It is my understanding that Conservatives object to having to pay for other people’s healthcare. We’re not a society that just lets people die on the street (yet, and for the most part), so even if Paul Ryan passes his Wet Dream of All Wet Dreams and a couple of tens of millions of people lose their coverage, Conservatives are still going to pay for other people’s treatment.
When someone goes to the E.R. and cannot pay, the hospitals have to recoup the costs somehow. So they charge more for the care they provide, insurance companies raise their rates, and everyone who has insurance pays for other people’s healthcare.
Do you think this is the way it should work? Since you’re going to pay for other people’s healthcare anyway, is there a more efficient – and cheaper – way to do it?
First of all, let me state for the record that I totally think that the USA should implement some form of universal single-payer health care.
But I believe that the objection in the interview can be addressed within the current system. If ER care is more expensive to provide than physician-based primary care, but people who can’t afford health insurance impose themselves upon the ER to great cost - why don’t hospitals simply have a two-tiered ER, one for genuine emergencies, and one that has a clinic of on-staff primary care physicians for the type of problems that should be handled by such?
This sounds a bit like blaming the victim. Suppose someone has, say, a staph infection. It’s not life-threatening, but it’s very painful. He has no coverage, and cannot afford to pay out-of-pocket for a doctor’s visit. Is he ‘imposing’ himself upon the E.R.? What other option does he have?
There exist free clinics, but I haven’t heard of any within a hospital. (Fortunately, I am not in a position to know where free clinics are.) And still, ‘free’ clinics need to be funded.
What I’m getting at is this (and let me say I agree with both of you that we should have universal, single-payer health care): I hear Conservatives say that people should take responsibility for their own health care. I hear them say that people shouldn’t make poor choices. I hear them object to paying taxes to pay for other people’s treatments. And yet they seem to have no clue that they’re already paying for other people’s treatments through higher premiums and, due to higher costs, higher copays. So my question for Conservatives is whether it makes more sense to not have to pay insurance premiums, either entirely out-of-pocket, or through a deduction from their pay check, and instead have a deduction from their pay check that funds a single-payer system?
I agree that there is probably a more efficient way to do it than the ER-as-doc system. But, as a conservative and anarcho-capitalist, I have ZERO FAITH that putting it in the government’s hands will make anything cheaper or more efficient. Better to keep everything as free-market as possible.
(answering seriously while acknowledging the smiley at the end of your question) U.S. Capitalism does not exist in a vacuum. The Sherman Anti-Trust Act is an excellent example of the government stepping in to prevent the citizens from getting screwed over by the insufficiency of pure free-market solutions. The way the hodge-podge of US health care has evolved has introduces inefficiencies that are costing the citizens (and the government!) of the United States a bundle. It’s past time to enact some sort of solution that cuts out the middlemen and makes the overall delivery more efficient.
Obviously, when all that exists for emergency care is an ER, that’s where such a person will go. (related adage - when all you have is a hammer, every problem looks like a nail) But it seems to me that this Pollack fellow is complaining that the ER resources are expensive and ill-suited to people who really only need a simple doctor visit. So I’d think the obvious solution is to have a less-expensive emergency room for those whose problems do not require true ER care.
I’m not talking about free. I’m just parsing the problem expressed by this Pollack fellow in the quote you cited in the OP and proposing a solution that lets hospitals provide the care that people coming to the ER need to get without costing what it costs to provide ER care.
The interview snippet in the OP doesn’t seem to be objecting to universal health care. It seems to be talking about the problems that hospitals face in providing emergency care to all, and he blames it on the fact that many of the people seeking the mandated emergency care don’t really need emergency care, which leads to a great burden on the hospitals.
As a conservative, I think it’s because “insurance” *feels *different than “governmental pool,” even if it’s similar. The whole private vs. public thing.
I don’t think single-payer should be seen as a liberal vs. conservative thing, and the sooner it can shed a left-wing label the sooner it can get bipartisan support.
That being said…
If we can’t get single-payer, then this:
Put cost ceilings in place. How can the electricity to run an MRI possibly cost more than $10? The machine itself is a sunk cost. How can an ambulance ride cost more than 2-3 times a taxi?
Punish patients who can pay, but willfully don’t.
Make med school much cheaper.
Penalize hospitals who have fake “shortages” of meds, etc.
Public health insurance option.
Insurers compete across state lines.
Death panels should be discussed.
Reduce insurance premiums.
No more unnecessary preventive medicine.
Cap malpractice damages to something reasonable. $5 million for a broken spine, maybe, but not for a broken pinky.
What indication do we have that emergency room visits have been reduced under Obamacare? AFAICT that’s not necessarily true.
How is that different from a walk-in clinic that’s open 24/7? I don’t see how such a clinic would be less expensive than an emergency room - it has to be staffed all the time, patients have to be triaged/diagnosed/treated or referred.
And if we had single payer, taxes would have to be raised by the same amount as insurance rates went up.
I’m sure there is, but it has little to do with who pays.
The idea of Obamacare was to make everybody buy health insurance (with subsidies for those who couldn’t afford it), and that would increase the size of the risk pool and that would pay for all the people with pre-existing conditions and all the things that Obamacare mandated had to be covered and premiums were going to go down because lots more people were paying in. That didn’t happen. Another idea is that preventative care was going to save a lot, especially in ER visits. That also doesn’t seem to have happened. There is very little evidence that preventative care saves money, overall. Obamacare did cover a lot more people, but in terms of reducing costs, not so much. Single payer isn’t going to be any different. Everybody would be covered, demand goes up, you get more ER visits and more PCP visits. Saving money on administration? I had to negotiate the health care exchanges in my state, and it took me six hours a day for more than a week.
If we wanted to save money on health care, we will need to implement some kind of rationing, and that will require a sea change in expectations and culture. No one is going to like it - patients won’t like it, doctors and hospitals will hate it, drug companies will hate it. And people will die, because we don’t want to spend the money.
Is that how it should work? That’s how it does work. Shielding people from the cost of health care, either thru insurance premiums or thru taxation is not going to fix that. And no amount of “it’s cheaper in Canada” is going to help - the US is bigger, more diverse, has more violent crime, we’re fatter, and people are used to the best health care in the world.
How is it not self evident that it is oodles cheaper to subsidize insurance premiums for the poor and the destitute, than it is to continue paying for their uninsured costs? Their catastrophic, (the MOST expensive) care, where no early intervention or health maintenance is accommodated, AT ALL, are huge!
If the rest is all too complex, will piss off the mighty, or whatever, why, oh why, wouldn’t you at least want to realize the enormous cost savings such a measure would immediately produce?
(It’s pretty hard not to assume it’s because the poor and the destitute are unworthy or somehow deserving of punishment.)
It’s not, except that the hospital is having a problem with people who would be better off with one of those using their emergency room. If that’s causing their costs to be high, then maybe they get a cost savings from opening one up.
The impression I have gotten is that primary care for simple problems is less expensive than emergency room care. I’m not entirely sure why, but it seems that from the quote in the OP.
I think that’s a misunderstanding of the problem. People aren’t going to the ER for sore throats. They’re going to the ER after ignoring all those little problems they should have seen a regular doctor for but couldn’t, at which point it has become a legitimate emergency. And then the ER gives them the bare minimum care required to keep them from dying right then and there, and then tosses them back onto the street to begin the cycle over again. Often with a useless prescription in hand for medicine they absolutely need but can’t afford. See you again next week!
No shit, that’s the very question we’re debating. Should healthcare be rationed such that millionaires can get hair transplants and braces while people with treatable cancer die for lack of funds? Or is there a better way to ration healthcare?
The question isn’t will we ration, because that’s an economic fact of life for all goods and services. The question is how we will ration.
Would you include reconstructive cosmetic surgery?
You have at least a driver and an EMT in the ambulance, so you are already looking at a higher labor cost.
Taxis cost maybe $20,000 to buy and outfit, I couldn’t tell you what an ambulance costs to buy and outfit, but at a guess, it’s a bit more. WAG: $250,000.
They do, they send them bills, take them to court, and garnish their wages.
I agree entirely here. Not just cheaper, but not as long either. We don’t need people with 8 year degrees handing out z-packs.
You should have a tier of medical professionals, from essentially a nurse practitioner toe a brain surgeon. We should have far more of the low level running around, administering to the somewhat sick and injured, and allowing the people with more aptitude and training to work on the more complicated cases.
Is this a thing? If so, I agree, but I hadn’t heard of this sort of fraud from hospitals before.
Absolutely.
Well, with the public option, I guess this doesn’t matter, but I always see this as a problem, as then you will have states lower their requirements, and all the insurance companies will move there. This is a race tot he bottom where you can no longer get the kind of medical coverage that your state requires an insurance company to provide, as there are no longer any insurance companies in your state, because they all moved out.
That said, I do not have a problem with states voluntarily entering into reciprocity with other states, allowing the insurance of another state to be sold within its borders, but a federal law telling the states that they have no right to control the kind of insurance sold in their borders is a non-starter to me.
Discuss? What do yo mean by that?
At some point, everyone has to die, and if we have no sort of “death panel” and we have the govt paying for medical treatment, then sure, someone could be using millions of dollars of medical resources to eak out every next minute, and that sort of thing might be a thing to limit.
But for anything reasonable, and especially anything that is actually a bridge to better health, those decisions should only be made by the patients and their doctors.
Great idea. How? Using subsidies, or just requiring insurance companies to charge less?
What do you deem necessary?
Now, if there is a treatment that costs tons of money, and prevents an extremely rare issue, then I would agree that that is probably unnecessary.
But most things that are preventative end up saving money, not just in the long run, but pretty quickly.
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I think that 5 million is probably much higher than what current payouts are, even for death.
Malpractice payouts usually cover the medical costs required to fix what the first procedure did wrong, or to provide assistance to those whose quality of life has suffered i.e., your broken spine patient will need a home nurse, wheelchair ramp, a van with wheelchair access, and so on.
Only if the doctor or hospital is shown to be negligent or willfully malicious are you going to get any sort of multimillion dollar payout.
A large part of the cost is that it is taking up valuable real estate in a hospital. Opening up a second clinic in the same hospital will do very little good.
If you want to reduce costs, get people to go to urgent care centers. These cover 90% of your needs, and are significantly cheaper.
On this one, I don’t line up with most so-called ‘conservatives’* - I’m both technically educated and I at least try to be a good Christian.
Compassion and enlightened self-interest tell me that looking out for the other members of my community are good for my health and well-being, too. The extra cossts of caring for the less fortunate are investments in community. And yes, I help where I can with homeless, and I volunteer at things like the local Nature Center, so that I don’t have to pay as much in cash taxes for those features of a decent community in which to live - I pay in time and effort, instead.
I also take a pretty legalistic/acadmic view on what is and isn’t a true conservative - Most of what people label ‘conservative,’ I consider reactionary, or worse.
The free-marketers have to explain why we in Canada pay about 2/3 as much per capita as Americans and have generally better outcomes.
I read an article recently about medical coders. It is a huge operation. Half of the them work for hospitals and their job is to code each procedure as expensively as possible. The other half work for the insurance and their job is to fight the first half. All that costs money and is an utter waste. Hospitals in Canada are all non-profit, funded entirely by the government. When I was growing up in Philadelphia, most of the hospitals were either under the aegis of churches (I was born in the Presbyterian Hospital), medical schools, or municipalities and non-profit. Now they are mostly private, hugely profitable with bloated overpaid administrations. They take out full-page ads in the NY Times Sunday Magazine.
Free market makes sense only when the market is free. You generally don’t have meaningful choice.
Oh, if you are diagnosed with a serious illness in the ER (e.g. cancer), they have no obligation to do more than fix you up and ship you out. After that, you are on your own. Good luck.
And if you don’t want to pay for my medical care, I don’t want to pay for your wars. Don’t brag how antisocial you are.
It’s NOT just the “electricity to run the machine”, it’s the cost of the machine itself being paid for over time, the non-magnetic furniture and supplies near the machine, the cost of producing, maintaining, and if necessary, replacing liquid helium for the super-conducting magnet, the cost of the highly trained people who use and maintain the machine, the cost of the highly trained doctor to interpret the results…
The ambulance costs more than the taxi because it’s driven by people with advanced medical skills (which your taxi driver probably doesn’t have), and a vehicle filled with medical equipment, some portion of which is consumable and needs to be regularly replaced.
This is part of the problem - people such as yourself who equate an ambulance with a taxi which demonstrates a profound lack of understanding of the differences between the two modes of transportation.
We already do this.
How? Cut the pay of the instructors? Elimate gross anatomy so we don’t have to pay for the costs of obtaining, preserving, using, and disposing of cadavers? (sort of sucks if your surgeon doesn’t have adequate grounding in basic anatomy, though…) How do you propose to do that.
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4. Penalize hospitals who have fake “shortages” of meds, etc.{/quote]
Is this actually a problem? Because I haven’t heard of it before your post.
You mean, things like the Medicaid expansion the Republicans are doing their best to eliminate.
How about we just eliminate the middleman entirely? Oh, right, this is what we do if we can’t get single-payer. All this would get us is a race to the bottom - the state with the least regulations and protections will win, and the rest of us will be screwed.
So… you’d be OK if a committee voted to have you killed?
How?
Please give an example of this “unnecessary” preventive medicine. What? Mammograms? Prostate exams? Measles vaccines? What?
Please provide a cite for someone getting $5 million for a broken pinky finger.
“Death panels” were a fake outrage in 2009 over Obamacare, but I think it would have actually been a reasonable thing. If a patient is 95 years old, for instance, it may not be worth it to give him a certain, expensive treatment that will only prolong his life a bit. Or if a vegetative patient has been in that state for twenty years and likely will be there for twenty more years, it may not be worth it to keep expensive treatment ongoing.
Yes, this is fine and necessary. Things like Botox, breast-augmentation, or liposuction for beauty, though, no.
Yup. And if doctors aren’t graduating with $250,000 in student debt, then a case can be made for giving them slightly lower pay, which would also help trim healthcare costs a bit.
Finally, not directly health-care related, but I’d be perfectly fine with sky-high taxes on tobacco, sugary drinks, etc. More governmental revenue, and if it stops some lung cancer or diabetes, I’m sure it more than pays for itself.
The great part is that, once that is in place, then the free market can start filling in the rest, offering supplemental plans with varying degrees of luxury. You want chiropractic or acupuncture? The government plan won’t help you, but a private company will happily step up and sell such coverage.
