Obama: It's OK to borrow to pay for health care

[Bolas 5]

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>This is where payment plans come in. Not everyone skips out in their bills.

I agree. But even here in this forum, we had a poster suggesting just not paying hospital bills so they could better afford rent, food etc. This is common, and is the unofficial "national health care" plan that many people use nowadays.

You said you would call 911 for a friend of yours who couldn't pay. So would I, and I think most people would as well, even if they knew the guy would never pay, and would do whatever he could to "skip out" on his bills. Who pays for him?

And people wonder WHY this stuff is so expensive.

Cuz ya gotta pay for all the deadbeats.

Stupidity if left untreated is self-correcting
If ya can't be good, look good, if that fails, make 'em laugh.

[billvon 3,008]

>And people wonder WHY this stuff is so expensive.

Partly because of people like you and me who call 911 even when we know the guy won't pay.

[Bolas 5]

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>And people wonder WHY this stuff is so expensive.

Partly because of people like you and me who call 911 even when we know the guy won't pay.

Then why should we pay either? Not just for him, but for our own selves?

Stupidity if left untreated is self-correcting
If ya can't be good, look good, if that fails, make 'em laugh.

[wmw999 2,460]

Because it's the right thing to do. And, by consistently paying, we can get a higher standard of care overall, because more vendors will work with us (i.e. those who aren't forced to because of their charter).

Emergency rooms have to treat emergencies, then ask questions.

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)

[Bolas 5]

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Because it's the right thing to do. And, by consistently paying, we can get a higher standard of care overall, because more vendors will work with us (i.e. those who aren't forced to because of their charter).

Emergency rooms have to treat emergencies, then ask questions.

Wendy P.

Sadly I used to believe that.

These days I think the right thing to do would be also not pay and let the system collapse under its own incompotence and mismanagement.

All we're doing now is just delay tactics and the costs to those doing the "right thing" as more people don't pay just keep going up and up.

I agree emergency rooms have to treat emergencies. What they don't have to do is treat Bobby's sniffles.

Stupidity if left untreated is self-correcting
If ya can't be good, look good, if that fails, make 'em laugh.

[mnealtx 0]

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I agree emergency rooms have to treat emergencies. What they don't have to do is treat Bobby's sniffles.

Agreed - abuse of ER (and EMT) services for routine medical issues is a HUGE drain on the system.

Mike
I love you, Shannon and Jim.
POPS 9708 , SCR 14706

[lawrocket 3]

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Who pays for him?

We all do.

An interesting concept, however, would be to institute some rules that would require some form of recompense. For example, let's say there is a $10,000 hospital bill for that broken leg. This could be paid by the taxpayer.

The government then opens a collections action. We see this all the time in child support cases. Rents and mortgages don't mean much in those - the government will ensure that it gets the money.

How about hospitals assigning these cases to the government for immediate collection? The usual thing to do in Cali - even in county hospitals - is to slap a Medi-Cal lien on the property and wait for the debtor to die.

But why not get a payment plan? Wage assignment? Etc. It works for anythign else the government does?

Or, offer a person to do 50 hours of community service per $1k owed?

There are ways.

My wife is hotter than your wife.

[Bolas 5]

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Quote

I agree emergency rooms have to treat emergencies. What they don't have to do is treat Bobby's sniffles.

Agreed - abuse of ER (and EMT) services for routine medical issues is a HUGE drain on the system.

This is what probably bothers me the most. There is a huge economic disensentive (high personal cost, even if insured) to go the emergency room for non emergency treatment. Those that do have to pay, don't go unless it is an emergency.

Such disensentive does not work when the people are getting the treatment "for free."

So how do you discourage those people from going to the ER for non emergency care?

Do you just ban them outright?

What alternative do you offer them?

Stupidity if left untreated is self-correcting
If ya can't be good, look good, if that fails, make 'em laugh.

[billvon 3,008]

>Then why should we pay either?

If your morality is such that you don't care about reneging on debts, then I guess you don't have to, either. Most people, however, are willing to pay the debts they incur.

[billvon 3,008]

>But why not get a payment plan? Wage assignment? Etc. It works
>for anythign else the government does?

I would assume because the worst abusers do not have wages to attach. A payment plan is a great idea provided that the program will pay for itself. In other words, if we spend $50 million to set up a "deadbeat payment agency" and it only can get $40 million out of patients it's not such a great deal.

[billvon 3,008]

>These days I think the right thing to do would be also not pay and let
>the system collapse under its own incompotence and mismanagement.

I'm not sure letting hospitals collapse and doctors go bankrupt is the best way forward.

>I agree emergency rooms have to treat emergencies. What they don't
>have to do is treat Bobby's sniffles.

Exactly. Have an urgent care clinic that's free to Bobby's parents. There's a doctor there who says "your kid has the sniffles. Here's some aspirin. NEXT!" He takes care of 70 patients a day - that's 70 patients that aren't clogging up ER's with the sniffles.

[mnealtx 0]

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So how do you discourage those people from going to the ER for non emergency care?

Do you just ban them outright?

What alternative do you offer them?

Under EMTALA, they at least have to be triaged to determine if they're an emergent case. I've read blogs from medical personnel that *say* that hospitals are afraid of turning away non-emergent cases in fear of a suit under EMTALA, but I don't have any proof of that.

For those that are under welfare/wic/afdc/etc...maybe some sort of voucher for a "doc-in-the-box" local clinic would be an answer. They can still get preventative healthcare/checkups, and they wouldn't be clogging the ER/EMT services. Seems like a win-win to me.

Mike
I love you, Shannon and Jim.
POPS 9708 , SCR 14706

[Bolas 5]

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>Then why should we pay either?

If your morality is such that you don't care about reneging on debts, then I guess you don't have to, either. Most people, however, are willing to pay the debts they incur.

I pay my way and support myself. However that seems to be rapidly becoming the exception not the norm...

Stupidity if left untreated is self-correcting
If ya can't be good, look good, if that fails, make 'em laugh.

[Bolas 5]

Quote

>These days I think the right thing to do would be also not pay and let
>the system collapse under its own incompotence and mismanagement.

I'm not sure letting hospitals collapse and doctors go bankrupt is the best way forward.

And pumping billions or trillions to prop them up is?

Sure we'd lose some hospitals and maybe some doctors, but the majority would figure out how to survive and thrive versus being on life support now.

Sometimes the best way to move forward is to start again anew...

Stupidity if left untreated is self-correcting
If ya can't be good, look good, if that fails, make 'em laugh.

[TomAiello 26]

Interesting article on the costs of the Obama plan here.

Amazingly, the Congressional Budget Office estimates that coverage for 16 million of the currently uncovered 51 million people (roughly 1/3 of those currently uninsured) will cost a trillion dollars. What would it cost to cover the other 2/3rds?

-- Tom Aiello

Tom@SnakeRiverBASE.com
SnakeRiverBASE.com

[billvon 3,008]

>I pay my way and support myself. However that seems to be rapidly
>becoming the exception not the norm...

Yep, that is indeed a problem.

>And pumping billions or trillions to prop them up is?

Nope, the system we have now is broken; there is surely a better way to do it.

>Sure we'd lose some hospitals and maybe some doctors, but the majority
>would figure out how to survive and thrive versus being on life support
>now.

Sure, there's an easy way that will let any hospital avoid this issue. Turn away people. That friend of yours who is lying bleeding in the landing area? No ER will take him; he will die and not saddle the hospital with debt.

Fortunately we do not consider that a viable solution.

>Sometimes the best way to move forward is to start again anew...

That may well be! We just need a better system.

[lawrocket 3]

I decided to take a look at the source of healthcare spending.

Here's some stuff put together:
http://www.cms.hhs.gov/NationalHealthExpendData/Downloads/proj2007.pdf

Something of note was that in 2009, they estimated $2.105 trillion in healthcare spending. Out of pocket spending was $256.5 billion. This means that $1.849 trillion was spent by thrid-party payors.

Private funds (insurance, etc) paid $878.7 billion of the third party payor-claims. So ou tof this $2.106 trillion, private pay was responsible for $1.135 trillion.

$970.3 billion comed from the government. The largest third party payor is the government! Tyhe government (federal and state) spends 110% of the third-party payments. The Federal government alone spent $704.9 billion.

So, how is it that private insurance is responsible for the problems in government when private insurance is responsible for 34.4% of the payments in health care?

It seems there is more at work and insurance companies are a convenient scapegoat for the government - who owns a bigger share of the health care economy in the US.

My wife is hotter than your wife.

[millertime24 8]

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Interesting article on the costs of the Obama plan here.

Amazingly, the Congressional Budget Office estimates that coverage for 16 million of the currently uncovered 51 million people (roughly 1/3 of those currently uninsured) will cost a trillion dollars. What would it cost to cover the other 2/3rds?

$3 trillion?

Muff #5048

[lawrocket 3]

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Under EMTALA, they at least have to be triaged to determine if they're an emergent case.

Ah, EMTALA. If you want to move toward a socialist system, the best way to do this is to create a federal law that wreaks havoc with the health care industry. Take some bad examples, say there ought to be a law, and pass a law to prevent that conduct.

The Emergency Medical Treatment and Active Labor Act was passed as part of the 1986 Onmibus Budget Reconciliation Act. It was to prevent patient dumping. People would show up at ER's and the hospitals wouldn't see them because they wouldn't pay. Members of Congress thought that was awful, so Congress decided that for all hospitals that accept Medicare.

So EMTALA requires any hospital with an ER to examine and stabilize any person who walks through the door - that's it. Anybody, The ER must perform an examination and assessment. If the person is found out to have nothing, the person may be discharged with their informed consent. If the person has something wrong, the person must be admitted or stabilized and transferred.

Here's the kicker - Congress doesn't fund it. Hospitals are required to do it by law, and are not paid. Now you've got places like California where half of all ER treatments are uncompensated. Hence, costs are shifted to those who DO pay - leading to the increases in health care costs.

ER's and trauma centers used to be plentiful in the Los Angeles reason. Not anymore. They are going out of business. I think roughly 75% of trauma centers in California have been closed.

Now we've got fewer ER's and more people seeking treatment. This means the long delays that can be found in an ER nowadays.

I can trace a substantial amount of the economic issues with medicine to EMTALA. An unfunded mandate. How does one do socialized medicine without calling it socialism? By forcing hospitals to treat people for free.

And we see the effects.

p.s. many of you think, "Well, let them not accept Medicare." This isn't a bad thought. The problem is that at that point, the hospital takes itself out of more than 25% of the sources of income.

It is a practical impossibility.

My wife is hotter than your wife.

[justinb138 0]

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Interesting article on the costs of the Obama plan here.

Amazingly, the Congressional Budget Office estimates that coverage for 16 million of the currently uncovered 51 million people (roughly 1/3 of those currently uninsured) will cost a trillion dollars. What would it cost to cover the other 2/3rds?

So it'd cost $63,500/person for health coverage for 16 million people?

I'm pretty sure private insurance is a little cheaper than that...

[kbordson 8]

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>These days I think the right thing to do would be also not pay and let
>the system collapse under its own incompotence and mismanagement.

I'm not sure letting hospitals collapse and doctors go bankrupt is the best way forward.

>I agree emergency rooms have to treat emergencies. What they don't
>have to do is treat Bobby's sniffles.

Exactly. Have an urgent care clinic that's free to Bobby's parents. There's a doctor there who says "your kid has the sniffles. Here's some aspirin. NEXT!" He takes care of 70 patients a day - that's 70 patients that aren't clogging up ER's with the sniffles.

Then Bobby gets Reyes Syndrome from the ASA and has to go to the ER... Now a VERY SICK lil Bobby.... maybe even a dying Bobby

And the parents then go to the lawyers.

[TomAiello 26]

Quote

Quote

Interesting article on the costs of the Obama plan here.

Amazingly, the Congressional Budget Office estimates that coverage for 16 million of the currently uncovered 51 million people (roughly 1/3 of those currently uninsured) will cost a trillion dollars. What would it cost to cover the other 2/3rds?

$3 trillion?

I doubt that very much, because it's likely that the first third is the easiest.

-- Tom Aiello

Tom@SnakeRiverBASE.com
SnakeRiverBASE.com

[Bolas 5]

Quote

Quote

>These days I think the right thing to do would be also not pay and let
>the system collapse under its own incompotence and mismanagement.

I'm not sure letting hospitals collapse and doctors go bankrupt is the best way forward.

>I agree emergency rooms have to treat emergencies. What they don't
>have to do is treat Bobby's sniffles.

Exactly. Have an urgent care clinic that's free to Bobby's parents. There's a doctor there who says "your kid has the sniffles. Here's some aspirin. NEXT!" He takes care of 70 patients a day - that's 70 patients that aren't clogging up ER's with the sniffles.

Then Bobby gets Reyes Syndrome from the ASA and has to go to the ER... Now a VERY SICK lil Bobby.... maybe even a dying Bobby

And the parents then go to the lawyers.

How is the above clinic different from any other HMO PCP or family practice?

You're on the inside, how do you propose getting the non emergency cases out of the ER?

Stupidity if left untreated is self-correcting
If ya can't be good, look good, if that fails, make 'em laugh.

[TomAiello 26]

Quote

Quote

>These days I think the right thing to do would be also not pay and let
>the system collapse under its own incompotence and mismanagement.

I'm not sure letting hospitals collapse and doctors go bankrupt is the best way forward.

>I agree emergency rooms have to treat emergencies. What they don't
>have to do is treat Bobby's sniffles.

Exactly. Have an urgent care clinic that's free to Bobby's parents. There's a doctor there who says "your kid has the sniffles. Here's some aspirin. NEXT!" He takes care of 70 patients a day - that's 70 patients that aren't clogging up ER's with the sniffles.

Then Bobby gets Reyes Syndrome from the ASA and has to go to the ER... Now a VERY SICK lil Bobby.... maybe even a dying Bobby

And the parents then go to the lawyers.

And then Bobby's parents sue the doctor who saw him for free, hoping to collect their millions.

-- Tom Aiello

Tom@SnakeRiverBASE.com
SnakeRiverBASE.com

[Bolas 5]

Very intersting about EMTALA.

Hopefully things such as this will be taken into account when designing this new solution. An approach of "This is what we intend to do and change the existing laws accordingly will be much more successful that trying to shoe horn something in under the old illogical constraints.

Stupidity if left untreated is self-correcting
If ya can't be good, look good, if that fails, make 'em laugh.