Are you under the impression that insurance companies will routinely pay claims for ED visits for non-emergencies? At best, the patient will have a high co-pay. At worst, they’ll deny the claim.
I don’t think a poor patient will be able to pay their high co-pay or their hospital bill.
I apologize, I exaggerated. But roughly 35% (instead of “all”) of the hospitals in the US is for-profit. The insurances, on the other hand, that aren’t for-profit are few. You have about 20 BCBS affiliations, a few regionals like Harvard Pilgrim in the northeast, and the rest are profit-motivated. The pharmaceutical industry is completely centered on profit.
And the for-profit bias in hospitals is growing.
The big problem with ER visits is what everyone tends to ignore: If I go to my PCP, I wait three weeks just to get my foot in the door. For my yearly turn and cough? I’ll schedule that several months in advance. For most common things though, i don’t even bother. Most colds/flus/etc I just treat with something OTC and get on with my life. So if I have a flu-like set of symptoms, I wait a week and, if I still got them, I go to urgent care, where I can be seen in two hours or so and then sent to an ER if something is eating through my insidey parts.
Now, what happens if I end up having the latest in stomach cancers? Well, I didn’t go to my PCP and get a preventative checkup for it, and now I’m in the ER for it. Yay! I’m a statistic!
So while there are issues with not getting in early enough, most people are busy with life in general and they don’t have time to wait for their PCP to be available when they get a symptom of some kind. A lot of poor people would go to a free/low cost clinic if they could, but getting into those is even harder than trying to get into a PCP. That’s the main reason the underinsured use ERs (And also why even some insured use ERs).
The ACA attempts to help this by allowing you to see an PA or NP, but that’s not really adding a lot of capacity to the PCP pool in general. It may in the future, but we are already going to nose dive in PCP population (which we have been warned about for the last 10+ years). The ACA doesn’t offer any incentives for someone to become a PCP compared to a specialist of some kind.
We will have to find some way to address this issue if we truly want to drop the number of ER visits. After all, wait timer were such a major issue that Canada spent something like $5 billion to decrease wait times in Canadian health starting in 2003. We will need to do the same.
On point 1), while true, I’d still bet big $ against you - whatever minor reduction in ER visits and chronic condition management expenses will be dwarfed by increased usage in general IMO.
On point 2) IMO it isn’t Universal health care that saves the big bucks, but essentially wage & price controls on Health care providers and Health care services that save the big bucks. We went out of our way not to do anything like that with the ACA (which is why I think the ACA is far better than our current system, but still crap).
And, they predictably have fewer bright people who are willing to sign on and spend years of their lives slogging through medical school so that they can be paid government salaries instead of market determined rates. So then how do they make up the shortfall? Have doctors come in as immigrants, typically from third world countries where medical training is usually subsidised.
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I’m a little bitter about this. By not letting the market decide doctor salaries, which should be very high - these are very bright people who study very many years, work very hard and live very busy lives - they reduce the supply of people wanting to become doctors, and make up the shortfall from countries like India, which need those doctors quite a bit more. And then the NHS gets touted as a system everybody loves, because the distortionary costs can be passed on to someone else.
Canadian GPs make in the area of $200,000 CND a year. That’s $195,000 USD/£125,000 British Pounds. US GPs make between $150,000 and $190,000 a year. Canadian short falls of providers aren’t from what the doctors are paid.
British, shortfalls, however, certainly can be (but I have little experience with British health). British doctors who are apart of a clinical commission group make £54,319 to £81,969, which is significantly lower than Canadian or US doctors.
Relative cost and length of medical school must be factored into that, too. U.S. doctors average something like $250K in debt when they graduate, and those high salaries don’t start until the residency is over–which may be some years after graduation.
In that case, I need to be a doctor after schooling in Canada. According to this site, in the 2010/11 school year, tuition for doctors averaged $13,660 ($13000 USD) across all of Canada.
In Britain, they charge roughly £4,000 ($6500 USD) a year.
Canada is still heads, shoulders, and butts above Britain and the US in terms of pay.
Insurance company worker:
I can comment on paying non-emergency room visits. Some of our policies have the “prudent layperson” standard in writing, but we don’t enforce it. In fact most claims, including ER claims, are never touched by a human. To enforce it we’d have to have a staff physician or nurse manually review every ER claim (and we pay those people a lot), and probably request documentation from the provider, so it’s not worth our effort to deny ER claims. We do have blacklist of subscribers that are obviously abusing the system singled out for extra attention, usually the ones on Medicaid so they have no deductible or copay, but these are few and far between.
A government forcing an independent insurance company to insure someone with a pre-existing condition may not be socialist but it sure borders on totalitarian. It may be the warm and fuzzy thing to do but certainly not what one would expect in a free country. Oh yeah, I didn’t hear that on Fox News.
As a matter of fact, getting ‘insurance’ for pre-existing conditions is quite misleading. Insurance is by definition an attempt to insulate people from the impact of low probability but high impact events. A pre-existing condition means that’s not true anymore.
It is when you have everyone in the pool. Like pretty much everyone of the nations we compete with economically do. It’s been shown to provide the same or better levels of overall care just about everywhere. Most everyone agrees that the model we had been working under was unsubstanible.
You know what else everyone hates? Sore losers.
If you’re replying to my post, I have no stake in the US healthcare insurance market(apart from the fact that it’s setting a bad example). And it is a fact that if you compel insurance companies to sell ‘insurance’ to people with pre-existing conditions. you shouldn’t refer to it as insurance anymore. It’s like selling accident insurance to the guy with a totaled car outside. For the accident that totaled it.
Like most states do with car “insurance”? Good drivers and bad have to have insurance and they can shop around for better deals. Just like the ACA does.
Except that if you have a wreck, you can’t buy new insurance and have your new carrier cover it.
Bad anology. You can buy new car insurance. The wreck was covered under your old policy.
But basically the old way of doing health insurance wasn’t working and was unsustainable so they rewrote the definition of insurance. With a law. That’s the way it happens when you play by the rules. They pass a law to define things.
Alright. If you can’t understand this one, I’ll give you another one. It’s like trying to buy disaster insurance for your house after a tornado has ripped the roof off. And trying to get them to pay for the roof.
What these examples sharply illustrate is how badly suited the insurance model is to healthcare delivery.
This particular problem is sometimes referred to as “the umbrella that melts in the rain” problem. The people most in need of healthcare are the least attractive customers.
It’s also that most people have trouble understanding a paradigm shift in long standing practices such as healthcare. The analogies they cite are based on applying problems to the old system while not yet understanding (or not wanting to understand) how the new system is being set up to handle things like pre-existing conditions.
Is the ARC perfect? No, nothing in life is perfect but that doesn’t mean you don’t face problems and deal with issues when they come up. Playing up the fear card all the time is getting old and not really worth responding to at this point.
+1
Socialized medicine would be even better.