Medicare for All!

[lupinus]

That's because the people turning it around are morons.

The hospital gets paid, but there are a lot more people going to the ER instead of Urgent Care or a PCP. Real cost "savings" there.

I never said it was a good argument lol.

My insurance this year actually now has it where using the emergency room for a non emergency isn't covered, period, it's on you for being a jackass and going to the ER cause you have the sniffles.

If you go the the ER with chest pains and it turns out to just be swamp gas or something like that where it turns out to be nothing, that's cool cause you had a legitimate reason to feel there was an emergency. But show up with the sniffles and you can pay the stupidly high bill on your own.

Sent from my Pixel XL using Tapatalk

[Firethorn]

Hospitals should be able to give them the minimum care needed to keep them alive another day and then kick them out.  I know a lot of people don't like that idea, but it is a form of welfare handout that needs to change.  There has to be a way to get hospitals out of that cost/liability trap and force people to pay their own way. 

That's actually the current system, more or less, and it has turned out to be extremely expensive.  Because they show up with a critical condition, because they wouldn't or couldn't get care earlier when it would have been cheaper, the hospital spends a lot of resources saving their life, then because there isn't any followup care they end up back in the emergency room next week.

It's like how it has been determined that homeless people are actually extremely expensive, it's cheaper to house them.

As for forcing people to pay their own way, remember the phrase "cannot get blood from a stone"?  Medical bankruptcy is one of the leading types of bankruptcy.  People are literally going broke paying their own way, and a lot of these people have insurance, but are going broke from copays and other uncovered expenses. 

It is difficult to do because Americans are generally compassionate and don't want people to be left without care.  I just think it is a cost we are all paying for via Govt/Taxes that is greatly magnified by the way it is done.

We don't need single payer, I think, but we do need "insurance of last resort", I think.  Because people ARE going to get medical care one way or another, even if they have to rob a bank to get it in prison.  Yes, that sort of stuff has happened.  Prison is expensive on top of the medical expenses, better to just cover it first.

If you go the the ER with chest pains and it turns out to just be swamp gas or something like that where it turns out to be nothing, that's cool cause you had a legitimate reason to feel there was an emergency. But show up with the sniffles and you can pay the stupidly high bill on your own.

Here's a question.  Why does an ER visit need to be so much more expensive than a Urgent Care visit during the same sort of hours?  Sniffles are sniffles, right?  Just expand the ER a bit so that it has a sniffles section that is seen on it's own time.

The answer, I think?  The ER is legally mandated to provide care, and this mandate isn't funded.  Urgent care centers aren't.  That means that the ER needs to charge for all those that don't pay, on those that do pay.  Thus, outrageous bills.  Many hospitals will take any excuse to close their ER down, because it is a money sink.

Fix that, and prices can come down a lot. 

[RocketMan]

I have to wonder if some of it is not feasible simply because with today's medical costs, potential bills for serious conditions can vastly outweigh money collected in the pool. Even adjusting for inflation, I'm guessing there was nothing like $10K/day hospital stays, and single surgeries that can cost $200K or more, back when these programs were more popular.

If we could get some of those costs under control, medical pools would possibly have a better chance of working and remaining solvent.

Much of those exorbitant healthcare costs have come about due to the ever expanding pool of insurance dollars available to pay for it.  Increase the available dollars, costs will go up accordingly to absorb those dollars.  Self-perpetuating after a fashion.

[Scout26]

Have you spent any time in a a ER ??  At least around here, if you go in it's all Medicaid and Illegals in there.  That's the problem.   Not Suzie Soccermom bringing in Little Timmy with the Sniffles.  It's Pedro and Maria bringing in Little Jose with the Sniffles, because they don't have insurance, nor even Medicaid, but the ER is "Free"...to them.   I've been to the ER a couple times for legit reasons, and I'd bet any amount that 1) I'm the only person there with Insurance and 2) I'm the only person there that speaks English.

[Hawkmoon]

You get some really bizarre administrative/bureaucratic nonesense, too.

In October, I had a house guest for a week, a woman from my late wife's native country. She had been an exchange student in the U.S. when she was in high school, and wanted to come back for a visit. She takes medication for something heart-related. She lost the medications she had brought with her. Obviously, a pharmacy couldn't just give her a supply without a prescription ... but we asked anyway, and got the expected response. I called my cardiologist and asked if he could write an emergency prescription to carry her for ten days. Nope -- not allowed.

Next, we went to an urgent care clinic that is affiliated with the hospital in a nearby city. A doctor there told us that she could not write the prescription there in the urgent care setting, but if we were in the hospital ER she could.

So, next we went to a hospital ER. She did eventually get her prescription, but the ER charge for entering her into their computer, having a nurse take her vital signs, and then having a doctor ask her what the medication was and give her a prescription came to several hundred dollars.

And then she received a separate bill (sent to my address, after she had returned to South America) for two or three hundred dollars for the doctor. Apparently that hospital (and I suppose this is becoming the norm) isn't employed directly by the hospital, he's an independent contractor. I suppose this is for liability insurance reasons, but to me it stinks. In the end, my wife's friend's lost pill bottle cost her almost $1,000 ... for about 15 minutes in the ER, and a ten-day emergency supply of the medication.

[MillCreek]

Very few physicians are directly employed by the hospital any more.  The hospitalist service, anesthesiology, radiology, pathology and the emergency department are almost always staffed by independent contractors or a staffing agency.  This means you get separate physician bills for these services.

[Nick1911]

Have you spent any time in a a ER ??  At least around here, if you go in it's all Medicaid and Illegals in there.  That's the problem.   Not Suzie Soccermom bringing in Little Timmy with the Sniffles.  It's Pedro and Maria bringing in Little Jose with the Sniffles, because they don't have insurance, nor even Medicaid, but the ER is "Free"...to them.   I've been to the ER a couple times for legit reasons, and I'd bet any amount that 1) I'm the only person there with Insurance and 2) I'm the only person there that speaks English.

I went in a few years ago due to a particularly bad laceration.

There were many hispanic people waiting, some older folks, and a few crazies/drug seekers.

After about 30 minutes in the waiting room I had managed to get the bleeding to more or less stop by keeping pressure on it, so I went home.

[BobR]

Have you spent any time in a a ER ??  At least around here, if you go in it's all Medicaid and Illegals in there.  That's the problem.   Not Suzie Soccermom bringing in Little Timmy with the Sniffles.  It's Pedro and Maria bringing in Little Jose with the Sniffles, because they don't have insurance, nor even Medicaid, but the ER is "Free"...to them.   I've been to the ER a couple times for legit reasons, and I'd bet any amount that 1) I'm the only person there with Insurance and 2) I'm the only person there that speaks English.

Honestly, the last time I was in the ER as a patient I didn't see anyone there that would raise any suspicion of being Hispanic much less here illegally. Then again, being in a county that is 89.3% White and only 5.7% Hispanic could have something to do with that. I guess here you just replace Hispanic with "tweaker" and it is about the same

bob

[KD5NRH]

I've been to the ER a couple times for legit reasons, and I'd bet any amount that 1) I'm the only person there with Insurance and 2) I'm the only person there that speaks English.

Actually, I saw another English speaker at the ER once.  College kid with a radial fracture to the tibia that he'd kept quiet about all weekend so as not to spoil his girlfriend's birthday.
Dude was clearly in some serious pain, and could finally whimper and hobble in to get it taken care of after she'd headed home.  Hope she turned out to be worth it.

[Andiron]

Have you spent any time in a a ER ??  At least around here, if you go in it's all Medicaid and Illegals in there.  That's the problem.   Not Suzie Soccermom bringing in Little Timmy with the Sniffles.  It's Pedro and Maria bringing in Little Jose with the Sniffles, because they don't have insurance, nor even Medicaid, but the ER is "Free"...to them.   I've been to the ER a couple times for legit reasons, and I'd bet any amount that 1) I'm the only person there with Insurance and 2) I'm the only person there that speaks English.

You're causing my kidney stone PTSD to flair up.   That was exactly how it went.  Here I am,  pissing kool-aid and wanting to die,  in a room full of *expletive deleted*ing illegals and their anchor babies.  Gotta wait my turn, Jorge has a cold or something.  good times. 

Similar thing after I stopped a piece of angle iron at work with my skull, requiring 23 stitches.  Bloody terry cloth towel be damned, wait your turn and the doc will see you when he can. 

Hooray.  Build the *expletive deleted*ing wall.

End rant.

[230RN]

Much of those exorbitant healthcare costs have come about due to the ever expanding pool of insurance dollars available to pay for it.  Increase the available dollars, costs will go up accordingly to absorb those dollars.  Self-perpetuating after a fashion.

Confirmed.  A little off topic, but over the decades, I've often stated that insurance always causes service costs to rise.  What the hell, insurance is paying for it, so let's charge some little extra, the customer won't complain.  My data mostly comes from observing automobile insurance rates.  For decades.  Not to drift the thread, but I've been looking at the bigger picture regarding insurance and I can confirm RocketMan's thesis.

Terry

[Pb]

Yes.

No.  Absolutely not.  Do you want the FedGov to prevent companies from negotiating for better prices?

Yes.  When my wife was going to have our first child, I asked the hospital how much it would cost.

"$9000"

 

"Oh, you have insurance?  It will be $5000 then."

I oppose letting hospitals screw over people unlucky enough to not have insurance... for the same procedure.

I also oppose the gov requiring hospitals to treat non-paying customers.

Charge everyone the same per procedure, with the price clearly stated and published before treatment is given. 

[Fly320s]

Charge everyone the same per procedure, with the price clearly stated and published before treatment is given. 

I hope you don't use any discounts you are offered from your workplace.  Or from coupons.  Or because you are a frequent shopper at a business. 

[MechAg94]

That's actually the current system, more or less, and it has turned out to be extremely expensive.  Because they show up with a critical condition, because they wouldn't or couldn't get care earlier when it would have been cheaper, the hospital spends a lot of resources saving their life, then because there isn't any followup care they end up back in the emergency room next week.

It's like how it has been determined that homeless people are actually extremely expensive, it's cheaper to house them.

As for forcing people to pay their own way, remember the phrase "cannot get blood from a stone"?  Medical bankruptcy is one of the leading types of bankruptcy.  People are literally going broke paying their own way, and a lot of these people have insurance, but are going broke from copays and other uncovered expenses.  

You went past my point.  The emergency room should not be free to anyone.  If the hospital was allowed to require people to pay up front or get out, the people who really needed help would come up with the money.  Those who didn't have an actual emergency would either pay or find a less expensive alternative like they should in the first place.  Right now, all those people using the ER for free health care are a drain on the system and ramping up the cost for everyone else.  

I have a relative who nearly got their arm cut off in a tractor accident a few decades ago.  He had no insurance and couldn't pay for it all.  However, he talked to the hospital and others and just paid what he could when he could and eventually paid it all off.    It is possible handle this stuff rationally.  We just need to figure out how to get our system back into a rational form.  

[AmbulanceDriver]

One thing no one is really talking about in this lunacy is the back side of the equation.  Everyone is looking at the "how do we pay for it" part.   Because as bad as that is, the reimbursement rate part of it is actually worse.  Because you've already got doctors and clinics who are not taking new Medicare patients.  Medicare, in many cases, does not pay enough to even cover costs.  An example in my industry - a $1200 ambulance bill may get $400 of it paid.  May.   Oh, and the balance?  we're not allowed to go after the patient for the remainder, we have to accept Medicare's payment as payment in full and write off the rest.   I cannot think of any clinic, hospital, or other healthcare service that could survive on a 100% Medicare patient load.

[MillCreek]

One thing no one is really talking about in this lunacy is the back side of the equation.  Everyone is looking at the "how do we pay for it" part.   Because as bad as that is, the reimbursement rate part of it is actually worse.  Because you've already got doctors and clinics who are not taking new Medicare patients.  Medicare, in many cases, does not pay enough to even cover costs.  An example in my industry - a $1200 ambulance bill may get $400 of it paid.  May.   Oh, and the balance?  we're not allowed to go after the patient for the remainder, we have to accept Medicare's payment as payment in full and write off the rest.   I cannot think of any clinic, hospital, or other healthcare service that could survive on a 100% Medicare patient load.

According to the practice management consultants, in ambulatory care, for the typical private practice clinic, you cannot allow your Medicaid/Medicare patient mix to get much above 30% for very long, otherwise you will go out of business.  The private insurers (Blues, Aetna, Optum, etc.) are what keep private practice afloat.  The sticky wicket is that the private insurers use Medicare rates as a basis for setting their own reimbursement schedules.

[MillCreek]

You went past my point.  The emergency room should not be free to anyone.  If the hospital was allowed to require people to pay up front or get out, the people who really needed help would come up with the money.  Those who didn't have an actual emergency would either pay or find a less expensive alternative like they should in the first place.  Right now, all those people using the ER for free health care are a drain on the system and ramping up the cost for everyone else.  

I have a relative who nearly got their arm cut off in a tractor accident a few decades ago.  He had no insurance and couldn't pay for it all.  However, he talked to the hospital and others and just paid what he could when he could and eventually paid it all off.    It is possible handle this stuff rationally.  We just need to figure out how to get our system back into a rational form.  

The Federal law requiring hospitals/ERs to provide this care is called EMTALA: The Emergency Medical Treatment and Active Labor Act.  It was passed precisely to avoid hospitals turning away patients based on inability to pay.  So if you can get that overturned, we can go back to performing a wallet biopsy at the door to the hospital and denying care accordingly.

[dogmush]

What is this "Free ER" everyone is speaking of?  The care isn't free, it's stolen.

If 40% of the population ate out once a week and skipped their restaurant bill, we wouldn't be crying about "Free Food" running our costs up, we'd be crying about thieves stealing food.  That's an important distinction.

If one goes to an ER and accepts healthcare for what ails them, knowing either, they can't pay, or they are on a government program that won't pay for this visit, that person is a thief.  And should be treated as such.

As far as I am aware the only thing ER's are required to provide is an appropriate Medical Screening Evaluation.  At that point they can, and should, say "OK, this is what's wrong, and here is an estimate of the cost to treat it.  Cash or Credit?"

Barring actual emergency care (bleeding out, heart attack, stroke, etc.) There's time to get payment details before treatment.

[MillCreek]

As far as I am aware the only thing ER's are required to provide is an appropriate Medical Screening Evaluation.  At that point they can, and should, say "OK, this is what's wrong, and here is an estimate of the cost to treat it.  Cash or Credit?"

Barring actual emergency care (bleeding out, heart attack, stroke, etc.) There's time to get payment details before treatment.

Unfortunately, you are wrong. EMTALA not only requires hospitals to provide a medical screen, but also to provide treatment to resolve or stabilize an emergency medical condition or active labor, or to transfer the patient to another facility if they cannot be treated or stabilized.  In many cases in which the patient is without insurance or assets, the hospital ends up eating the cost.  This is a driving factor in many (especially smaller) hospitals closing down the emergency department.

http://newsroom.acep.org/2009-01-04-emtala-fact-sheet

[dogmush]

Unfortunately, you are wrong. EMTALA not only requires hospitals to provide a medical screen, but also to provide treatment to resolve or stabilize an emergency medical condition or active labor, or to transfer the patient to another facility if they cannot be treated or stabilized.  In many cases in which the patient is without insurance or assets, the hospital ends up eating the cost.  This is a driving factor in many (especially smaller) hospitals closing down the emergency department.

http://newsroom.acep.org/2009-01-04-emtala-fact-sheet

True, and while I knew that I glossed over it and phrased my post poorly.

This thread had a bunch of folks up in arms about people in the ER for colds and sniffles. That's not free, and isn't required.  There's a lot of stuff that happens at ER's that isn't required by EMTALA.  My wife (RN) tells me it's more complicated than it seems, because there's some programs where if a patient comes back for the same thing within 30 days the .gov programs that give them some money take that money back.  So hospitals sometimes provide more than the minimum treatment required by law in the hopes that they can get some reimbursement.

None of which changes my point.  The care isn't free, even if it's required to be provided.  The folks using ER's with no intention of paying are thieves.

[MillCreek]

^^^Readmission penalties for Medicare patients are a very real thing and is something we worry about a lot.  On the one hand, there is pressure to get the patient out of the hospital as soon as possible.  On the other hand, if they come back within 30 days for the same thing, the Feds take money back, don't pay for the second admit, or impose penalties.  So we have to discharge people quicker and sicker and then cross our fingers.  If the patient can be seen in followup by a provider within a week, or arrange for home health care, the odds are better.

[BobR]

On the one hand, there is pressure to get the patient out of the hospital as soon as possible.

Thank CMS (Center for Medicare and Medicaid Services) who came up with a system where a diagnosis is assigned a number (DRG) that translates into days the .gov will pay for. Some can have comorbidities that increase the stay but often not. because them DRG length of stay is all the .gov pays for many (all) of the private insurances will also go by those guidelines. You have to be a pretty sick camper to get a DRG that goes over 5 days, unless it is a psychiatric diagnosis. :(

bob

[MillCreek]

In regards to patients not paying for their care, here is a Washington appellate court decision that just hit my inbox: http://www.courts.wa.gov/opinions/pdf/767208.pdf

A patient tried to get out of paying his hospital bill by claiming that he signed an open-ended consent to care, rather than a definite amount that he would be billed. The Court rejected his claim.

[MechAg94]

Sounds like there are factors that increase cost on all sides.  It shouldn't surprise anyone that costs are high. 

[RoadKingLarry]

^^^Readmission penalties for Medicare patients are a very real thing and is something we worry about a lot.  On the one hand, there is pressure to get the patient out of the hospital as soon as possible.  On the other hand, if they come back within 30 days for the same thing, the Feds take money back, don't pay for the second admit, or impose penalties.  So we have to discharge people quicker and sicker and then cross our fingers.  If the patient can be seen in followup by a provider within a week, or arrange for home health care, the odds are better.

Do you get the same penalties if they die?