Like Long Medical Wait Times, Crowded Emergency Rooms? You’ll Love ObamaCare.

In the final weeks before the passage of last year’s health care overhaul, President Obama made his pitch to the nation. Part of that pitch was an argument that the alternative plan put forth by Republicans wouldn’t do anything to address the problem of taxpayer subsidized emergency-room care. When you buy into the Republican plan, he said, “you...don't do anything about the fact that taxpayers currently end up subsidizing the uninsured when they're forced to go to the emergency room for care.”

One complicating factor that went unmentioned: Obama’s plan isn’t going to do anything to lift the burden on emergency rooms either. Thanks to ObamaCare, we’re going to end up subsidizing those folks anyway, through Medicaid. And Medicaid won’t reduce the use of emergency room care, which tends to be far more expensive than regular visits to the doctor. Just the opposite. Expanding coverage, especially through Medicaid, will almost certainly increase the total number of visits to the emergency room. That’s because Medicaid recipients use emergency room services more than any other class of individual. Here’s NPR with yet another report making the implicit point the coverage expansion in the health reform signed into law by the president is expected to crowd our already overfull emergency rooms even further:

Hospital emergency rooms, the theory goes, get overcrowded because people without health insurance have no place else to go.

But that's not the view of the doctors who staff those emergency departments.
The real problem, according to a new survey from the American College of Emergency Physicians, isn't caused by people who don't have insurance — it's caused by people who do, but still can't find a doctor to treat them.

A full 97 percent of ER doctors who responded to the ACEP survey said they treated patients "daily" who have Medicaid (the federal-state health plan for the low-income), but who can't find a doctors who will accept their insurance...."The results are significant," said ACEP President Sandra Schneider in prepared comments. "They confirm what we are witnessing in Massachusetts — that visits to emergency rooms are going to increase across the country, despite the advent of health care reform, and that health insurance coverage does not guarantee access to medical care."

The Massachusetts story Schneider refers to is important because it shows exactly what we can expect under the new health care law. In the wake of the Bay State’s 2006 health care overhaul, which provided the model for ObamaCare, emergency room visits soared. Backers of that overhaul made arguments similar to President Obama’s, saying that they hoped that by expanding insurance coverage, they’d get people set up with primary care physicians and thus reduce the number of emergency room visits. Didn’t happen. Lines to see doctors got longer. And as they did, emergency room visits rose 9 percent between 2004 and 2008, at which point the commissioner of the state’s Health Care Finance and Policy division kind of shrugged his shoulders and admitted that the uninsured aren’t really the cause of emergency room crowding. Too bad, I guess, and too late: Massachusetts passed the law anyway. And now the rest of us are stuck with it too.

What now? Well, as with much of the health care overhaul, we’ll have to wait and see how bad the damage is. But John Goodman, the head of the National Center for Policy Analysis, did some rough calculations for the health policy journal Health Affairs last year, and he estimated that thanks to the law’s coverage expansion, we can expect somewhere in the range of 848,000 to 901,000 additional emergency room visits each and every year. ObamaCare's backers are right that, as passed, the law will result in significantly greater health insurance coverage across the country. But all that coverage will come with a hefty price tag attached: about a trillion dollars over the next decade, and more like $1.8 trillion in the first full decade of operation. In return we’ll get longer wait times at the doctor, and even more crowded emergency rooms—but nothing like a guarantee of actual access to care.

Update: More on the Bay State's long wait times from IBD's David Hogberg

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  • Tim||

    It's a self-negating chiasma.

  • Tacos mmm...||

    Is than an amphiboly?

  • ||

    A full 97 percent of ER doctors who responded to the ACEP survey said they treated patients "daily" who have Medicaid (the federal-state health plan for the low-income), but who can't find a doctors who will accept their insurance...

    We'll just force them to take Medicaid and Obamacare patients. And if they don't like it, they can go be vets. Boo-hoo.

  • ||

    And when no one wants to be doctors, we will just draft people and force them to be doctors at a set salary. What is the big deal?

  • robc||

    Salary?

    Slave doctors are cheaper. We will feed them in the commissary and give them a cot in the hospital. Budget problems solved!

  • ||

    Yeah. And I am sure slave doctors will be really dedicated to. We can just beat them if they are not. I like the cut of your jib Rob.

  • sarcasmic||

    They'll be dedicated if the law says they're supposed to be dedicated.

    Laws are magic.

  • ||

    As I've mentioned before, the 13th Amendment exempts prisoners from the prohibition against slavery. Make the practice of medicine illegal, convict all of the doctors, then enslave them. Problem solved!

  • robc||

    The 13th amendment is just words. Its like 150 years old too, cant be expected to follow that. Its out of date.

  • ||

    No, no, you're doing it wrong. The Constitution is God's Word when it can be interpreted to increase government power.

  • No, PL||

    Make them politically appointed, high-level Govt Bureaucrats with 250K salaries, retirement at 55 with super-bloated pensions and total immunity from malpractice. This will attract the best and the brightest.

  • cynical||

    Kickass. I'll be stockpiling white suits and mint juleps.

  • Dr Cal||

    But I don't want to take a paycut

  • WTF||

    The plain language of the 13th Amendment didn't seem to stop conscription, so why bother with all the machinations for doctors? Just declare a vital government interest, and voila! The 13th now has another 'exception'.

  • ||

    There's a reason I call them Copperheads. The difference between a plantation and a collective is spelling. Democrats have always been the slavery party.

  • Ray Pew||

    And when no one wants to be doctors, we will just draft people and force them to be doctors at a set salary. What is the big deal?

    Sorry to inject a serious critique in this comedy gold, but IMO the claim that universal healthcare systems will make people not wish to be doctors is unsupportable. The current high income of doctors is a definite incentive for this career choice, but it is relatively new, artificially high, and only one reason out of many for why people become doctors. I think that the "people won't want to become doctors" meme is logically flawed and counterproductive to the real problems of socialized healthcare.

  • Highway||

    The "current high income of doctors" is mostly a myth. There are some, particularly those who work in surgical and specialty fields, that have high incomes. But most of the GP's and Internists, the ones that these laws all want people to go see, get squat for Medicaid/ Medicare reimbursement, and pay tons of money for compliance. They're certainly not rolling in dough. So people don't want to become that kind of doctor, and we'll get more crowding of those doctors, while the (artificially small) stream of doctors coming out of med schools continue to be specialists and surgeons.

  • Tacos mmm...||

    So people don't want to become that kind of doctor, and we'll get more crowding of those doctors, while the (artificially small) stream of doctors coming out of med schools continue to be specialists and surgeons.

    Increasing the number of physicians in a third-party payer system doesn't really drive down prices anyway.

  • Ray Pew||

    The "current high income of doctors" is mostly a myth.

    Maybe I mispoke. My point is that the current income is artificially higher due to protectionist policies: controlled numbers of yearly graduates, licensing, etc.

  • Dr Cal||

    One would think that if you just increase the number of doctors, then costs will go down. Like econ 101....This is entirely wrong. Anywhere the number of docs go up, cost follow. More docs = more expensive tests.

  • cynical||

    I'm not sure that medicine used to require as much expertise as it does now, though; it was as much a skill as a knowledge set. Fact of the matter is that when you combine the mental requirements with the tolerance for nasty stuff, you already have a small group of quality candidates, and the former attribute is useful in so many things other than medicine that there is plenty of competition for those people.

    You can still get doctors without high salary, of course, but next time you go in for a checkup, expect to hear "Well, don't want to sound like a dick or nothin', but, ah... it says on your chart you're fucked up. You talk like a fag, and your shit's all retarded"

  • Ray Pew||

    I'm not sure that medicine used to require as much expertise as it does now, though; it was as much a skill as a knowledge set. Fact of the matter is that when you combine the mental requirements with the tolerance for nasty stuff, you already have a small group of quality candidates, and the former attribute is useful in so many things other than medicine that there is plenty of competition for those people.

    You can still get doctors without high salary, of course, but next time you go in for a checkup, expect to hear "Well, don't want to sound like a dick or nothin', but, ah... it says on your chart you're fucked up. You talk like a fag, and your shit's all retarded"

    Not buying it. Medical schools reject thousands of applicants each term who are by all reason perfectly eligible to enter. Obviously there will always be a limitation on resources (medical schools, teachers, etc.), but the current limitation is promoted for protectionist purposes.

  • Temujim||

    I wouldn't let half of my medical school class touch me with a ten foot pole. And you want to bring the rejects in now? Good luck!

  • An Engineer||

    Considering my father, who is a doctor, told me to not become a doctor because there's no money in it any more, I'd say the claim is supportable.

  • Warty||

    I have an extremely fat cat, and I can't wait until she becomes diabetic in a few years and gets better medical treatment than you. Sucker!

  • ||

    You really should put kitty on a diet.

  • Tacos mmm...||

    I'm sure Warty thinks she's sexy just the way she is. Mrrrrow!

  • Warty's Cat||

    I like fishnets. Is that so wrong...?

  • Fist of Etiquette||

    Why are there so many cat people at Hit and Run? Is it because, like libertarians, cats are anti-authoritarian, disloyal and aloof pricks who do nothing when someone breaks into your house and who couldn't care less if poor people have access to free healthcare?

  • Sudden||

    That and the SWAT Gestapo won't kill the kitties when busting our doors down to retreive an 1/8 of kush.

  • Warty||

  • Warty||

    I've tried. She stays as fat as ever, but keeps me up all night by frantically running around the apartment looking for food. Kitty can stay fat.

  • cynical||

    Then those of us who are smart will deal under the table with vets.

  • Zeb||

    If vets were allowed to treat people, that would be a pretty good plan. Vets are way cheaper and more consumer oriented than hospitals.

  • WTF||

    Vets are way cheaper and more consumer oriented than hospitals.

    Hmmmm..why would that be? Could it have something to do with the fact that consumers are directly responsible for the costs of vet care?

  • Tacos mmm...||

    One word: euthenasia. That saves a shitload of money right there.

  • Sudden||

    Oregon is the only place in the US that seems to get that.

  • WTF||

    Otherwise known as rationing end of life care.

  • andrew||

    Good Idea - then your visit to your doctor will be much longer.

    There are only so many Doctors and if you force them out of the profession...them where do you go.?
    answer: the rush more doctors into practice, without good training (like NP's).

  • sarcasmic||

    Results don't matter. Only intentions matter. Since longer lines at the ER were never intended, then they don't matter.

    We're too busy paving the Road to Hell to care about silly things like results.

  • robc||

    Predictable consequences arent unintended. Or something like that.

  • OO||

    more people using the ER means more access not less. perhaps reason is advocating that folks w access NOT seek medical treatment. if so, the gop solution in sum is dont go to the doctor or...just die quickly!

  • ||

    Yeah, because that is what they were saying last year when they passed Obamacare. They were not decrying the cost of uninsured people going to emergency rooms or anything. Jesus Christ do you really completely lack any sense of intellectual shame or self awareness?

  • Warty||

    Think about who you're talking to.

  • OO||

    who's "they"?

  • Dr. Who||

    Why not just build federally subsidized clinics to serve the poor?

  • Zeb||

    That would seem like a sensible option. But one that doesn't give nearly enough power to the federal government. And it probably would make the poor people feel bad, or something, too.

  • prolefeed||

    You must think that having building equals having care.

    Care is delivered by doctors, who generally view working for the federal government as a last resort if they're no good.

  • Dr. Who||

    The Feds can add incentives like school districts do regarding student loans.

  • andrew||

    Bush yes THAT Bush already did this.

    he created over 1300 community health centers.

  • ||

    all I know now is that medical care is totally un affordable. Its scary dude.

    www.real-privacy.es.tc

  • Comment Tater||

    Like Long Medical Wait Times, Crowded Emergency Rooms...

    The DMV? Toll booths? State liquor stores? The FDA?

  • JohnD||

    It's not just Medicaid that's the problem. I moved to another town a couple of years ago and decided to find a doctor closer to where I live. I could NOT find one that would take Medicare!! Most would file the Medicare claim for me, but expected full payment up front. I would have to pay the full amount and Medicare would reimburse me at a much lower rate.

    So I still drive 35 miles (one way) to the next town to see my old doctor. He complains about Medicare, but he still accepts it from his existing patients. He will not take on new Medicare patients and has told me that he will stop taking Medicare if they cut his reimbursement payments again.

  • ||

    health insurance coverage does not guarantee access to medical care.

    Well, dog mah cats!

  • Irresponsible Hater||

    Father of Hater got a big, very deep cut on his arm (monkey knife fight), and went to the ER (in SoCal).

    They told him it would be a FIVE HOUR wait.

    He went home and cleaned it out and superglued it together himself.

    The lesson: don't give knives to monkeys.

  • Tacos mmm...||

    This is exactly why I give my monkeys guns.

  • Tony||

    Once we adopt the libertarian solution--healthcare as a privilege for those who can afford it--those waiting rooms are sure to be nice and calm.

  • ||

    That is right Tony. Instead of providing great care to 80% of the country. Lets make sure we provide equally awful care to the entire country.

  • Tony||

    How does subsidizing more care translate to less care for those who want to pay for it in any way?

  • #||

    when you have price controls on supply (medicare, medicaid) and you have fiat restrictions on supply (AML cartel, cetrificate of public needs laws, new bans on doctor ownend facilites)you end up with supply shortages.

    So you end up subsidizing people to use care that they realyl don;t need, and you end up with people waiting in line or searching for a doctor when they really need one, plus you end up with less total quanity of care due to the price controls.

    Thats how.

  • #||

    essentially, artificially drive up demand (and price), artificually drive down supply (and upwards price) - then enter Tony to blame predicted results on the "free market"

  • Ice Nine||

    How does subsidizing more care translate to less care for those who want to pay for it in any way?

    Try this: a 40 million increase in new subsidized patients and a zero increase in new doctors.

  • prolefeed||

    Subsidizing ANYTHING results in excessive demand for that product, leading to long lines or spiraling costs of the subsidy, or both.

    Witness rush hour traffic, caused by the roads being "free" in the sense of not having congestion pricing, leading to people making trips they would have not made, or made at a different time, under a more market-based system of roads.

  • Somalian Road Corporation||

    The Soviet Union was praised back in the day for having a populace that was "equally shabby". Egalitarian misery is the abject stated goal of a disturbing amount of people (a few MNG posts come to mind).

  • sarcasmic||

    It is better to be hungry and know that there are no rich people, than to be well fed and have people to envy.

    America is the worst place in the world because it allows people to get rich and because poor people are fat.

    It would be so much better if there were no rich people and if poor people starved like they do in the rest of the world.

  • Tony||

    If you think that's the goal of people who want universal healthcare, it's no wonder you have a problem with it.

    Every other developed country manages to do it at half the per capita cost of our healthcare system. You can't just dismiss that fact as if it's not relevant.

  • sarcasmic||

    Innovation lead to profit, and profit is theft.
    Most health care innovations originate in this country because this country allows people to profit from their innovations.
    That's bad.
    All innovation should come from government because government does not seek a profit.
    If we socialized all medicine in this country they we would eliminate the chance for anyone to profit from innovation, and end most innovation in the medical industry.
    Then innovation would only come from government.
    Government is God.

  • Tony||

    Sometimes, I dream of Government standing behind me -- all naked and priapic and Obama-y -- and I wake up shivering in a cold, eager sweat.

  • Bawny Fwank||

    Here I am!

  • #||

    So tell me Tony, why is it that out current single payer system for old people, doesnt opperate at that low cost? Medicare and Medicaid use up as much GDP percentage as all fo the European health systems. Should have Obama been able to just take allt hat money and cover everyone?

    You ever think for a moment that Europs does what it does not because of it being single payer, but rather that they ration and put in price controls which lead to shirtages and waiting lines. Cancer survival rates for example are much lower in Europe.

    Not to mention they have been freeloading off of out R&D for years via the price controls. Cancer survival rates for example are much lower in Europe.

    I will start taking you and lefties single payer price claims more seriously when you include the whole truth and start advocating for fiat rationing along with nationalized care not just the nationalized care.

  • #||

    And I's add that of the European systems that work relatively better, they are the ones that are least single payer (ie switzerland and Germany) where patients pay a lot out of pocket - much more so than they do in the US.

  • Tony||

    Medicare is relatively lavish as single-payer systems go, but it's still cheaper than a private alternative.

  • prolefeed||

    Dying or not being treated certainly makes it possible for a single-payer system to be cheaper than a more market-based system.

    I would hesitate to describe that as a feature rather than a bug, though.

  • prolefeed||

    I had cancer cut out of me by a very talented private doctor. A government doctor would have resulted in me being dead and not being here to point out your inability to grasp economics or unintended consequences.

    Me dying would certainly have resulted in lower overall costs for "the system", though, if that's what you think is important.

  • #||

    Its only cheaper because it places price controls in place at only about 75% of the cost of service. The difference is mad up by cost shifting to private plans, helping to drive them up.

    But regardless, this still doesnt answer the question. Why isnt the money we already spend on Medicare enough to cover everyone if single payer systems are so magical?

  • sarcasmic||

    It's not rationing when an altruistic government bureaucrat denies care based upon policy guidelines.

    It's only rationing when evil profit seekers deny care based upon ability to pay.

    Government is God.

  • WTF||

    Every other developed country manages to do it at half the per capita cost of our healthcare system. You can't just dismiss that fact as if it's not relevant.

    Citation please showing the same quality and volume of care at half the cost. Or are you just making shit up again?

  • Tony||

    Since most countries with universal systems have better health metrics than we do, it would seem that we are not getting our money's worth. I'm talking about health care costs in general.

  • Somalian Road Corporation||

    and I'm sure the detailed article you're about to link to that details these "better health metrics" is shortly forthcoming

  • WTF||

    and I'm sure the detailed article you're about to link to that details these "better health metrics" is shortly forthcoming

    HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA

  • Kelldog||

  • Kelldog||

  • #||

    how mush do you want to bet that in 5 or 6 years when all this stuff we have been saying happens, people like you will be blaiming it on the "free market"?

  • sarcasmic||

    My parents told me of the days before Medicare when only the wealthiest 1% had access to medical care and everyone else was left to rot.
    No doctors ever negotiated cost or helped people out of the goodness of their hearts, because nobody does anything unless government tells them to.
    Not one charity existed either. Not a one. Charity only came into existence when it was created by government.
    Yes, without government we would have nothing.
    Government is God.

  • WTF||

    Government is God.

    Well, according to Tony only since January 2009. Or from 1992 to 2000.

  • Tony||

    If you have to invoke charity then you've already lost the argument.

  • sarcasmic||

    What about charity?
    Charity is a function of government.
    Until Medicare and Social Security there was no such thing as charity, and if government programs were to end then all charity would end.
    Nobody voluntarily gives to charity. Nobody.
    Churches don't count either because they're not government, and because most liberals would never give a penny to a church.
    Churches are to be sneered at.
    Government is God.

  • Tony||

    If charity were adequate to the task of providing healthcare for the poor, old and disabled, we wouldn't have needed to invent medicare and medicaid.

  • sarcasmic||

    That is absolutely correct.
    No charity existed before government.
    None.
    It is absolutely false that charity covered the poor, old and disabled, though with a stigma of shame attached to it, because there was no such thing as charity before it was created by Medicare and Medicaid.
    Nope, no way did charity cover these people. Never.
    And it is ludicrous to think that these programs were created not to fill a void, but to take that stigma of shame away, because no charity existed to be ashamed of.
    Government is God.

  • Tony||

    I didn't say charity didn't exist. Charity exists with or without a safety net program. What's ludicrous is to pin your hope for the outcome of universal coverage on charity. I prefer not treating the old, infirm, and poor as charity cases. Much better to treat them as equal citizens and participants in the system.

  • sarcasmic||

    But charity couldn't exist unless it was sanctioned by government.
    Nothing exists without some government policy.
    Without words from Our Great Government On High commanding it into existence, it is nothing but fiction.
    Nobody would voluntarily give to a charity in order to help the old, infirm and poor without it being deducted from their paycheck in the for of payroll taxes.
    You sure wouldn't. And if you wouldn't then nobody would.
    That's what government is for.
    Government is God.

  • Zeb||

    You know what, Tony? If that is what you really believe, then you really are a piece of shit. You think so little of people that you can't imagine people actually helping each other out voluntarily. Or do you just think it is better that everyone is forced to do so whether they like it or not? In either case, fuck you.

  • Tony||

    If charity were adequate to the task of providing healthcare for the poor, old and disabled, we wouldn't have needed to invent medicare and medicaid.

  • WTF||

    If charity were adequate to the task of providing healthcare for the poor, old and disabled, increasing government power and bureaucracy by creating a dependent class we wouldn't have needed to invent medicare and medicaid.

  • Tony||

    So elderly, poor, and disabled people are "a dependent class" who would be better off being thrown to the insurance industry? Sounds an awful lot like "man up and die" to me.

  • WTF||

    Sounds an awful lot like "man up and die" to me.

    That's because you are a dishonest idiot.

  • prolefeed||

    You're the one defending a socialized medicine system that results in untreated people and unnecessary deaths.

    You're the one defending the "man up and die" system.

  • Tony||

    Citation? I am interested in the policy outcome, not the policy details really. I want more people with access to quality healthcare. Other countries have figured out how to do it universally for half the per capita cost of our system. I'm sorry if that contradicts your free market worship, but that's your problem.

  • sarcasmic||

    "Other countries have figured out how to do it universally for half the per capita cost of our system."

    This is because instead of insurance company bureaucrats denying care, government bureaucrats deny care.

    When insurance refuses to pay they are evil, but when government refuses care it's perfectly acceptable.
    Government refuses care based upon policy that is written by high priests of Social Democracy.
    Government is God.

  • WTF||

    Other countries have figured out how to do it universally for half the per capita cost of our system

    Either link to proof or stop lying.

  • Tony||

    Link. First result on Google. And with pretty graphics.

  • #||

    and once again the only two "performance metrics" are two things that are effected by a lot of things other than healthcare. Child mortality differences are afunction fo us trying to save more fetues via c-section, who then have a higehr mortality rate than in Europe where they just die and never get counted in the birth stats.

    And life expectancncy is a function of dietary habits, crime, car accidents etc. You adjust for murders and car accidents, the US has the highest life expectancy in the world and thats even with a fucked up healthcare system.

    Show me soemthing that actually measures the quality of health care itself. I know for example cancer survival rates are lower in Europe - cant find the article but the Economist had a piece and charts on this a few years back.

  • Tony||

    What you mean is that once you adjust for all the things that are killing Americans early, we have a darn high life expectancy.

    This only contributes to my position, even though you don't realize it. If you survive until old age, you have great health metrics. Because you have access to a single-payer healthcare system!

  • #||

    that stripping out car accidents and murders in other countries too - we have more of those because we drive more and for some reaosn murder more - niether of those are outputs of the healthcare system.

    When you actually measure things like cancer survival or lieklyhood to be diagnosed with x disease, things that are actually measured of healthcare - then the US ourperforms other countries. Even with a messed up distorted healthcare market.

  • Kelldog||

    What he is saying is that when you remove deaths from murder and car accidents, neither of which fall under the umbrella of "Health care" we already survive until old age, more so than other countries, and we do it without a single payer system.

  • Tacos mmm...||

    I want more people with access to quality healthcare. Other countries have figured out how to do it universally for half the per capita cost of our system.

    This is true, but that doesn't mean that they're systems are exportable. There's much more going to support their systems that a mere series of laws and programs. Almost all of the difference between medical costs in France and the United States, for example, is made up by lower salaries for healthcare providers - in approximate terms, nurses make three quarters of what their US salaries would be, general pracitioners half, specialists a quarter. These kinds of salaries work in France because our current completely disasterous employment rate is the norm there; people (especially young people) are generally more content just to have a job, and salaries are comparatively depressed. Getting practioners in the United States to work for levels of pay commensurate with a 40 hour work week and four year degree is unlikely.

  • sarcasmic||

    "Getting practioners in the United States to work for levels of pay commensurate with a 40 hour work week and four year degree is unlikely."

    Why not have the government determine salaries for health care providers once government is the sole payer of health care?

    Better yet it could pass a law making all health care workers government employees.

    What would be even better would be to make it a crime to disobey your doctor, just as it is a crime to disobey a policeman.

    Doc says change your diet and you don't change your diet, you go to jail where they'll make sure you change your diet!

    Government can fix anything because Government is God!

  • Tony||

    sarcasmic, just because you think the free market is god doesn't mean everyone else is similarly ideologically extreme.

  • The Ingenious Hidalgo||

    How do you still not know what free market means? The clue is in the word 'free': it requires obedience to no one. How does that translate into thinking the free market is god?

  • Tony||

    The thing about France is that it can absorb higher unemployment rates because it has a stronger safety net. A lot of the rhetoric here ignores the fact that there are still healthcare costs even without government subsidy.

  • Tacos mmm...||

    The thing about France is that it can absorb higher unemployment rates because it has a stronger safety net.

    Eh, it's more complicated than that, but the essence of my point was that one simply can't import a system and impose it on the US from the top down.

  • Kelldog||

  • Bender Bending Rodriguez||

    "And a gold-pooping unicorn for everybody!"

  • OO||

    keep repeating tony but the libtards still wont get ur point.

  • Ice Nine||

    Once we adopt the libertarian solution--healthcare as a privilege for those who can afford it--those waiting rooms are sure to be nice and calm.

    Your lament merely reflects the fact that health care, at least top notch health care, is not a privilege as you would claim - it is simply another luxury commodity.

  • Anti Tony||

    Once we adopt the libertarian solution—food as a privilege for those who can afford it—those grocery stores are sure to be nice and calm.

  • rather||

    Once Obamacare is instituted, EMTALA will become obsolete because of the availitbity of preventive care. Your story misses the whole picture

  • #||

    because thats exactly what happened in Massachusetts... oh wait...

  • fish||

    EMTALA will become obsolete because of the availitbity of preventive care.

    That should help after those Monkey knife fight.

  • rather||

    Hawaii has mandated insurance and it has reduced emergency room visits

  • prolefeed||

    I live in Hawaii. I'm married to a doctor. The mandated insurance has resulted in a near-monopoly by insurance companies and a chronic shortage of doctors, not to mention raising the cost of living.

    If you think making it impossible to walk away from the negotiating table with an insurance company works for the benefit of the patient rather than the insurance company, you have failed to grasp the coercive nature of that law.

  • rather||

    mandated insurance has resulted in a near-monopoly by insurance companies
    your point is not exclusive to Hawaii. Arguably, there is a complete monopoly of insurance companies.

    a chronic shortage of doctors
    ditto in other states

    raising the cost of living
    ditto in other states, including California and Texas who have tort reform

    insurance company works for the benefit of the patient rather than the insurance company
    ditto, who thinks their duty is anything other than to make money?

  • Sudden||

    I live in Hawaii. I'm married to a doctor.

    You sir are living the fucking life. Do you just wake up every morning, kiss the wifey, and then take a stroll outside your beachfront home at Diamond Head, and post up on the sand with a Mojito? The tan lines around the monocle must be the worst thing you have to deal with...

    (I of course know that this is likely not true, but allow me to fantasize.)

  • Ice Nine||

    Incidentally, the cost-reducing value of preventive care is largely a myth.

  • rather||

    The myth that preventive care is not cost-reducing is libertarian wishful thinking

  • Ice Nine||

    Perhaps you would attempt to convince us why you think that is the case.

  • rather||

    Easy,

    #1 call a hospital for a pre-planned surgery and you get a set rate. Show-up in an emergency for the same procedure and pay through your ass.

    #2 For example, treating appendicitis before rupturing is a hell of a lot cheaper, and so is all deteriorating medical conditions.

    #3 I don't know of any disease that improves odds, comfort , or cost when diagnosed or treated in late stages

  • Ice Nine||

    The subject of elective vs emergency surgery and the subject of treatment of acute appendicitis have nothing whatever to do with preventive care.

    Your third point, as it happens, is relevant to the subject even if not in the way you think it is. Preventive care can certainly make a cost difference in individuals but in society in general it results in greater costs which are not recovered in savings as a result of preventing or diagnosing early diseases in a much smaller group of individuals. This has been corroborated by the Congressional Budget Office (to the great chagrin of Obama and the Democrats) as well as by studies reported in the respected medical journals, Circulation and New England Journal of Medicine. As I mentioned before - myth.

  • rather||

    Cherry picking does not define complete truth.

    Diagnosing chronic appendicitis in a doctors office would prevent an emergency hospital visit to rule out acute.

    The CBO works with figures given to them: garbage in = garbage out

  • Ice Nine||

    Your cherry picking "axiom" is the refuge of the uninformed feebly trylng to appear otherwise.

    Your speaking of chronic appendicitis - a condition that is so exceedingly rare as to be negligible - tells me immediately that you have no idea what you're talking about. As someone who has diagnosed acute appendicitis a few thousand times I actually didn't even need to read your whole sentence to readily confirm that.

    CBO got its information from Circulation and NEJM. I assure you, those two pubs get their figures from rigid, peer-reviewed scientific studies - hardly from garbage peddlers.

    You are flailing. It is becoming clear why these people here ignore you. I believe I must join them.

  • Please do||

    a physician‽ My ass

  • Ice Nine||

    Uh, yes. Sorry though, not a proctologist.

  • rather||

    I played doctor when I was a kid but that doesn't make me a physician.

    Your vocabulary/countenance suggests you couldn't even finance/effectuate offshore medical school.

  • Sudden||

    Generally speaking, burdens of proof fall upon the person making the claim. You're the one making the preventative medicine claim; present your evidence.

  • NoVAHockey||

    Nurse Practitioners and Physician Assistants -- get used to seeing more of them.

  • Ice Nine||

    And lots of little funny-talking brownish dudes in white coats with stethoscopes around their necks, as well.

  • rather||

    OMG! The brown menace!

  • Ice Nine||

    Not really a menace. There are plenty of them that are well-trained. There are however lots of them that aren't. I'm not sure that the net effect will be an increase in the quality of medical care here.

  • ||

    Even the ones that are well trained have a lot of trouble communicating. I had regular visits with a neurologist who was from India for a drug study. I am sure he was a great doctor, intelligent and all, but he did not understand how to communicate with Americans.

  • rather||

    Your ignorance is hebetating

  • Ice Nine||

    Your thesaurus is exhausted.

  • rather||

    I'll put in to bed with a blanky and bottle

  • Zeb||

    What I would like to see is a lot of non-emergency care clinics in storefronts where LNPs and such can treat people for minor injuries and illnesses without all of the overhead of a full hospital. A whole lot of medical services could be delivered in much less complicated and expensive ways.

  • ||

    My parents told me of the days before Medicare when only the wealthiest 1% had access to medical care and everyone else was left to rot.

    Back on the farm, your parents would just shoot you if you broke your leg, to put you out of your misery. Like with the horses.

  • ||

    Nurse Practitioners and Physician Assistants -- get used to seeing more of them.

    Not FAIR, dude.

    Two-tier provision of services must be banned. If EVERYBODY can't be treated by a highly trained specialist, then NOBODY should be allowed to see one.

  • NoVAHockey||

    i actually think we'll end up in three-tier system. boutique doctor offices, doctors supervising NPPs and PAs, and clinics/FQHCs.

  • ||

    Every other developed country manages to do it at half the per capita cost of our healthcare system.

    But that's not because we in a very real sense subsidize their low costs, like all those "cheap" Canadian prescription drugs. No way.

  • ||

    It's not just a matter of which doctors will or won't accept government insurance plans either. In some cases, it's a matter of how many doctors are available.

    Once we get all those uninsured millions insured where are the doctors to service them? Where I live it's hard to find a doctor NOT because they won't accept my insurance, but because they are too busy to accept new patients.

    Gotta love those AMA-promulgated, government-enforced practitioner education and licensure laws...

  • ||

    Complaints about what might happen under ObamaCare abound, but what's the answer? Problem with healthcare is it's not a commodity that can be eschewed when an unfortunate medical event happens. Care will be given without regard to ability to pay. If patient can't pay, then the rest of us do. Best approach is to compel some level of insurance of everyone to help costs. Biggest issue isn't so much providing care, it's the cost of that care that must come down in line with every other developed nation's. We are twice as expensive and 30% less effective than other nations.

  • #||

    "and 30% less effective than other nations"

    [citation needed]

    plus the healthcare bill does nothing to reduce costs - its was an insurance coverage bill - that's it - not a healcare bill, and you can't even really call it insurance when it no longer insures against risk. It was mandating the socialization of costs via fiat rather than taxes.

  • Zeb||

    Catastrophic insurance is not terribly expensive for most people. That would cover the severe unexpected medical emergencies. If you can't afford the deductible, most hospitals will let you set up a payment plan. People who truly can not afford such insurance could get some sort of subsidy, or free clinics could be set up.

    There are lots of options besides mandated health coverage and ultimately people should be responsable for their own actions. If you can afford insurance, but didn't buy it and you get sick or injured and can't pay for it, tough shit. You had the opportunity to do something to prevent it and you didn't. That is not someone else's problem.

  • robc||

    30% less effective than other nations

    If we are 30% less effective then how come if you cut off your hand you want to be flown to Jewish Hospital in Louisville for it to be sewn back on?

    From anywhere in the world.

    And that is just one specialty I know something about. There are plenty in which the US has hands down the best available care. [pun not intended, but I wish it had been]

  • ||

    Biggest issue isn't so much providing care, it's the cost of that care that must come down in line with every other developed nation's.

    We'll just impose price controls.

    What could possibly go wrong?

  • ||

    Since most countries with universal systems have better health metrics than we do, it would seem that we are not getting our money's worth.

    Please. This again? Better health metrics caused by different lifestyles in no way illuminate the value of health care spending.

  • Tony||

    Ah, the old "we're fat lazy slobs and dern proud of it" defense of our wasteful healthcare system and awful health metrics.

    I'm for making the US into more of a walking culture too.

  • Zeb||

    Nobody here is terribly keen on our current shitty healthcare system. We just don't want it to be made worse.

  • Zeb||

    And if people want to be fat, lazy slobs, or fail to do anything that prevents them from being fat, lazy slobs, that is their own damn problem. Why the fuck do you want that to be everyone's problem?

  • Tony||

    Because when we are by far the fattest country on earth, it's not just an individual choice issue, it's a social one.

  • The Ingenious Hidalgo||

    Why?

  • ||

    In your heart, you dream yourself their master.

    That is why I don't like you.

  • ||

    The myth that preventive care is not cost-reducing is libertarian wishful thinking

    Not really. Plenty of studies out there showing that preventive medicine doesn't reduce costs, mostly because preventive medicine includes lots of tests for things you are asymptomatic for and the vast majority of time don't have.

  • NoVAHockey||

    "majority of time don't have." and won't ever get.

  • #||

    the simple fact that insurance companies dont already subsisze it more suggests that it isnt a money saver on average. If preventative care really paid huge dividents insurance ocmpanies would pay you to go so so their outlays would get reduced.

  • robc||

    Pay you?

    They would just mandate an annual physical to keep your insurance. And yet...they dont. Its almost like they have employees who run numbers on these things.

    Note: My college roommate finished 2nd on some national actuarial exam his senior year. He pretty much had his choice of jobs and chose based on location.

  • ||

    "Why not just build federally subsidized clinics to serve the poor?"

    Almost every County Health Department in the country operates clinics where primary medical care is free. Especially for womens' and childrens' health issues.

    My observation has been that the only section operating anywhere near capacity in any of them is the one for STDs.

  • Tim Cavanaugh||

    That’s because Medicaid recipients use emergency room services more than any other class of individual.

    It's the system. People will be different after the Revolution.

  • Mike_K||

    Massachusetts has plans to deal with this by requiring all doctors to see those Medicaid patients or lose their licenses. That will help. Expect a flood of applications for other state licenses if it hasn't already started.

  • Fidel from Madrid Hospital OR||

    En Cuba, everything is free.

  • Michael Moore||

    Why can't I meet Fidel? Oh, he's out of the country...what a wonderful health care system.

  • I'm all for conscription||

    Obama can fire up the draft again and make the conscripts doctors. All male, but what the heck -- leave Sasha and Malia out of it. Bonus is he has the leftovers ready for cannon fodder in Asia and Africa -- might force a few tea-bagging chickenhawks to prove their patriotism -- as well as the ObamaBots, who could no longer burn their draft cards -- get rid of all exemptions except the political ones. Ask not what your country can do for you, but what you can do for Barack.

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