Did you hear that you can't keep your policy even if you liked it?
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SkyDekker, in Speakers Corner
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turtlespeed 212
bodypilot90and rates skyrocketing....where is the promised $2500 reduction.
a lie as well
But the rates would have gotten there anyway!
Like in 15 years or so.
I'm not usually into the whole 3-way thing, but you got me a little excited with that. - Skymama
BTR #1 / OTB^5 Official #2 / Hellfish #408 / VSCR #108/Tortuga/Orfun
BTR #1 / OTB^5 Official #2 / Hellfish #408 / VSCR #108/Tortuga/Orfun
wmw999That's how insurance works. Alternatives are to have her simply die quickly, or have the government (which is also us) pay for her expenses, or have her be rich in the first place -- because for her to become employable and pay for future expenses, she'll have to have some rehab and help.
The problem with health insurance is that we got a system that the government de facto mandated. Why are there so many uninsured? Because there was a long-standing government inducement not to be (EMTALA).
The ACA actually tries to fix that. But does so in a way that, in my personal opinion, is the quintessential act of corporatocracy - forcing citizens to buy private service from private entities.
QuoteEdit to add: What do you see as alternatives? One can't go back in time.
Get rid of EMTALA would have been a great start.
[Quote]My car insurance pays for the guy who got drunk and wiped out an entire family. Sucks, because I don't drive drunk, but that's how it is.
Right. That's insurance.
[Quote]I'm not in the high-risk pool, so I don't keep paying for him,
Bingo. You've been responsible and proven to be a lesser risk. The private market thus has given you a reward of being in a low-risk pool and paying lower insurance costs.
[Quote] but we don't treat cars like healthcare.
I think that's part of the problem - we don't. What the ACA has done is said, "Wendy. You've been a great driver. But, we have to make insurance affordable for everybody. So you need to pay more so that the DUI guy can afford his insurance. Additionally, you make good money, and he's unemployed. So that means more from you so he can afford coverage."
And this is supposed to lower cost? No. It amplifies moral hazard.
[Quote]I've said before that Obamacare isn't the best model -- but it's better than what we had, in part because it thinks about more parts of our healthcare complex, and in part because it will require change, which might just hone in on a more sustainable model.
The term "better." Better for whom? By what metric? There is no such thing as better for everyone. And I think that may be my biggest problem.
Exactly who is the ACA better for? Identify those people/groups/big corporations. Those who aren't identified? It's worse for them.
My wife is hotter than your wife.
wmw999 2,131
I understand the issue with EMTALA. I also understand the issue with patient dumping. There isn't a good answer, is there?
EMT's don't want to be in the business of leaving people in wrecks if they can't verify insurance, and they probably don't like it when they have to pick and choose hospitals based on insurance -- their job is to transport injured parties to hospitals.
As far as "better" is concerned, it's going to be hard to quantify, because there are so many aspects. Personally, I really liked Tom Aiello's basic-insurance-for-all plan. I'd also be in favor of a basic nationalized healthcare system, with additional benefits being available for money. The biggest problem with that second is that the definition of "basic" is always a moving target, and someone in the gummint would be in charge of hitting it.
What we have had is awful; ACA may or may not be better -- all the yelling is going to make it hard to tell.
Wendy P.
EMT's don't want to be in the business of leaving people in wrecks if they can't verify insurance, and they probably don't like it when they have to pick and choose hospitals based on insurance -- their job is to transport injured parties to hospitals.
As far as "better" is concerned, it's going to be hard to quantify, because there are so many aspects. Personally, I really liked Tom Aiello's basic-insurance-for-all plan. I'd also be in favor of a basic nationalized healthcare system, with additional benefits being available for money. The biggest problem with that second is that the definition of "basic" is always a moving target, and someone in the gummint would be in charge of hitting it.
What we have had is awful; ACA may or may not be better -- all the yelling is going to make it hard to tell.
Wendy P.
There is nothing more dangerous than breaking a basic safety rule and getting away with it. It removes fear of the consequences and builds false confidence. (tbrown)
DanG 1
QuoteGet rid of EMTALA would have been a great start.
No medical care for the indigent, huh? Do you really want to live in that country?
- Dan G
GeorgiaDon 340
According to a former student of mine who is now an EMT, it is not uncommon for patients to be transported to the hospital without their wallet/purse/proof of insurance or bank account. When a patient is having a heart attack or has been in a serious wreck, seconds count (ever hear of the "golden hour"?). EMTs don't waste time looking for the purse or wallet that flew out the car window in the wreck, or searching the house for proof of insurance before transporting the patient. When that patient gets to the hospital, medical staff evaluate the patient and begin treatment as soon as is necessary to have a shot at saving their life. Police or family will bring in the ID/insurance info when they can.QuoteGet rid of EMTALA would have been a great start.
Do you really want a system where people are left to die because their purse flew out the window in the wreck, or because the EMTs don't know where to look for an unconscious heart attack victims wallet? Where people who have paid for insurance are denied care just when they most need it because of a circumstance beyond their control.
Lawrocket, I've asked you this before when you brought up the "get rid of EMTALA" line, and you never answer. Perhaps you are thinking solely of the person who walks into the emergency clinic and demands care they have no intention or ability to pay for, but there are lots of ways for an unresponsive patient to arrive at the hospital without ID. If you advocate getting rid of EMTALA, how do you think hospitals should deal with such patients?
Don
_____________________________________
Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996)
“Education is not filling a bucket, but lighting a fire.” (Yeats)
Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996)
“Education is not filling a bucket, but lighting a fire.” (Yeats)
dpreguy 14
"Wonder if it is widespread"? According to MSNBC, 5 million.
turtlespeed 212
dpreguy"Wonder if it is widespread"? According to MSNBC, 5 million.
So Far.
I'm not usually into the whole 3-way thing, but you got me a little excited with that. - Skymama
BTR #1 / OTB^5 Official #2 / Hellfish #408 / VSCR #108/Tortuga/Orfun
BTR #1 / OTB^5 Official #2 / Hellfish #408 / VSCR #108/Tortuga/Orfun
mistercwood 287
lawrocket
(1) So long as that person has remained insured, that person cannot be denied coverage. That's been the law for about 30 years now.
Please do correct me if I'm wrong, but isn't that kind of moot? My understanding was that the vast majority of Americans get their health insurance via their employer. But there aren't the same kind of unfair dismissal protections as say, I'm used to. So you end up with the following sequence happening very easily:
Doc: Jim, you've got cancer. We'll need to start treatment right away.
Next Day at work...
Jim: Boss, I got cancer. I'l need some extra time off work for treatments.
Sometime later...
Boss: Sorry Jim, I gotta let you go. Budget cuts, you're not working the hours I need you to, blah blah blah some excuse that's barely justifiable but still legal.
Soon after...
Jim: I'd like to buy insurance please, I need to get treatment so I can get better and get back into the workforce
Insurance Company: Seems you got cancer. We're either not covering you, or we're going to charge you so much you'll need a lottery win to cover the interest.
As I said, I could be way off. But my understanding was that my scenario here was perfectly legal, and not necessarily uncommon.
You are playing chicken with a planet - you can't dodge and planets don't blink. Act accordingly.
I am not suggesting that people in need of medical assistance not get treated. In fact, even prior to EMTALA, there were trauma centers and ambulance services and the like. What did they do? They took care of these Level I and II and III and IV traumas. Remember the show "Emergency?" Every time eliminating EMTALA is mentioned, the flippant and ill-considerd conclusion is that emergency medical service will be eliminated.
Are you suggesting that people without identification and health insurance and a checkbook to pay copays and deductibles were left in highway intersections as food for crows before EMTALA was enacted? I can tell you that EMTALA resulted in the closing of lots of emergency rooms and trauma centers. The 1990s was a bad decade for trauma centers. It's why the Mayo clinic doesn't accept medicare anymore - it is free of EMTALA because of it.
[Reply]Perhaps you are thinking solely of the person who walks into the emergency clinic and demands care they have no intention or ability to pay for, but there are lots of ways for an unresponsive patient to arrive at the hospital without ID. If you advocate getting rid of EMTALA, how do you think hospitals should deal with such patients?
Are you suggesting that people without identification and health insurance and a checkbook to pay copays and deductibles were left in highway intersections as food for crows before EMTALA was enacted? I can tell you that EMTALA resulted in the closing of lots of emergency rooms and trauma centers. The 1990s was a bad decade for trauma centers. It's why the Mayo clinic doesn't accept medicare anymore - it is free of EMTALA because of it.
[Reply]Perhaps you are thinking solely of the person who walks into the emergency clinic and demands care they have no intention or ability to pay for, but there are lots of ways for an unresponsive patient to arrive at the hospital without ID. If you advocate getting rid of EMTALA, how do you think hospitals should deal with such patients?
The way they did BEFORE. Why? Because their presence is compromising the care for the true emergencies. EMTALA turned the ER into the primary care provider for millions. Sure, I could be uninsured, have a pcp, pay $50 and get assessed and treated. Or, go to the ER, pay nothing, get assessed and maybe even get some antibiotics given to me.
It's inefficient. It's rationed. It's expensive. It's hazardous. And it's policy.
Leave the primary care to a pcp. Leave urgent care for urgent care. In fact, having a policy that saves emergency rooms for either ambulance or referral could be a better idea.
Save the emergencies for emergencies. For some reason, this is a lost concept. A law designed to prevent the outlier from occurring made things just that much worse. So instead of making the 30 minute trip to the county hospital (which they used to do), they go to the nearest ER and wait.
So short answer: no. I don't want that. Question: why do you think emergency medical care started with EMTALA?
My wife is hotter than your wife.
wmw999 2,131
I agree with this.
I also agree that there was abuse that led in part to EMTALA. Patients who were moved to other hospitals when not particularly stable, because of the insurance.
I don't know where the balance belongs, we don't have it now, and we didn't have it then.
Wendy P.
I also agree that there was abuse that led in part to EMTALA. Patients who were moved to other hospitals when not particularly stable, because of the insurance.
I don't know where the balance belongs, we don't have it now, and we didn't have it then.
Wendy P.
There is nothing more dangerous than breaking a basic safety rule and getting away with it. It removes fear of the consequences and builds false confidence. (tbrown)
GeorgiaDon 340
QuoteIn fact, even prior to EMTALA, there were trauma centers and ambulance services and the like. What did they do? They took care of these Level I and II and III and IV traumas.
From this source:
"HISTORICAL PERSPECTIVES
In 1986 and 1987, 2 articles appeared in the literature by physicians from Cook County Hospital in Chicago detailing the extent of patient dumping to that facility (1, 2). The authors defined dumping as “the denial of or limitation in the provision of medical services to a patient for economic reasons and the referral of that patient elsewhere” (1). The majority of such transfers to Cook County Hospital involved patients who were minorities and unemployed. The reason given for the transfer by the sending institution was lack of insurance in 87% of the cases. Only 6% of the patients had given written informed consent for their transfer. Medical service patients who were transferred were twice as likely to die as those treated at the transferring hospital, and 24% of the patients were considered to have been transferred in an unstable condition. It was concluded that this practice was done primarily for financial reasons and that it delayed care and jeopardized the patient's health. This practice was not limited to Chicago but occurred in most large cities with public hospitals. In Dallas, such transfers increased from 70 per month in 1982 to more than 200 per month in 1983 (1)."
and (my bolding for emphasis):
"The ironic twist to this story is that safeguards for indigent patients already existed; however, most were guidelines without the force of law that were being ignored by private hospitals and doctors. The Joint Commission on Accreditation of Hospitals stated that “individuals shall be accorded impartial access to treatment or accommodations that are available or medically indicated, regardless of race, creed, sex, nationality, or sources of payment for care” (3). The American College of Emergency Physicians had similar language in its bylaws (4). The Hospital Survey and Construction Act of 1946 (commonly called the Hill-Burton Act) had established federal guidelines for emergency medical care at certain hospitals, and many state laws were also on the books mandating nondiscriminatory access to emergency care (1)."
So no, people were not being left in highway intersections as food for crows, but they were being put at the back of the line, behind insured patients with more minor complains, and they were being shifted from hospital to hospital or dumped back on the street before they were stable, and people died as a result. EMTALA was a response to public outcry over these practices.
Is EMTALA perfect? Clearly not. But what reason is there to believe the problems that led to its enactment won't return, but even worse (given that there are fewer facilities available to treat people now than there was back when the law was first enacted)? Rather than simply repealing EMTALA and trusting that everything will return to a Norman Rockwell version of America that never really existed, it would be more useful to consider approaches that replace EMTALA with a system that would function better. Of course to do that we would have to define "function better", and that would necessarily involve a discussion of ethical values we would want reflected in our society. Can we agree as a society that people have intrinsic worth, and should not be left to die or suffer unnecessarily because of a circumstance of the size of their bank balance? Or should we choose to embrace a vision in which people are commodities to be exploited for labor or profit, but are otherwise disposable (our own immediate families excepted, of course)?
Personally, I would favor funding emergency and trauma centers, and clinics to provide basic non-emergency care, out of a sales tax. None of us are immune from risk of needing emergency or trauma care, and none of us are benefited by having people with infectious disease such as TB walking around untreated. Everyone pays sales taxes, as everyone buys stuff. At the same time insurance premiums could (and should) decrease if the risk of huge ER bills went away, so those of us who pay for insurance would have the sales tax at least in part offset by reduced premiums. A network of publicly funded ER and trauma clinics could eliminate the need for EMTALA without returning us to the days of patient dumping.
Don
_____________________________________
Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996)
“Education is not filling a bucket, but lighting a fire.” (Yeats)
Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996)
“Education is not filling a bucket, but lighting a fire.” (Yeats)
okalb 79
I just helped another friend get a new policy yesterday. She was paying $550/month with a $3000 deductible and a max out of pocket of $5K. Her new policy is $470/month with a $0 deductible and $2000 max out of pocket. She had 2 surgeries last year (shoulder/knee) and would not have been able to switch policies without the ACA because they would have been considered pre-existing conditions in the past. She could have paid $370 if she wanted to keep the deductible the same as she had, but decided to pay the $470 since it was less than she has been paying for the past few years and had a zero deductible.
Time flies like an arrow....fruit flies like a banana
and rates skyrocketing....where is the promised $2500 reduction.
a lie as well
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