a bottomless money pit with no end. Even the military (which wastes an incredible amount of money) is capped at some amount and doesnt have the ability to redistribute money to this degree. Firefighers and police are a drop in the bucket compared to what lengths people are willing to spend (other peoples money) when it comes to healthcare- basically a limitless amount that we cant say no to.

By the way, voters recently outlawed any liftime cap on insurance, no matter what coverage you buy. Imagine you could buy car insurance with no cap, and it was increasingly each year possible to get into an accident that would cost 5 million dollars. Would you expect that system to work?

 

[VA Hopeful Dr]

Should we privatize the police, fire department, and military? I'm not a bleeding heart, but I do have a tough time understanding how people can be OK with safety services like these being publicly funded but are against the premise of providing basic health care for everybody.

Roughly 15-20% of every health care dollar goes to admin bloat in our current setup. That's insane. Medicare runs with something like 1-2% overhead as I understand it. I'd be far happier to have my bloated insurance premiums (or their equivalent via a tax increase) go to government coffers than to the insurance CEO's multi-million dollar bonus and his shareholder leeches wallets while they make life more of a PITA for docs and patients.

You've never had to deal with Medicare's administration, have you?

It took me 6 months and roughly 20 hours of insanely expensive lawyer time just to re-enroll because each person at CMS I spoke to gave me a different answer about how to do it.

Say what you want about them, re-enroll in good in Blue Cross was a 2 page form that took 15 minutes.

 

[deuist]

Option 2: Pay $500/month tax per person in your household and the government will take care of all your health needs.....trust us!

Blue Cross/Blue Shield in my area charges over $2000 month for a family of three and does not cover the most basic of services.

 

[boomshaketheroom]

The problem with your “non bleeding heart” argument is twofold. First, what is the definition of BASIC healthcare? And second, healthcare as we know it is not comparable with fire, police or even the milirary really.

BASIC healthcare is vaccines, possibly maternity and cheap, generic drugs. Basic healthcare is NOT what medicare provides -which tries to cover “modern medicine” that includes super-expensive meds and interventions. Where do you draw the line? Does basic healthcare cover a million-dollar cancer treatment which we deem “standard” care now? A transplant? A 100k pacemaker? After all, these can easily be considered “life saving” interventions. If the US public could openly admit this “basic” healthcare will be straight-up INFERIOR to a seeparate private system, and people on this system will NOT be given the same resources (even if they are dying), and it will be hard-capped at X dollars then maybe I could support that. Until then, it would be just a bottomless money pit with no end. Even the military (which wastes an incredible amount of money) is capped at some amount and doesnt have the ability to redistribute money to this degree. Firefighers and police are a drop in the bucket compared to what lengths people are willing to spend (other peoples money) when it comes to healthcare- basically a limitless amount that we cant say no to.

By the way, voters recently outlawed any liftime cap on insurance, no matter what coverage you buy. Imagine you could buy car insurance with no cap, and it was increasingly each year possible to get into an accident that would cost 5 million dollars. Would you expect that system to work?

I dont think you can say healthcare is not comparable to fire/police/military and then compare health insurance to car insurance a paragraph later.

Also, I think a big problem is I have some difficulty telling someone they can't have a medical intervention that will save their life because they are too poor. I'm not saying I have a solution, but its easy to spend money that doesnt exist when its life or death/severe disability. If you cant afford to fix your car you don't die, you just dont drive that car any more.

Also also basic healthcare only *possibly* includes maternity. Come on now, thats dumb.

 

[VA Hopeful Dr]

Blue Cross/Blue Shield in my area charges over $2000 month for a family of three and does not cover the most basic of services.

It may not cover the appendectomy or the diabetes, but you'll get your free pap smear!

 

[VA Hopeful Dr]

I dont think you can say healthcare is not comparable to fire/police/military and then compare health insurance to car insurance a paragraph later.

Also, I think a big problem is I have some difficulty telling someone they can't have a medical intervention that will save their life because they are too poor. I'm not saying I have a solution, but its easy to spend money that doesnt exist when its life or death/severe disability. If you cant afford to fix your car you don't die, you just dont drive that car any more.

Also also basic healthcare only *possibly* includes maternity. Come on now, thats dumb.

I've been a doctor for 8 years. I've never told someone that I can't treat them because they are poor.

If its an emergency, they get treated and then billed later (and most hospitals will do payment plans, I've seen some do as little as $20/month). If its not, there are usually work arounds.

 

[el_duderino]

I've been a doctor for 8 years. I've never told someone that I can't treat them because they are poor.

If its an emergency, they get treated and then billed later (and most hospitals will do payment plans, I've seen some do as little as $20/month). If its not, there are usually work arounds.

Why should it be your personal responsibility to treat people who can't pay? Why should a patient have to seek treatment without knowing whether the provider will ever get paid?

 

[VA Hopeful Dr]

Why should it be your personal responsibility to treat people who can't pay? Why should a patient have to seek treatment without knowing whether the provider will ever get paid?

You not surprisingly misunderstand.

There are ways to see people without much money and still get paid. Most places will do payment plans. That way everyone wins.

I don't recall ever seeing someone for free.

 

[namethatsmell]

That is because the one real purpose of having a government is to protect the rule of law and property rights. The public safety services fall under that. Healthcare is a completely separate entity.

That may be your opinion, but the preamble of the constitution is more expansive:

"We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America."

 

[namethatsmell]

The problem with your “non bleeding heart” argument is twofold. First, what is the definition of BASIC healthcare? And second, healthcare as we know it is not comparable with fire, police or even the milirary really.

BASIC healthcare is vaccines, possibly maternity and cheap, generic drugs. Basic healthcare is NOT what medicare provides -which tries to cover “modern medicine” that includes super-expensive meds and interventions. Where do you draw the line? Does basic healthcare cover a million-dollar cancer treatment which we deem “standard” care now? A transplant? A 100k pacemaker? After all, these can easily be considered “life saving” interventions. If the US public could openly admit this “basic” healthcare will be straight-up INFERIOR to a seeparate private system, and people on this system will NOT be given the same resources (even if they are dying), and it will be hard-capped at X dollars then maybe I could support that. Until then, it would be just a bottomless money pit with no end. Even the military (which wastes an incredible amount of money) is capped at some amount and doesnt have the ability to redistribute money to this degree. Firefighers and police are a drop in the bucket compared to what lengths people are willing to spend (other peoples money) when it comes to healthcare- basically a limitless amount that we cant say no to.

By the way, voters recently outlawed any liftime cap on insurance, no matter what coverage you buy. Imagine you could buy car insurance with no cap, and it was increasingly each year possible to get into an accident that would cost 5 million dollars. Would you expect that system to work?

Sure, basic health care including vaccines, maternity care, and offering preventative care and generic drugs would be a great start.

Rationing of care currently happens -- if you're telling me that everybody has access to unlimited care right now I'd be curious to know where you practice.

I also find it interesting that you're concerned that a public health system would become a "bottomless money pit with no end" as that's pretty much our current reality with our present day "system." The military having a hard budget as you refer to illustrates the point that the government is capable of containing costs.

I do agree that society needs a re-adjustment of attitudes towards health care. I'm tired of CEOs and health care marketing folks preaching falsehoods about these mythical "perfect" health care landscapes they've created for patients to populate. We all know that's not true. There's no reason to think a public option would be perfect either--though I'm guessing for the same amount of money we could provide a lot more care to a lot more people.

 

[namethatsmell]

You've never had to deal with Medicare's administration, have you?

It took me 6 months and roughly 20 hours of insanely expensive lawyer time just to re-enroll because each person at CMS I spoke to gave me a different answer about how to do it.

Say what you want about them, re-enroll in good in Blue Cross was a 2 page form that took 15 minutes.

Nope, I have minimal experience interacting with these guys or the privates. Part of the reason I was drawn to EM was my disgust at watching my family medicine attending in med school be put on hold for 40 mins by some insurance troll while trying to get a pre-auth for a patient. Bless you for being willing to work the bureaucratic machinery to achieve your ends. You don't deserve the stuff the insurers put you through.

There are crappy aspects to every payer--public or private. Currently the American College of Emergency Physicians is suing Anthem BCBS and there are numerous stories of private insurance refusing to cover ED visits for their members.

 

[VA Hopeful Dr]

Nope, I have minimal experience interacting with these guys or the privates. Part of the reason I was drawn to EM was my disgust at watching my family medicine attending in med school be put on hold for 40 mins by some insurance troll while trying to get a pre-auth for a patient. Bless you for being willing to work the bureaucratic machinery to achieve your ends. You don't deserve the stuff the insurers put you through.

There are crappy aspects to every payer--public or private. Currently the American College of Emergency Physicians is suing Anthem BCBS and there are numerous stories of private insurance refusing to cover ED visits for their members.

That attending was an idiot. I haven't done a prior auth in years, that's why God invented staff members. A physician's time is way too valuable to spend doing that kind of nonsense.

If I were an insurance company, I'd deny lots of ED visits as well. We all know that a shocking amount of obviously minor stuff shows up at y'all's doors. I'm not talking the chest pain that resolves with Maalox, ankle sprains, or things that could be major and just happen not to be. I'm talking the obvious URI, the pregnancy test, the 2AM work/school note. Patients should be on the hook for that kind of nonsense.

 

[GeneralVeers]

That may be your opinion, but the preamble of the constitution is more expansive:

"We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America."

By your logic that one sentence gives the Federal government the power to do anything it wishes, as long as some do-gooder feels its in the "general welfare". I feel the opposite. I think it would not be in our general welfare to bankrupt the country, redistribute massive wealth, and herd people against their will into a crappy government insurance scheme. But we can agree to disagree on what "general welfare" means.

 

[namethatsmell]

That attending was an idiot. I haven't done a prior auth in years, that's why God invented staff members. A physician's time is way too valuable to spend doing that kind of nonsense.

If I were an insurance company, I'd deny lots of ED visits as well. We all know that a shocking amount of obviously minor stuff shows up at y'all's doors. I'm not talking the chest pain that resolves with Maalox, ankle sprains, or things that could be major and just happen not to be. I'm talking the obvious URI, the pregnancy test, the 2AM work/school note. Patients should be on the hook for that kind of nonsense.

I've only had one straight up "I need a work-note" patient in the last year. People lie and the current system penalizes me in multiple ways for trying to guess who is bogus vs telling the truth. So if a 20 yo f comes in with a cc of no period for 2 months and new vaginal bleeding they're getting testing. Yup, the pt may have made the whole thing up but until the system changes I'm not going to waste my time trying to be a human lie detector.

After an MSE is done and there's clearly nothing emergent (which would be a small minority of patients), I'd love to be able to ask for cash from the patient before proceeding further. But alas our "system" isn't set up for that..and again people can/will lie to get more things out of their visit.

BCBS isn't trying to not pay for just work-note visits in some noble gesture to save the system...they're setting the stage to deny much more and increase their profits (at the expense of myself and my colleagues who cannot refuse to see their patients under federal law):

BCBS Georgia Plan to Charge for Unnecessary ER Visits Draws Ire

 

[namethatsmell]

By your logic that one sentence gives the Federal government the power to do anything it wishes, as long as some do-gooder feels its in the "general welfare". I feel the opposite. I think it would not be in our general welfare to bankrupt the country, redistribute massive wealth, and herd people against their will into a crappy government insurance scheme. But we can agree to disagree on what "general welfare" means.

It's my opinion that the founding fathers commented on the "general welfare" to help craft a nation where citizens would be able to avail themselves of certain services that would in turn also generally improve society.

Treating drug addicts with medically assisted therapy/buprenorphine is a succinct example of how society benefits by offering health care to the individual. The cliff notes are that for every $1 spent on treating addicts, society saves $6-12 dollars in downstream costs, and the rates of HIV/Hep C go down, crime goes down, etc. You don't need to believe me, you can google it yourself.

That said, I personally don't agree with giving people free unlimited access to unlimited care. I just think our current system is the worst blend of public/private care. If I could chose what direction private health care could go, it would be to reform/eliminate Stark and reduce all the useless bureaucratic/admin red tape so physicians can try to regain some control of health care and have more of a free market. To provide more care to the less fortunate in society (and without penalizing docs), I'd like to see tax breaks for private docs who give uncompensated care to low income people and/or treat people insured by the fed. At the same time, I'd also like to prevent companies with shareholders from participating in health care. But unless that could all actually happen yeah I'd rather have a more expansive government supported system in place alongside a private market.

 

[el_duderino]

Curious where "unlimited access to unlimited care" comes from.

 

[southerndoc]

I've only had one straight up "I need a work-note" patient in the last year. People lie and the current system penalizes me in multiple ways for trying to guess who is bogus vs telling the truth. So if a 20 yo f comes in with a cc of no period for 2 months and new vaginal bleeding they're getting testing. Yup, the pt may have made the whole thing up but until the system changes I'm not going to waste my time trying to be a human lie detector.

After an MSE is done and there's clearly nothing emergent (which would be a small minority of patients), I'd love to be able to ask for cash from the patient before proceeding further. But alas our "system" isn't set up for that..and again people can/will lie to get more things out of their visit.

BCBS isn't trying to not pay for just work-note visits in some noble gesture to save the system...they're setting the stage to deny much more and increase their profits (at the expense of myself and my colleagues who cannot refuse to see their patients under federal law):

BCBS Georgia Plan to Charge for Unnecessary ER Visits Draws Ire

BCBS of Georgia has gotten so out of hand with denials that the ACEP and the Medical Association of Georgia is suing them. Denials for chest pain diagnosed as costochondritis, partial amputations of a toe in a child that required plastic surgery to reattach being denied saying they should've gone to urgent care, patients falling and hitting their head meeting Canadian head CT criteria being told they should've went to their primary care physician. BCBS says they don't do this in children, admitted patients, patients getting a CT, etc., but I know from firsthand experience in family members that this is not the case.

 

[namethatsmell]

Curious where "unlimited access to unlimited care" comes from.

It was in response to some above posters who try to insinuate that’s what people mean when they discuss government funded health care.


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[miacomet]

That attending was an idiot. I haven't done a prior auth in years, that's why God invented staff members. A physician's time is way too valuable to spend doing that kind of nonsense.

If I were an insurance company, I'd deny lots of ED visits as well. We all know that a shocking amount of obviously minor stuff shows up at y'all's doors. I'm not talking the chest pain that resolves with Maalox, ankle sprains, or things that could be major and just happen not to be. I'm talking the obvious URI, the pregnancy test, the 2AM work/school note. Patients should be on the hook for that kind of nonsense.

Those visits are cheap, so there's not much ROI on denying them. It's the negative chest pain eval and the negative abd pain eval that insurance is focusing on. With copays as they are today, my guess is the work note and pregnancy test crowd are either uninsured or on Medicaid/

 

[namethatsmell]

BCBS of Georgia has gotten so out of hand with denials that the ACEP and the Medical Association of Georgia is suing them. Denials for chest pain diagnosed as costochondritis, partial amputations of a toe in a child that required plastic surgery to reattach being denied saying they should've gone to urgent care, patients falling and hitting their head meeting Canadian head CT criteria being told they should've went to their primary care physician. BCBS says they don't do this in children, admitted patients, patients getting a CT, etc., but I know from firsthand experience in family members that this is not the case.

Completely agree.

Anthem is a greedy dangerous company trying to best serve its actual masters—it’s share holders—rather than trying trying to honor its supposed purpose of covering reasonable care to its paying customers.

This is exactly why I don’t think publicly traded companies belong in the insurance game.


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[el_duderino]

Man with private insurers doing such a bang-up job meeting the needs of their clients, why would anyone ever want more regulation and government oversight?

 

[VA Hopeful Dr]

Man with private insurers doing such a bang-up job meeting the needs of their clients, why would anyone ever want more regulation and government oversight?

I've never had a problem with my private insurance

 

[VA Hopeful Dr]

Those visits are cheap, so there's not much ROI on denying them. It's the negative chest pain eval and the negative abd pain eval that insurance is focusing on. With copays as they are today, my guess is the work note and pregnancy test crowd are either uninsured or on Medicaid/

Really? An ED visit for a URI is cheaper than going to your PCP or Urgent care?

I find that very hard to believe.

 

[miacomet]

Really? An ED visit for a URI is cheaper than going to your PCP or Urgent care?

I find that very hard to believe.

I don't think you read my post. Medicaid patients don't have to pay the copay for ER visits, whereas their PMDs can require it to be seen. Medicaid in most states does not bill the patient aggressively, if at all, so yes, it's cheaper to go to the ER. Uninsured patients will get a bill, but most get written off, whereas most practices require payment. In these instances, yes, it's easier to go to the ER. With higher copays, privately insured patients don't tend to use the ER for, say, a BP med refill or a work note, and those visits aren't that expensive anyway. What Anthem is going after (if you would take the trouble to read the articles on this you would find many examples) are visits that require an expensive workup that turns out negative. They are trying to dissuade people from going to the ER for more expensive complaints, like belly pain.

 

[miacomet]

I've never had a problem with my private insurance

Do you have Anthem? No? Then this doesn't apply.

 

[miacomet]

Here is what ACEP had to say. I would personally consider "chest pain on breathing" a serious issue. ACEP is concerned about this for both financial and patient care reasons. I'm surprised VA, that you think it's hunky-dory.

Emergency Physicians: Anthem Blue Cross Blue Shield Policy Violates Federal Law

 

[EctopicFetus]

I hate the "well if you want social program x, why aren't you personally already doing that for some people by yourself?" argument. First of all, the charitable habits of any given person are none of your business. Beyond that, one of the points of the entire idea is that it will cost the same or less overall. The Koch-funded study said it would save $2 billion over 10 years. There's no reason a universal system would have to cost more to anyone than what we currently have.

Thats BS. My point is simple. If it is so important to you then put your money where your mouth is. you hate the argument simply because it makes you feel bad and is common sense.

I think people should work. People should pay for their own stuff. People should weight their own risks/benefits. I DONT want to pay for other peoples decisions.

The universal system will cost more because people will consume more healthcare. Isn’t that the point? Be it primary care, medications etc.

Will you force the alcoholics and smokers to quit or will we fund their bad decisions. Similarly for the obese? Or is there no personal responsibility in the universal healthcare model you propose.

For universal healthcare to work at similar costs we will have to ration and change what we pay for and how much we pay. I am all for taking the system to the studs and starting over. It wont happen.

 

[EctopicFetus]

Culture shifts can and do happen quickly. Look at how quickly gay marriage happened.

It wasn’t that quick and the overall change was due to a legal challenge not the opinions of the people. Yes the people have moved more in favor of gay marriage. I support it as well. Why do I or should I care who people marry?

 

[EctopicFetus]

Do you have Anthem? No? Then this doesn't apply.

I have them. never had an issue for my family. I have a family member on Stellara for psoriasis 20k a pop. Another family member needed and MRI/MRA for severe new onset HAs. Insurance paid. Thanks Anthem! I’m getting my premiums worth.

 

[el_duderino]

I've never had a problem with my private insurance

That's a great perspective.

 

[southerndoc]

I have them. never had an issue for my family. I have a family member on Stellara for psoriasis 20k a pop. Another family member needed and MRI/MRA for severe new onset HAs. Insurance paid. Thanks Anthem! I’m getting my premiums worth.

Anthem is only applying the ED policy in Georgia, Missouri, and Kentucky if I remember correctly.

They also have a policy -- albeit not 100% enforced -- where they tell Georgia members that outpatient stress tests, imaging, etc. must be performed at a non-hospital affiliated company. We've had a rash of "$100 MRI's" that come with a CD that contains poor images and no radiology read. Our radiologists must re-read the MRI (and sometimes repeat them if they are inadequate) without getting paid.

It's really a conflict of interest: healthcare members needing as much of their premiums used on healthcare expenses as a whole and a corporation trying to make as much profit as possible for their shareholders. Although there are limitations for minimum spending on members, many find ways to get around these by "reinvesting" into their corporation for the "benefit of members."

 

[leviathan]

Thats BS. My point is simple. If it is so important to you then put your money where your mouth is. you hate the argument simply because it makes you feel bad and is common sense.

I think people should work. People should pay for their own stuff. People should weight their own risks/benefits. I DONT want to pay for other peoples decisions.

The universal system will cost more because people will consume more healthcare. Isn’t that the point? Be it primary care, medications etc.

Will you force the alcoholics and smokers to quit or will we fund their bad decisions. Similarly for the obese? Or is there no personal responsibility in the universal healthcare model you propose.

For universal healthcare to work at similar costs we will have to ration and change what we pay for and how much we pay. I am all for taking the system to the studs and starting over. It wont happen.

The evidence seems to support that a single-payer system is far cheaper while providing similar services. I guess the question is why the US would not work the same way as every other first-world country on the planet that all have a universal insurance program (+/- a second tier of private insurance). I've outlined previously how there are dozens of reasons why a single-payer system is more cost-effective WITHOUT rationing time-sensitive medical care. Both private and public insurance systems limit costs in various ways, so rationing happens in both.

 

[VA Hopeful Dr]

I don't think you read my post. Medicaid patients don't have to pay the copay for ER visits, whereas their PMDs can require it to be seen. Medicaid in most states does not bill the patient aggressively, if at all, so yes, it's cheaper to go to the ER. Uninsured patients will get a bill, but most get written off, whereas most practices require payment. In these instances, yes, it's easier to go to the ER. With higher copays, privately insured patients don't tend to use the ER for, say, a BP med refill or a work note, and those visits aren't that expensive anyway. What Anthem is going after (if you would take the trouble to read the articles on this you would find many examples) are visits that require an expensive workup that turns out negative. They are trying to dissuade people from going to the ER for more expensive complaints, like belly pain.

I meant cheap to the insurance company.

I promise even Medicaid pays more for an ED visit than for an UC visit.

 

[VA Hopeful Dr]

Do you have Anthem? No? Then this doesn't apply.

Really? Because the post I was replying to made no mention of Anthem. Just private insurance as a whole.

 

[VA Hopeful Dr]

That's a great perspective.

You said they're doing a bad job.

I disagree.

 

[VA Hopeful Dr]

The evidence seems to support that a single-payer system is far cheaper while providing similar services. I guess the question is why the US would not work the same way as every other first-world country on the planet that all have a universal insurance program (+/- a second tier of private insurance). I've outlined previously how there are dozens of reasons why a single-payer system is more cost-effective WITHOUT rationing time-sensitive medical care. Both private and public insurance systems limit costs in various ways, so rationing happens in both.

Well first, I'm not sure that the data does show that.

Second, we are roughly the size of the whole of Western Europe. There's no proof that heathcare is scalable. Admittedly, there is no proof that it isn't either, but I think the burden of proof is on those wanting to radically change our system as a big change could leave us worse off than before.

Third (and interestingly to me), we already spend roughly the same amount on public healthcare as most 1st world countries as a percentage of GDP. This is despite only having 50% of our population on some form of government insurance while the average for western Europe of people on private insurance is about 1%. So yes, the reason we spend more is due to private insurance its also because that private insurance covers 34X more of our population than Europe does. And even more interestingly, it appears that private insurance in Europe actually spends more than it does here.

How does health spending in the U.S. compare to other countries? - Peterson-Kaiser Health System Tracker

 

[EctopicFetus]

The evidence seems to support that a single-payer system is far cheaper while providing similar services. I guess the question is why the US would not work the same way as every other first-world country on the planet that all have a universal insurance program (+/- a second tier of private insurance). I've outlined previously how there are dozens of reasons why a single-payer system is more cost-effective WITHOUT rationing time-sensitive medical care. Both private and public insurance systems limit costs in various ways, so rationing happens in both.

Is there evidence to support this? The most recent thing I saw was from a libertarian study showing an increase of about 30T over a decade.

Simply you can not offer more services and be cheaper without rationing. Seems to me this would be common sense.

 

[EctopicFetus]

We also have to keep in mind that few people go to Europe for surgery unless they are looking for a cheaper option. Do you wonder why the saudis fly here for healthcare?

Few people are currently uninsured and most can get insurance if they work. While I know the number of jobs covering health insurance is shrinking there are still plenty that do.

The costs will skyrocket. Don’t believe me look at the actual cost of the ACA vs expected. No shock it is higher. Look at the Oregon study on their Medicaid population if you think it will decrease ED visits.

Lastly, health insurance companies are really just financial services businesses and they serve their shareholders. The “patients” are simply how they generate revenue.

Lastly, they are all different and to those who claim Medicaid / Medicare has low overhead its all in how they play with the numbers. The reality is they have huge overhead, are incredibly open to fraud and abuse and outsource this service as a percentage of collections. This isnt in their overhead but incredibly adds to what they pay out. It’s just which bucket the money goes in. In the end it isnt appropriate medical care for their beneficiaries.