Healthcare going forward

[tobymerwin]

Perhaps but what does that have to do with healthcare?

My post was on topic...free healthcare.

 

[gsdx]

Nobody is talking about 'free healthcare'. We are talking 'universal healthcare'. There is a huge difference. Canada has universal healthcare, but it is not free. We pay for it.

 

[KaraBulut]

Nobody is talking about 'free healthcare'. We are talking 'universal healthcare'. There is a huge difference. Canada has universal healthcare, but it is not free. We pay for it.

Exactly. Most countries have a combination of publicly financed and privately financed systems. It's not realistic to call any of these systems "free healthcare" just because there's not an out-of-pocket payment at the time of service.

 

[Benvolio]

Exactly. Most countries have a combination of publicly financed and privately financed systems. It's not realistic to call any of these systems "free healthcare" just because there's not an out-of-pocket payment at the time of service.

The subsidies under Obamacare mean that many receive free health care at the expense of the taxpayers, and by expanding the subsides the system can be expanded to free for most at the expense of a few.

 

[KaraBulut]

The subsidies under Obamacare mean that many receive free health care at the expense of the taxpayers, and by expanding the subsides the system can be expanded to free for most at the expense of a few.

Incorrect. About 80% of ACA enrollees get subsidies but still have to pay their share of the premium, generally under $75 per month which, since they are paying a portion of their premium, doesn't meet the definition of "free healthcare".

Most people enroll in bronze or silver plans which have copays, deductibles and coinsurance which is also not "free".

 

[gsdx]

^ He won't get that. He still insists that Canada's healthcare is free. It is not.

 

[Benvolio]

Not yet, but the structure is in place to make it free for most.

 

[KaraBulut]

^ He won't get that. He still insists that Canada's healthcare is free. It is not.

I don't correct the disinformation for his benefit; I correct it so that the disinformation does not spread.

The US healthcare system is complicated even for those of us who have trained and worked in it for years. When false information is stated as fact (when it's really opinion), it's important to correct the record.

 

[thewiz]

The subsidies under Obamacare mean that many receive free health care at the expense of the taxpayers, and by expanding the subsides the system can be expanded to free for most at the expense of a few.

I know this will make little difference since you seem to have no compassion for those less fortunate than yourself, but here goes:

1. They are called "subsidies" for a reason. The person pays all that they can afford based upon their income. I know you'd like it that we could possibly extract blood or other bodily fluids from the person but the fact is that many people working working full-time jobs (and sometimes multiples) do not make enough to survive much less pay for "luxuries" like being healthy and living. They pay all that they can based upon a formula that is established to reflect the poverty rates and necessities. The subsidies pay the rest of the premium but the person pays all that they can logically afford.
2. If the person does not have health care, they can still get treatment. Unfortunately, they show up at emergency rooms which cannot (although you and most Republicans would have no problem) throw them on the street and await death's arrival. Instead, hospitals like the one I was president of, provide the necessary treatment in the ER which is the most expensive place that we can deliver care. They also usually have to wait a long time, cause other patients to wait, stress staff, and the outcomes are not the best because they cannot often afford the long term care or treatment necessary to prevent further degradation of their lives. Since they live in poverty, they also cannot pay the bill which the hospital then has to spread across those who pay in cash (fewer and fewer) or who have insurance. The other option, which is being seen in the south (that refused to participate in ACA because of the governors desire to see failure instead of protecting their citizens) is that hospitals then close; particularly smaller, rural hospitals that cannot afford uncompensated care. Thus, we (including you) all pay. If treated in ER, we all pay more and the outcome is far less successful.

 

[Benvolio]

I know this will make little difference since you seem to have no compassion for those less fortunate than yourself, but here goes:

1. They are called "subsidies" for a reason. The person pays all that they can afford based upon their income. I know you'd like it that we could possibly extract blood or other bodily fluids from the person but the fact is that many people working working full-time jobs (and sometimes multiples) do not make enough to survive much less pay for "luxuries" like being healthy and living. They pay all that they can based upon a formula that is established to reflect the poverty rates and necessities. The subsidies pay the rest of the premium but the person pays all that they can logically afford.
2. If the person does not have health care, they can still get treatment. Unfortunately, they show up at emergency rooms which cannot (although you and most Republicans would have no problem) throw them on the street and await death's arrival. Instead, hospitals like the one I was president of, provide the necessary treatment in the ER which is the most expensive place that we can deliver care. They also usually have to wait a long time, cause other patients to wait, stress staff, and the outcomes are not the best because they cannot often afford the long term care or treatment necessary to prevent further degradation of their lives. Since they live in poverty, they also cannot pay the bill which the hospital then has to spread across those who pay in cash (fewer and fewer) or who have insurance. The other option, which is being seen in the south (that refused to participate in ACA because of the governors desire to see failure instead of protecting their citizens) is that hospitals then close; particularly smaller, rural hospitals that cannot afford uncompensated care. Thus, we (including you) all pay. If treated in ER, we all pay more and the outcome is far less successful.

We can be sure that more and more people will be found unable to pay. The subsidies will get higher and higher and the individual payment less and less. More ever more will be required of fewer and fewer taxpayers.
We know that the people who pay the most into social security, but have savings, recieve less and less benefit. Many have to pay federal and state income taxes on social security benefits. Medicare as well is worth less and less.
Meanwhile the more benefit we give people the less they are willing to work, so we bring others to do the work until they catch on.
The American experience with welfare does not encourage belief in any scheme to “subsidize” those who cannot afford health care.

 

[KaraBulut]

1. They are called "subsidies" for a reason. The person pays all that they can afford based upon their income....

And to add to this, the ACA required employers to provide group health insurance if the employer had more than 50 employees. This was a big exemption for small businesses.

I have heard several politicians bemoaning the ACA's cost to "small business". I've always questioned whether an employer who had more than 50 employees was still a "small business".

All this gnashing of teeth over the ACA really misses the point that most Americans still get their insurance from their employers and this insurance is still heavily subsidized by employers which gives employees a distorted understanding of the actual cost of their health insurance.

For employees of small businesses, the Marketplace and the government subsidies are a bridge that allows people who work for small businesses to buy affordable insurance that their employer may not be able to provide.

2. If the person does not have health care, they can still get treatment. Unfortunately, they show up at emergency rooms which cannot (although you and most Republicans would have no problem) throw them on the street and await death's arrival. Instead, hospitals like the one I was president of, provide the necessary treatment in the ER which is the most expensive place that we can deliver care...

When the ACA mandates were passed, I always thought it was a mistake that the Democrats didn't weaken EMTALA. There are people who would prefer to pay the $695 penalty instead of buying health insurance. I'm just not sure why hospital EDs should continue to be required to treat patients who don't have insurance even though the law mandates that they have health insurance.

The ACA mandate and penalty is not popular but if private hospitals were not required to treat the uninsured, the public's attitude toward the mandate might be different.

 

[ballcaphair]

The mandate is awful and for those who pay the penalty, their uncovered medical expenses are also awful. In ER and our clinic, "first do no harm" should include the client's financial future. We turn no one away. You and I collectively pay these costs. Universal health care is often called socialism. In the real world it is prudent and conservative.

 

[frankfrank]

In the real world it is prudent and conservative.

Yes. It is CONSERVATIVE!

For a nation to be robust and effective, health is very important. An unhealthy nation cannot meet its best potential in the modern world.

 

[KaraBulut]

The mandate is awful and for those who pay the penalty, their uncovered medical expenses are also awful. In ER and our clinic, "first do no harm" should include the client's financial future. We turn no one away. You and I collectively pay these costs...

Before EMTALA, patients would show up in the ED with minor complaints and after triage, they would be referred to their primary care physician or a public health clinic.

With EMTALA, because of the requirement that patients be assessed and "stabilized" before they could be referred, it pretty much transformed EDs into free clinics regardless of ability to pay. And you're right- the cost for the uninsured is picked up by the insured as part of the overhead costs billed by the hospital.

Under the ACA, all emergency care is considered "in network", so the reimbursement from insurance is guaranteed. If the mandate were effective and everyone had insurance, some of that overhead cost would be eliminated which would lower the cost for everyone.

 

[Kulindahr]

And to add to this, the ACA required employers to provide group health insurance if the employer had more than 50 employees. This was a big exemption for small businesses.

I have heard several politicians bemoaning the ACA's cost to "small business". I've always questioned whether an employer who had more than 50 employees was still a "small business".

They're probably using the inane definition of "small business" that was put in play by A.L.E.C. -- a business with few owners.

All this gnashing of teeth over the ACA really misses the point that most Americans still get their insurance from their employers and this insurance is still heavily subsidized by employers which gives employees a distorted understanding of the actual cost of their health insurance.

For employees of small businesses, the Marketplace and the government subsidies are a bridge that allows people who work for small businesses to buy affordable insurance that their employer may not be able to provide.

In effect, employer-provided insurance is a forced tax on employees and employers alike, which has served to distort the cost of medical care just as any tax where the budget(s) of those taxed are tight distorts costs.

When the ACA mandates were passed, I always thought it was a mistake that the Democrats didn't weaken EMTALA. There are people who would prefer to pay the $695 penalty instead of buying health insurance. I'm just not sure why hospital EDs should continue to be required to treat patients who don't have insurance even though the law mandates that they have health insurance.

The ACA mandate and penalty is not popular but if private hospitals were not required to treat the uninsured, the public's attitude toward the mandate might be different.

Interesting idea -- it would allow market forces to work more freely.

 

[Kulindahr]

The mandate is awful and for those who pay the penalty, their uncovered medical expenses are also awful. In ER and our clinic, "first do no harm" should include the client's financial future. We turn no one away. You and I collectively pay these costs. Universal health care is often called socialism. In the real world it is prudent and conservative.

The mandate is only awful because it is part of a set-up to guarantee that less than one's full dollar goes to actual care -- much less, even with the profit limits imposed by the ACA. If 100% of the mandate were guaranteed to be spent on medical care it wouldn't be awful.

What Ben and others fail to realize is that the only alternative to universal health care is either a system of plunder where providers can make money off people's misery or a system of anarchy where it's considered perfectly all right to just let some suffer and die. Even the ACA retains aspects of both those, since it allows "insurance" that many people can't afford to use anyway.

The cost of an annual physical plus the first five doctor visits a year should be a tax credit, if only because then people with policies under the ACA would actually be able to use them.

 

[Kulindahr]

Yes. It is CONSERVATIVE!

For a nation to be robust and effective, health is very important. An unhealthy nation cannot meet its best potential in the modern world.

Health is only unimportant if employers have such a large labor supply to draw from that they don't have to worry about employees being sick -- and that only if it's assumed that workers are interchangeable gears in a machine. Whenever labor is restricted in supply in any way, it's in the best interest of businesses to know that the health of all laborers is upheld by medical care.

In that light, it's crazy that any capitalist would oppose universal health care, as it is a major step in guaranteeing a useful labor supply.

 

[Kulindahr]

Before EMTALA, patients would show up in the ED with minor complaints and after triage, they would be referred to their primary care physician or a public health clinic.

With EMTALA, because of the requirement that patients be assessed and "stabilized" before they could be referred, it pretty much transformed EDs into free clinics regardless of ability to pay. And you're right- the cost for the uninsured is picked up by the insured as part of the overhead costs billed by the hospital.

Under the ACA, all emergency care is considered "in network", so the reimbursement from insurance is guaranteed. If the mandate were effective and everyone had insurance, some of that overhead cost would be eliminated which would lower the cost for everyone.

I remember going to an ER with an injury once only a few years before the ACA. It was in an urban area, near downtown, and the place was a madhouse. I waited over two hours for more than a cursory assessment to establish my priority.

In the last several years I've been to an ER three times, and the longest wait was twelve minutes.

 

[fabulouslyghetto]

I never know what to say on the topic of healthcare because it endlessly confuses me why it's a paid-for privelege. Government never runs out of money for wars or expansion projects, tax cuts for big corporations or private jets and luxury vacations but as soon as somebody gets a cold (or cancer) suddenly we're the poorest country in the world.

 

[KaraBulut]

Under the ACA, all emergency care is considered "in network", so the reimbursement from insurance is guaranteed. If the mandate were effective and everyone had insurance, some of that overhead cost would be eliminated which would lower the cost for everyone.

Interesting idea -- it would allow market forces to work more freely.

EMTALA came about because of patient-dumping. Before EMTALA, hospitals didn't want to deal with the large number of uninsured people and the proliferation of preferred-provider networks. If an uninsured patient or out-of-network patient showed up in a hospital ED, the registration staff would look at a patient's insurance status and they would send them to other hospitals without evaluating their condition. Of course, it was no coincidence that for-profit hospitals would send uninsured patients over to not-for-profit hospitals to avoid seeing them.

EMTALA said that hospitals had to assess patients and determine their condition before evaluating their insurance status. It also said that if the patient is pregnant, the hospital must evaluate both the patient and the fetus.

The ACA mandates insurance, expands Medicaid and it also removes the "preferred provider" requirement for emergency conditions. That pretty much removes the problem that EMTALA was designed to fix.

It would be acceptable at this point for there to be a requirement that all patients are triaged by a nurse in the ED. If the patient does not have an emergency condition, they should be referred to a clinic or their family physician. But because not all states expanded Medicaid and because of the efforts to undermine the ACA, we're probably stuck with EMTALA in its present form.

I remember going to an ER with an injury once only a few years before the ACA. It was in an urban area, near downtown, and the place was a madhouse. I waited over two hours for more than a cursory assessment to establish my priority.

In the last several years I've been to an ER three times, and the longest wait was twelve minutes.

EDs have completely restructured the way they do business. Instead of sitting in a waiting room, you can expect that a triage nurse will see you within 15 minutes of arrival. The nurse will assess you and assign you an acuity score that determines who will see you and how fast you will be seen.

Some very smart EDs have setup a Fast Track area that is staffed with physician assistants or nurse practitioners. If you have a minor condition- a fever, an infection, having stitches removed, etc- you are sent into Fast Track which runs more like an outpatient clinic. Moving low-acuity patients out of the emergency room opens up beds in the emergency room for patients who actually need to be seen by an emergency room physician.