The Doctor Will Not See You Now


One of ObamaCare's major promises was that it would increase access to health care, and, in particular, that it would help unclog the nation's crowded hospital emergency rooms. In fact, there's mounting evidence that the crowds—and the wait times that go with them—will grow larger: In Massachusetts, for example, emergency room wait times rose 7 percent between 2005 and 2007. Last year, USA Today reported that the state capitol, Boston, had the highest wait times in the country. Many experts expect to see wait times increase across the nation under the PPACA. As John Goodman of the National Center for Policy Analysis explains at Health Affairs, the issue isn't the uninsured. Instead, it's Medicaid, the health care program for those with low incomes.

The use of the emergency room by uninsured patients is not that much different than usage by the insured. The heaviest users of the ER (in proportion to their numbers) are Medicaid patients, probably because Medicaid rates are so low that physicians are not anxious to see them. And the reason why that is important is that more than half of the people who gain insurance under the new health reform bill will enroll in Medicaid.

The Congressional Budget Office estimates that the PPACA will add 16 million new individuals to Medicaid. And that almost certainly means many, many more emergency room visits. ObamaCare was sold as a way to ease America's health care burdens. Instead, it looks more and more like its legacy will be to increase the strain on a broken system.


NEXT: Should Justice Elena Kagan Recuse Herself from ObamaCare Cases?

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  1. One of ObamaCare’s major promises was that it would increase access to health care, and, in particular, that it would help unclog the nation’s crowded hospital emergency rooms.

    Really? Because that’s just ridiculous.

  2. When will we learn that handing out wads of cash only drives up prices and does nothing to increase the supply for which there already exists unfulfilled demand.

  3. Just waiting for Tony, Chad, MNG, and Max to come along and tell us why this is a good idea…

    Oh, hey, is that a year-old issue of People? Wow, this doctors’ office is really on the ball!

  4. WTF, an Obama inspired plan that didn’t work…it’s just not possible.

  5. probably should have read that bill before voting/signing…

    1. But passing it was the only way to find out what was in it!

      When people get used to this they are going to love it!

  6. The biggest single budget item in every state is Medicaid, which is also one of the biggest budget outlays for the federal government.

    The biggest single money hole in most hospitals is the ER.

    The geniuses in Washington managed to successfully locate the one piece of our health care system that causes the most financial damage all around, and increase it.

  7. That picture is actually a waiting area at your local DMV, and the dude on the right was clean shaven when he first came in.

    1. I’ve never seen a DMV with padded chairs.

      1. It’s in Connecticut.

        1. I’ll have you know that the chairs in DMVs in Connecticut don’t have padding. They’re lined with money.

    2. The dude on the right is Nobel Prize winner Paul Krugman wearing his fashionable hat disguise.

      1. He needs two of those hats; one to shit in and the other to cover it up with.

  8. I have to tell y’all, I positively delight in stories like these. Maybe because I’m a hateful bastard, and I’m pissed off at all the idiots who supported this fucking disaster of a bill. I get to relieve some of my anger by pointing out, yet again, that this bill won’t do anything good for health care.

    1. I’m not so optimistic. Yes it is a clusterfuck and yes it will implode but we don’t know where the blame for that will be placed. The lefties, having devised a plan to guarantee that insurance companies will go out of business, are just waiting to say “I told you private health care doesn’t work, now lets do single payer for real.”

      1. The real goal of Obamacare was to increase the expectation of “free” healthcare, even if it can never be dispensed. Once the populace becomes entitled to something that their neighbors pay for, it’s only a matter of time before the next liberal crusader harnesses that sentiment into a successful campaign for nationalized healthcare. I’m afraid the left has already won this battle.

  9. The worst thing about ObamaCare is that the undeserving poor will get better health care. Who needs that? They already get it in prison or in the army. What about the middle class? No wonder Obama’s poll numbers are falling. Geez!

    1. I can’t wait for Obama and his cronies to make it illegal to not buy health insurance… because I can’t afford it, and will refuse to do so even if I can find a way to afford it in the future, I will wind up being punished just so Democrats can find yet another way to bribe voters into supporting them.

      And that is ALL this is about… getting votes. Concern for the poor is just the means to that end.

    2. No they won’t, Max. Your statement is backed up by nothing but fantasy. You really should actually try to find a provision of that bill that actually provides more access to care and streamlines the process for the poor and uninsured. The bill does nothing to improve the provision of health care. It just reconfigures the way the money flows around and pretty much just drives up the costs.

      1. I’ve spent years working with the homeless. Never met one who didn’t have access to free medical care. True, they had to wait a few hour for it, but it’s not as if they’re busy people.

        1. There’s no such thing as a free lunch Eapie. Someone was paying for that medical care.

          1. The people volunteering were the ones that paid for it with their time.

            1. Why assume it was volunteers sage, Eapie didn’t mention that.

              And are you proposing that we have “volunteerism” as our health care for the poor? I’d love to see the volunteer chemotherapy and heart surgery…

              1. Wow, I like how you took my answer and applied it to other questions. Very honest of you.

              2. Doesn’t Doctors Without Borders already do this? Are there not multiple charities I always see in the rich-folks magazines where I can fix some little Ugandan’s cleft palate for 250 dollars?

                1. I’ll answer for MNG, TAO:

                  “Oh, so are you proposing that when a homeless guy needs chemo we just fix his cleft palate? And where does a homeless guy get $250?”

              3. If we weren’t legally actionable even if we do health care for free, you might see a bit more of that.

          2. Yes, MNG, as some have pointed out repeatedly at H&R, there were already tax-funded government programs available to deliver healthcare to the poor. Hence, we hardly need another one to do it. Very little about this debate has anything to do with “the poor” not having access to healthcare.

            Now there have been other occasions when some of us have questioned either the efficacy, the need or even the rightness of such programs, but those are different questions.

    3. The worst thing about ObamaCare is that the undeserving poor will get better health care.

      How so? The best guide we have to how ObamaCare will play out is Massachusetts. Are the po’ getting better care there? Citation, as they say, needed.

      1. I stand by this scenario:

        If we wind up with government health care, one of two things must happen:

        Either WE get the same level of care given to Obama… or he has to wait in line and get crappy care just like us.

        Of course, the former won’t happen.

        1. The latter doesn’t seem very likely either.

          1. True, but it would be sooooo much fun to watch Teh President sit in a waiting room to eventually get substandard care “good enough” for we mere mortals.

            1. True, but it would be sooooo much fun to watch Teh President sit in a waiting room to eventually Secret Service clear out a whole clinic and the surrounding block so the Pres can get substandard care “good enough” for we mere mortals.


      2. “Hawaii, though, where Limbaugh received such excellent health care, passed a mandate that employers provide generous health care benefits back in 1974. Perhaps as a result, Hawaii residents have longer life spans than most Americans, according to The New York Times. They also have lower insurance premiums”


        1. Hawaii has had higher life expectancy than the U.S. since 1950. The gap in life expectancy between the two has not budged since that law was passed. Also, the Chinese in Hawaii have the nation’s longest lifespan due to healthy lifestyle. Culture >> healthcare.

          1. Also, the Hawaiian system can’t pay its bills.

          2. “problems typical of low-income Asian and Pacific Island communities. They include high rates of asthma, diabetes, obesity, vaccine-preventable diseases, cardiovascular disease, combined socioeconomic and maternal and child health risk, substance abuse, mental health, and dental disease.”

            The Chinese food/health connection diminishes generationally, and any advantage is counterbalanced by the disease predisposition of its native population.

            1. Chinese and native Hawaiians are not the same people. Hawaii’s Chinese population still has the highest life expectancy of any ethnicity in the U.S. In fact, Asian Americans generally have much higher life expectancy than the U.S. as a whole, and Whites as a whole, despite having lower health insurance coverage rates than Whites.

              1. “Chinese and native Hawaiians are not the same people” Reread. It is why I said the statistical advantage is counterbalanced.

                1. Native Hawaiians are only about 7 percent of the population. Even when adding in other Pacific islanders you get less than ten percent.

                  The large percentage of Chinese and Japanese, both groups with excellent health records, skews the numbers up far more than Native Hawaiians skew them down.

                  1. Isaac, race for population purposes is self-identified and for this reason population records are deceptive. Chinese/Japanese populations lose much of their health advantages when they adopt a Western diet. Interestingly, It is also the case inside China and Japan.

        2. So you’re saying that people who live an active, healthy lifestyle will live longer and typically pay less for health care than people who live a more sedentary, less healthy lifestyle? I guess we learn something new everyday.

          1. No I am saying people who have access to HC and can afford to seek early treatment/preventable care live longer.

            1. In that case you’d be absolutely wrong. Lifestyle is much more predictive of long term health than is access to medical intervention. I don’t have a medication in my arsenal that can overcome obesity, cigarettes, and drug use.

              1. CP, what percentage of patients do you see have lifestyle issues? I have no doubt certain patients cannot/will not follow medical advice but the population of patients who cannot afford to avail themselves of your service is growing. In my opinion, the catalyst for hc reform.

                1. In the emergency department the percentage is actually pretty high, particularly among those who consume the most resources. I don’t have an actual figure for you, but I can tell you that much of the traumatic injuries I see inevitably lead off with the words “I had a few drinks tonight, then…”. It’s extremely rare that I see a patient with emphysema that didn’t smoke. There aren’t very many skinny type II diabetics. I could go on and on. The point is that you can’t out-treat poor lifestyle choices and you’ll spend an enormous amount of money trying.

            2. No, that’s not what you’re saying, since the life expectancy gap between Hawaii and the U.S. has not changed since Hawaii implemented universal care. By the way, this is also true for Sweden and the U.S.

              1. Jordan, Sweden is in the top 10%. While the US ranks 24th in this study. http://www.who.int/inf-pr-2000/en/pr2000-life.html
                It is reasonable to conclude that there is little room for improvement in Sweden. Unfortunately, that isn’t the case for us.

                1. Americans of Swedish descent are as healthy as Swedes in the old country. They have remarkably similar disease, mortality and crime rates.

                  To the extent Sweden’s welfare state is successful, it is due to the fact that Sweden has only about nine million people and they are almost all Swedes and they are all Lutherans.

                  To the extent that those demographics and cultural characteristics are changing so is the success of the welfare state declining.

                  But then you’re not the first newcomer to H&R who though he could dazzle us rubes with his simplistic comparisons of dissimilar societies.

                  1. The Swedes and the US shared equivalent issues during the same period of time. Yet, life expectancy results have clearly improved to a greater extent in Sweden. Could It possibly be their government health care? ” S?ren Edvinsson, and John Rogers, “H?lsa Och H?lsoreformer I Svenska St?der Kring Sekelskiftet 1900,” [Health Reforms In Swedish Towns, 1875-1910]. Historisk Tidskrift 2001 (4): 541-564. Issn: 0345-469x

                    In 2000 life expectancy for Swedish men was 77 years and for Swedish women, 82 years. However in 1870 life expectancy was only 45 for men and 49 for women…After 1900 investments in other health care infrastructures, such as epidemic wards and hospitals, took precedence. Public health investments were correlated with changes in infant mortality, mortality resulting from digestive disorders, and mortality from infectious epidemic diseases for the period 1876-1910. ”

                    The effect of uneven internal health care distribution indicates you are incorrect with your theory.

                    1. You seem to have forgotten the variable of time. Hmm, what happened between 1870 and 2000? What major disovery could possibly account for the decrease in deaths, especially deaths due to infectious disease? I think it starts with an “a”.

                      Over the 20th century, U.S. life expectancy increased by 30+ years. I have a feeling that the increase in life expectancy is roughly the same across the industrialized world, regardless of how big the government programs taking credit for it are.

                    2. Marlok, If you read the whole thread you would understand that the argument proposed was that the Swedish are genetically healthier, and the resulting unfair advantage secured the life expectancy results. Access to antibiotics improved life expectancy, and influenced mortality rates, but we are discussing present day. Why is the US not in the top ten percent of longevity statistics?

                    3. Several factors, not many of which have anything to do with healthcare “access”. Among them are: high rate of violent death, high obesity rates (leads to many, many chronic health issues), high rates of alcoholism (with resultant chronic disease and accidental mortality), and much higher miles driven in a car per year (leads to more fatal crashes). Add into that the fact that we count infant mortality differently than many countries, leading to a higher rate than would otherwise be reported. Adjust for those and other non-healthcare related factors and you might be surprised as to the numbers.

                    4. CP,
                      I picked one random fact to research:

                      Costa rica rate of violent death
                      # 19 Costa Rica: 0.061006 per 1,000 people/ #30 life expectancy
                      US rate of violent death
                      # 24 United States: 0.042802 per 1,000 people/ #38 life expectancy
                      Alcoholism is definitely prevalent in many of the greater life expectancy countries. Apparently you have never driven anywhere, but the US. ” [W]e count infant mortality differently”, clarify your difference.

                    5. Look up the obesity rate in Costa Rica. Also, how are the life expectancy numbers tracked there? You’ve got to look at how the stats are collected, not just the final numbers.

                      Here, we attempt to save just about any baby born after 20 weeks or so and those that don’t make it (and it’s a bunch) are counted as infant mortality. Other countries might choose to count those as spontaneous abortions. There aren’t standard reporting criteria.

                    6. CP, you are making criticism about the figures without being specific. I agree you can tweak facts, but I also know, that if we did have a greater life expectancy, I would have found that information. Cite one chart to prove that the USA has the greatest longevity.

                    7. CP, regarding lifestyle issues: “In the emergency department the percentage is actually pretty high, particularly among those who consume the most resources.” Of course, lifestyle induced illness is high in the emergency department! I did find a fair article on the subject, and a lot of the common assumptions have yet to be proven, but diabetes preventative care is not one of them. I think it is interesting that these preventive costs vs. medical treatment are studied in terms of the dollar expense. It may be cheaper for society to stabilize the addicted or mentally ill, but I don’t think It is a moral solution.

    4. Max|6.24.10 @ 3:29PM|#

      Go suck ron puals dick, morons. You peeple are fucking retarded. I`m done coming to this wingnut sight. this is my last post.

      1. The most interesting thing about this post is the substitution of a backtick (`) for an apostrophe (‘).

        Whaddup wit dat?

        1. Plus the spelling and capitalization is horrid.

  10. Any doubt left that it was just a stepping stone towards total nationalization of healthcare?

    1. Markets don’t work, we need regulation!

      Regulation didn’t work, we need more regulation!

      More regulation didn’t work, we need partial socialization!

      Partial socialization didn’t work, we need socialization!

      1. Aside from a few more iterations of step 2, spot on.

        1. I should have put something in there to the effect that no matter what iteration you’re on, it’s because markets don’t work.

      2. Socialization didn’t work, we need to liquidate the populace and get a new one!

  11. Boston is just a big building where legislation happens?

    1. No. By “state capital”, they mean Boston is where MA puts all of its money.

  12. Don’t know what you’re concern with socialized medicine is about? Here in Canada, a few weeks ago I only had to wait six hours in the emergency room to get some shit out of my eye. And it didn’t cost me a dime, the govt paid for it….hahahahahahahahaha…….

    1. You went to the emergency room for that?

    2. “the govt paid for it”

      Really? The govt got it’s money from where again?

  13. Everyone – liberals, conservatives and libertarians screwed when it comes to health care. For one, people are incapable of making rational decisions when it comes to their health.

    Liberals are screwed because their solution, universal care, in unsustainable in the long run (maybe even in the short term) because costs can go nowhere but up. People free to consume health care at no cost will do so exponentially unless limited by regulation, something that is obvious anathema to most in this country (death panels, etc).

    Conservatives are screwed because the high barrier to entry and opportunity costs (7-10 years of post-college education) to become a doctor and the high costs of basic and clinical research do not lend themselves to private enterprise due to low ROI (the NIH sponsors the vast majority of translational research and many drug trials either directly or through subsidy).

    Libertarians really have no answers either – get rid of the entire system and start from scratch? This is probably the best idea but is not realistic without some sort of societal collapse. A true free market + charity care? Who pays for the research? No one can deny that government (through major research institutions and the NIH) has been a major driver of advances in medicine. Private industry does not have a good track record in the 2000 years of medicine prior to about 1900 when medical research and education was reformed at Johns Hopkins. What is the the free market solution to

    1. “No one can deny that government (through major research institutions and the NIH) has been a major driver of advances in medicine.”

      Citation for that?

      1. You really need a citation for the idea that the gobs of money and expertise the NIH and other governmental agencies (like research universities) has driven medical advances?

        I guess you need one for “the sky is blue too.”

        One could argue that these advances would have been made better by other mechanisms, but one would have to have a retarded view of how incentives work to think it has not driven advances…

        1. The denial is that it’s a “major driver”. Sure, it has an effect. But is the effect significant relative to the effect of non-NIH investment? I would speculate that in the grand scheme of health research, the NIH and other Federal funding is a minor contributor. I’d need a cite to believe otherwise.

          1. Ok, we can all play this game. I need a citation for your speculation!

            1. Ok, the NIH budget for 2010 is listed here:

              The NIH’s mission in advancing research is explained here:

              So…The NIH is an agency that has a mission to advance medical research, has tens of billions of dollars to spend on that mission every year, and does so through through a variety of grants and initiatives working with private and public agencies.

              And somehow this is NOT a major driver of medical research advances.

              Since that last statement DEFIES logic and common sense I’m afraid you guys can please provide “citations” refuting it…

              1. MNG,

                You are amazing. You list its’ budget and mission but no evidence that it actually accomplishes anything. In your mind, the fact that it is the government and spends lots of money for a defined purpose is somehow definitive proof that it is not just effective but the only effective means of accomplishing the goal.

                And you post that without any irony. You honestly think that is proof. Get help. Your liberalism has really started to rot your brain.

              2. Do you really need a lesson to explain the difference between inputs and outputs?

                1. Do you really need a lesson to explain the difference between inputs and outputs?

                  A lesson lost on someone who shits from their mouth.

              3. Haha you’ve never been to the NIH where they have glass-breaking parties to give an excuse to buy new glassware… Use it or lose it, they say, with respect to their grant outlays.

                Seriously. OF COURSE the NIH is the major driver of medical advancement, because it effectively has a monopoly over it. That is completely different from arguing that the system would be better without it.

                1. I’ve only been active in the clinical side, but I don’t doubt what you say. Use it or lose it is bureaucracy 101 (both private and public I may add)

              4. NIH has a 31 billion dollar budget. Pfizer, all by it’s lonesome, spends almost 8 billion a year on R&D. Draw your own conclusions.

          2. There is all kinds of funding in the world of science – private industry, governemnt, foundations. The NIH drives biomedical research because it is the biggest overall player in the game and it sponsors all types off research – cancer, drug trials, heart, kidney, basic science, etc. It also tracks most protocols and has some skin in the game in major breakthroughs. It also runs pubmed and the national library of medicine, where everyone in medicine and basic science starts their research.

            Howard Hughes Medical Institute does the same thing on the private side (awesome organization). Pharma sponsors research specific to things they want to sell, devices and drugs mostly. Foundations similarly sponsor specific research based on their charter.

            So yes, NIH drives biomedical research, and yes, there are other players who are very important including private industry. I’m not saying that NIH is unfallible or the greatest organization ever, but sometimes its not as easy as NIH=Government=bad.

            1. I am not saying NIH is bad. But, why the existence of NIH somehow inconsistent with the existence of the free market? We could have a free market system and then subsidize research to. One really has nothing to do with the other.

              1. I agree completely. I am not saying they are incompatible, just that there are no barriers to more private money in medicine right now and it is not there.

                1. There are barriers to private money. When you are an NIH-funded research group, you have a blank check to buy the most state of the art instrumentation, so that drives up the cost of the hardware. (Of course extramurally funded bitch and moan about how intramural NIH groups get all the money, without realizing that they are part of the problem).

                  Why don’t we have primarily undergrad institutions competitively doing research? Even lower-end state schools that have trouble getting grants over HYPS, research privates, and research institutes, are being squeezed out of the real research business.

                  the government-funded system basically favors the entrenched academic elites, by amplifying their power, making the system more and more of an echo chamber – and this I think is not a good thing.

                  1. I agree with alot of what you say except that only the NIH allows you a blank check for equipment…. this is true of more than just NIH grant dollars.

            2. honestly, I don’t use pubmed anymore and mostly use google scholar. Although it does have the BLAST feature which is useful, but a bitch and half to use.

              1. Hate google scholar… although i do rss my pubmed mesh search terms into google reader, which I’m sure you can do with scholar as well. I’ll give it another look.

        2. You really seem to believe that only the government can create any good. If you look at the major medical advances in history most of them were done at privately funded universities and hospitals like Cambridge or Johns Hopkins. Yeah, maybe those received some public funding, but not before the 1950s. And even after that, they are hardly on the level of government control and funding the way NIH is. Most great medical advances have come from universities and hospitals that are not run by the government.

          The fact that you think the opposite is as obvious as the “blue sky” shows your profound ignorance. MNG, liberalism of your type really is a sickness of the mind that affects every mental faculty right up to your ability to perceive reality.


          1. Linking the first hit on google does not = knowledge.

            1. You might try to at least respond dipshit. Look up places like St. Jude Hospital or the Mayo Clinic or any of the world’s great research universities (most of whom are private) and you will find the most of the medical advances in the last 100 years came from there not the government.

              But maybe you shouldn’t do that. Ignorance seems to suit you.

              1. Goodness, what a potty mouth. Private universities compete for the public dollar, friend. Public universities compete for the private dollar. Competition is fierce. Yes, there are many great private universities doing great science, but there are also many great public universities doing great science. They all compete for the same research dollars.

                I know you like to make things simple, just like most people. Unfortunately, the day to day in medicine offers a bit too much complexity for a black and white political philosophy (lib, conservative, or libertarian)- sometimes you have to make compromises.

          2. Linking the first hit on google does not = knowledge.

      2. You won’t get on as it’s bullshit.

        1. Hmm, giving money and resources to researchers working on medical advances does not drive said medical advances.

          What an interesting idea Eapie! Let’s apply such logic to all kinds of interesting cases…

      3. Thats what’s fun about the internet, I don’t have to cite anything. If you’re interested in my assertions, why don’t you expand your mind a bit and do some research yourself. I recommend you begin at pubmed.

        1. And what’s silly about the internet is the goofy asking for “citations” for everything in the world.

          Sometimes a lil’ common sense helps. See my post above yours for your daily helping Pessie.

        2. What is fun is you can write stuff that is clearly been pulled out of your ass. The NIH didn’t even exist until a few decades ago. Yet, most of the improvements in life expectancy came long before that. As I said above, most of the great advances have come from private universities and hospitals.

          Is the kind of government worshiping that you exhibit the result of some sort of brain parasite? Perhaps NIH should do some work on that.

          1. “As I said above, most of the great advances have come from private universities and hospitals”
            John, can you pull that citation out of your ass–I would like to read it.

      4. I’m sure the citation is in some PhRMA press release…

    2. One of the problems with this “reform” is that it sees the problem as a lack of insurance, or of insurance costing too much. The basic problem is that medical care costs too much, in large part because of decades of government interference. The left has spent decades demanding that insurance cover mental illness, drug abuse, pregnancy, birth control, acupuncture, etc. There are numerous laws restricting what nurses and pharmacists can do. Hospitals and clinics have to pass special regulatory hurdles before they can be built. Etc.

      Look at it this way: the areas of health care not covered by insurance, and (often) with less regulation, tend to have competition and be affordable: dental work, eye care, LASIK, vitamin supplements, plastic surgery.

      1. “The basic problem is that medical care costs too much, in large part because of decades of government interference.”

        Interesting theory considering the cost is less in many nations with much higher levels of government interference in that sector…

        1. And many nations that have higher levels of government interference in that sector have much lower standard of living and quality of life.

        2. “Lowering costs” by rationing or raising taxes for higher subsidies isn’t what I had in mind.

  14. “As John Goodman of the National Center for Policy Analysis explains at Health Affairs, the issue isn’t the uninsured.”

    That guy was great in the Big Lebowski.

    1. Donny you’re out of your element! Dude, the Chinaman is not the issue here!

  15. Just so we get it clear, this has nothing to do with supply and demand.

    Any idiot with an economics degree can tell you that just because we’re lowering the price of healthcare, that doesn’t mean that those asshole insurance executives aren’t making GOBS of money that they don’t deserve and that they shouldn’t have to sit in those long lines themselves just to see how it feels.


    See, libtards, you assholes don’t have a monopoly on logical economic thought. Suckas.

    1. You are fined one credit for your improper use of Latin.

    2. “”…asshole insurance executives…”

      Why do u think they supported this shit?

    3. I think you’re making money you don’t deserve. Therefore clearly you aren’t entitled to it and it should be taken away. Can’t you see how ridiculous it is that you should just sit there and decide how much someone deserves to make? Maybe if the government weren’t planning to mandate that I buy these people’s product or it was my actual money, rather than my employer’s, that pays for insurance, that there might be some market control of salaries.


  17. Surprise, surprise, surprise!

  18. probably because Medicaid rates are so low that physicians are not anxious to see them
    I think is oversimplifying the issue. Personally I would like to see the numbers for weekend vs weekday wait times and ER visits. As well as the patient out of pocket expenses for ER visits vs Urgent Care. I have insurance and I know if my family or I get sick during non-normal office hours I am directed to either the ER or Urgent Care for services. I then weigh the severity of the issue and choose Urgent Care 90% of the time since my OOP is less. Simply claiming “Pay us more money”, without looking at all the factors or providing any baseline reimbursement rate that would make the physicians “anxious to see them” is more than just a little dishonest.

    1. Does Medicaid even include a co-pay for emergency care? Is there any incentive in going to an urgent care center rather than the ER?

      1. They are both expensive as hell. Insurance doesn’t want to pay for either, nor does medicare. What they want you to do is go see a primary care physician, who will screen you into the medical specialist system if need be or tell you you are fine. PCP’s get paid about $25 bucks per visit and are leaving medicine in droves because of this model. If you make patients pay more, they complain about a fucking $10 dollar copay while at the same time spending 300 bucks on a new haircut.

        You can’t fucking win in medicine. Everyone is getting screwed and there are very few answers.

        1. Urgent care is much less expensive than the ER, especially if it turns out that there isn’t all that much wrong with you (which is often the case).

  19. Based solely on my observations of my in-laws, lazy, fat and stupid people who get sick go straight to the ER even when it is not appropriate and other alternatives, such as scheduling a Dr appointment or visiting urgent care, are available.

    Also – I remember throwing my back out in Phoenix a few years back. My dad brought me over to a brand-new, private clinic. I was in and out in under an hour with drugs in hand, and I felt the care was as good or better than the many traditional medical facilities I’ve been to. Not sure what the name was though.

  20. Fatty, no medicaid makes it a crime to try to collect from a patient.

    Obamacare is a perfect storm of bad ideas.

    Small businesses now are going to find it cheaper for them and for their employees to simply cut insurance. They will pay a fine of $1K per employee, but together with their share of the premiums and the costs of labor that can be saved by not paying people enough to cover their share of the premium, the fine is better for the company and the employees who then go on Medicaid.

    Want to see who is most screwed by this? Kids. Yep, especially kids with serious chronic disease. Already very few places that will care for them, and this number will shrink further. Add to this, the wait caused by the hord of basically healthy kids who will no longer be served by community hospitals trying to keep their operations going on a medicaid budget, and you are looking at truly craptastic care for these kids.

    Wait for Barry to tax Make A Wish in order to provide free trips to illegal alien kids because of the embarassment of being called an illegal alien.

  21. As someone at least in the running for sickest person on the board, I find it curious that so many people run straight to an ER. Unless you are bleeding copiously, just about anything you can sit in a waiting room with for six hours can probably wait until the next day or Monday.

    1. Especially with urgent care clinics opening up all over.

      1. Will take care of those assholes. We can’t have entrepeneurship ruining our plans.

  22. We should be taking charge of our own health care costs. Check out Whatstherealcost.org

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