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Should we let people die in the street

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  • Should we let people die in the street

    Let's cut to the REAL question. We already DO provide free Universal Healthcare and have since 1986, when laws were passed saying hospitals could not turn away those who could not pay (which most of them had not been doing for years anyway)....the consequence of this is that the ER has been healthcare for all those who have neither means nor insurance and it is by far the most expensive, (and least effective since it doesn't provide chronic care), means of Universal Healthcare there is, BUT it IS still a form of Universal Healthcare, informal and flawed as it may be.

    So, do we let people just die in the street if they can't pay or do we adopt a cheaper and more effective form than what we have now, or do we keep the system we have now, for whatever reasons? Poll to follow

    And before you go screaming hyperbole etc, please give me an alternative to the above choices, because, honestly, I don't see any.
    24
    Yes. Let those who can't pay die
    20.83%
    5
    No, Adopt a cheaper and better form of health care (not necessarily Obamacare)
    45.83%
    11
    Keep what we have now, (please say why)
    8.33%
    2
    Alternative (What is it?)
    25.00%
    6

  • #2
    Re: Should we let people die in the street

    We don't provide universal health care. If you're referring to EMTALA, it applies only to life-threatening emergencies. And patients are still responsible for payment, they're just not asked for it up-front. This was the policy of nearly all doctors and hospitals before EMTALA, and it would likely remain the policy if it were repealed.

    Second, what do you mean by 'adopt a cheaper and more effective form' of health care? If you mean making health care a government responsibility, than I call foul. This isn't a choice between government and Social Darwinism. It isn't a choice between nationalizing health care and people dying in the street.

    Here's the alternative (that you surely won't like):

    The predominant insurance model we've been saddled with is not viable. It's going broke, and people are abandoning it, for a reason. It's fundamentally irrational to think that you can pay a low monthly fee and have all your health care expenses magically taken care of. This delusion is killing us.

    The fact of the matter is, insurance is a bad deal. It's a gamble that, for most of us, doesn't pay off. The more you can pay out of pocket, and the less you must use costly insurance, the better. Not only is it a bad investment at a personal level, it's deeply destructive to the health care market.

    To fix it, we've got to get it through our heads that we have to pay for health care, just like we pay for everything else. We need to remove all the legal infrastructure propping up the delusion and, if anything, encourage people to have less insurance. Only then will real market pressures come to bear, only then will providers have a genuine incentive to bring down prices and provide cost effective care.

    מה מכילות החדשות?


    • #3
      Re: Should we let people die in the street

      Originally posted by dblack View Post
      We don't provide universal health care. If you're referring to EMTALA, it applies only to life-threatening emergencies. And patients are still responsible for payment, they're just not asked for it up-front. This was the policy of nearly all doctors and hospitals before EMTALA, and it would likely remain the policy if it were repealed.

      Second, what do you mean by 'adopt a cheaper and more effective form' of health care? If you mean making health care a government responsibility, than I call foul. This isn't a choice between government and Social Darwinism. It isn't a choice between nationalizing health care and people dying in the street.

      Here's the alternative (that you surely won't like):

      The predominant insurance model we've been saddled with is not viable. It's going broke, and people are abandoning it, for a reason. It's fundamentally irrational to think that you can pay a low monthly fee and have all your health care expenses magically taken care of. This delusion is killing us.

      The fact of the matter is, insurance is a bad deal. It's a gamble that, for most of us, doesn't pay off. The more you can pay out of pocket, and the less you must use costly insurance, the better. Not only is it a bad investment at a personal level, it's deeply destructive to the health care market.

      To fix it, we've got to get it through our heads that we have to pay for health care, just like we pay for everything else. We need to remove all the legal infrastructure propping up the delusion and, if anything, encourage people to have less insurance. Only then will real market pressures come to bear, only then will providers have a genuine incentive to bring down prices and provide cost effective care.
      So, in other words, you believe in the Health Care System that largely motivates Robinette Broadhead in Pohl Anderson's Heechee series. "Full Coverage" is a province of the very, very rich, the rest of us, die if we get sick.

      Let me put it another way...Joe Average is a reliable long time worker at the Famous Acme Corp, making ingenious but strangely unworkable Road Runner Traps...Wile E. Coyote has recently won a heftly liability suit against them and Acme is now out of business. While out looking for new employment Joe is hit by a truck and taken to Mercy General. He needs an immediate and very expensive spleen removal or will die and has no insurance as his unemployment could not cover the COBRA payments. Should the hospital (and any others) be able to refuse him admittance and treatment?

      And after you answer that, please explain to me how having LESS insurance will give providers any incentive to bring down prices. You seem to think Medical care is like a faster vs slower cars or gourmet filet mignon vs hamburger. If you're going to die otherwise it seems to me you'd pay whatever you possibly could.

      Oh, and all insurance is a gamble that never pays off...If you win, you lose, and if you lose, you win.

      I recommend the book "Against the Gods" by Peter L. Bernstein to you, the only work I've ever seen that actually made a CLU class INTERESTING.
      Last edited by John Drake; 02-09-2012, 03:08 PM.

      מה מכילות החדשות?


      • #4
        Re: Should we let people die in the street

        Anyone with a medical emergency can go to any hospital that accepts Medicare/Medicaid and they will be treated whether they have Medicare/Medicaid or not because these hospitals are required, by law, to keep the patient until they are stabilized and can be sent to a charity hospital. If no charity hospital is available, the hospital must keep them until they are well enough for discharge. They can be billed after discharge but many hospitals receive federal funds in exchange for treating a percentage of uninsured patients each year so the patient can apply for this and have the majority of his bill wiped out in many cases.

        מה מכילות החדשות?


        • #5
          Re: Should we let people die in the street

          Originally posted by dblack View Post
          To fix it, we've got to get it through our heads that we have to pay for health care, just like we pay for everything else. We need to remove all the legal infrastructure propping up the delusion and, if anything, encourage people to have less insurance. Only then will real market pressures come to bear, only then will providers have a genuine incentive to bring down prices and provide cost effective care.
          Indeed... as explained here:

          http://www.uspoliticsonline.com/econ...insurance.html

          מה מכילות החדשות?


          • #6
            Re: Should we let people die in the street

            Originally posted by John Drake View Post
            So, in other words, you believe in the Health Care System that largely motivates Robinette Broadhead in Pohl Anderson's Heechee series. "Full Coverage" is a province of the very, very rich, the rest of us, die if we get sick.
            No, only that one use insurance as a method of off-loading risk and not for everyday maintenance crap. As I explained here:

            http://www.uspoliticsonline.com/econ...insurance.html

            מה מכילות החדשות?


            • #7
              Re: Should we let people die in the street

              Let them die but off the side of the street.

              מה מכילות החדשות?


              • #8
                Re: Should we let people die in the street

                Originally posted by John Drake View Post
                Let me put it another way...Joe Average is a reliable long time worker at the Famous Acme Corp, making ingenious but strangely unworkable Road Runner Traps...Wile E. Coyote has recently won a heftly liability suit against them and Acme is now out of business. While out looking for new employment Joe is hit by a truck and taken to Mercy General. He needs an immediate and very expensive spleen removal or will die and has no insurance as his unemployment could not cover the COBRA payments. Should the hospital (and any others) be able to refuse him admittance and treatment?
                Of course they should. I doubt they would, but it all depends on 'how expensive' and how likely it is that it will extend his life, and, yes how likely it is that he'll be able to cover the costs. The thing is - this is the kind of call socialized health care will have to make every day. Every single one of us will hit a point where it is prohibitively expensive to keep us alive. Pretending that if the government takes over, they'll pull out all the stops to keep us alive is naive in the extreme.

                And after you answer that, please explain to me how having LESS insurance will give providers any incentive to bring down prices. You seem to think Medical care is like a faster vs slower cars or gourmet filet mignon vs hamburger. If you're going to die otherwise it seems to me you'd pay whatever you possibly could.
                Not necessarily. My dad died at 55. He ran up against a nasty combo of congenital heart disease and diabetes. He might have lived to sixty or more if he'd pull out all the stops, drew a second mortgage on his house, etc, etc... But he chose not to. Admittedly, it wasn't all a question of finances, but that was definitely part of it. He hustled hard the last year or so of his life to arrange things so my mom had as good a nest egg as possible (her family is genetically long-lived). That was a decision that, while I'd have preferred to have him around, I have to respect.

                But to answer your question, it's fairly simple economics. Having less insurance benefits us in two important ways. First, from the individual perspective, the less insurance you have, and the more you pay for health care out of pocket - the more cost effective your money will be. This became very clear to me at my last employer where they were enthusiastic supporters of HSAs. They set up Health Savings Accounts for each of us to the tune of $2500 a year per individual - fully funded by the company. Then, they bought each of us a catastrophic insurance policy covering with a deductible equal to the HSA ($2500). The beauty of this arrangement is that if we managed to stay healthy - if we took care of ourselves and avoided illness and accidents - the money deposited in the HSA was ours to keep. It could be rolled over into an IRA, or withdrawn for a nominal fee. Secondarily, the net amount my company spent on health coverage was much less, as the premiums for catastrophic HC policies are quite low.

                The most important effect of less insurance, however, is the effect on health care inflation. It doesn't take much in the way of financial analysis to realize that people who aren't spending their own money don't really care much about low prices. Think about it - if you're insured (and you've already covered your deductible for the year) and you're faced with a choice between treatment A, which cost $500 and gives you %80 quality, and treatment B which costs $5000 and offers 90% quality, which would you choose? I dunno about you, but if I've paid expensive premiums for years, and it's no skin off my ass - I'm going for the most expensive treatment my insurance will pay for. How can that sort of decision, multiplied thousands of times daily, not drive prices higher and higher?

                If people are paying their own bills, the equation changes. People want value for their money when it's their money. When the money they save will put their kids through college they'll ask the doctor if there isn't a cheaper option. When you're "covered" there's virtually no reason to ever have that conversation.

                I recommend the book "Against the Gods" by Peter L. Bernstein to you, the only work I've ever seen that actually made a CLU class INTERESTING.
                I like books. I'll check it out.

                מה מכילות החדשות?


                • #9
                  Re: Should we let people die in the street

                  Originally posted by Damn Yankee View Post
                  Let them die but off the side of the street.
                  Unfortunately, it's too many...I've been in such countries. In India you can tell the large cities for miles by the flocks of buzzards overhead to eat all the dead human corpses, which are everywhere.

                  מה מכילות החדשות?


                  • #10
                    Re: Should we let people die in the street

                    Originally posted by dblack View Post
                    Of course they should. I doubt they would, but it all depends on 'how expensive' and how likely it is that it will extend his life, and, yes how likely it is that he'll be able to cover the costs. The thing is - this is the kind of call socialized health care will have to make every day. Every single one of us will hit a point where it is prohibitively expensive to keep us alive. Pretending that if the government takes over, they'll pull out all the stops to keep us alive is naive in the extreme.



                    Not necessarily. My dad died at 55. He ran up against a nasty combo of congenital heart disease and diabetes. He might have lived to sixty or more if he'd pull out all the stops, drew a second mortgage on his house, etc, etc... But he chose not to. Admittedly, it wasn't all a question of finances, but that was definitely part of it. He hustled hard the last year or so of his life to arrange things so my mom had as good a nest egg as possible (her family is genetically long-lived). That was a decision that, while I'd have preferred to have him around, I have to respect.

                    But to answer your question, it's fairly simple economics. Having less insurance benefits us in two important ways. First, from the individual perspective, the less insurance you have, and the more you pay for health care out of pocket - the more cost effective your money will be. This became very clear to me at my last employer where they were enthusiastic supporters of HSAs. They set up Health Savings Accounts for each of us to the tune of $2500 a year per individual - fully funded by the company. Then, they bought each of us a catastrophic insurance policy covering with a deductible equal to the HSA ($2500). The beauty of this arrangement is that if we managed to stay healthy - if we took care of ourselves and avoided illness and accidents - the money deposited in the HSA was ours to keep. It could be rolled over into an IRA, or withdrawn for a nominal fee. Secondarily, the net amount my company spent on health coverage was much less, as the premiums for catastrophic HC policies are quite low.

                    The most important effect of less insurance, however, is the effect on health care inflation. It doesn't take much in the way of financial analysis to realize that people who aren't spending their own money don't really care much about low prices. Think about it - if you're insured (and you've already covered your deductible for the year) and you're faced with a choice between treatment A, which cost $500 and gives you %80 quality, and treatment B which costs $5000 and offers 90% quality, which would you choose? I dunno about you, but if I've paid expensive premiums for years, and it's no skin off my ass - I'm going for the most expensive treatment my insurance will pay for. How can that sort of decision, multiplied thousands of times daily, not drive prices higher and higher?

                    If people are paying their own bills, the equation changes. People want value for their money when it's their money. When the money they save will put their kids through college they'll ask the doctor if there isn't a cheaper option. When you're "covered" there's virtually no reason to ever have that conversation.

                    I like books. I'll check it out.
                    Yes and no...If the alternative is a somewhat less care, or even somewhat greater risk, I can see your point...If the alternative is "die" I don't see many people taking it, your father, (and I sympathise with your loss) notwithstanding, most people will pay most all they own to stay alive, and the point remains that by your plan the entirety of our economy could easily be eaten up by a few lifesaving drugs. Were insulin to be kept for only those who could pay "what the market could bear" very few diabetics would survive and all the money in our economy would go to a very few drug cos that would dole out the precious supply to whoever could afford it.

                    Btw, I respect your father's decision too, but I can't say I agree with it...many people beat the odds and live for quite a few years beyond what is given them by doctors. My father died when I was rather young, but I still concur with Dylan Thomas in this regard.
                    Last edited by John Drake; 02-10-2012, 02:01 AM.

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                    • #11
                      Re: Should we let people die in the street

                      Anyone with a medical emergency can go to any hospital that accepts Medicare/Medicaid and they will be treated whether they have Medicare/Medicaid or not because these hospitals are required, by law, to keep the patient until they are stabilized and can be sent to a charity hospital. If no charity hospital is available, the hospital must keep them until they are well enough for discharge. They can be billed after discharge but many hospitals receive federal funds in exchange for treating a percentage of uninsured patients each year so the patient can apply for this and have the majority of his bill wiped out in many cases.
                      .
                      And these federal funds are a large reason why we pay twice as much as nearly any country in the world for healthcare and get a lousy 17 in global ratings for overall services. If we treated the chronic conditions that landed these people in the ER they'd probably never get there, let alone end up costing 10x as much when they do. The only way to really cut our cost of healthcare as the Republicans seen to want is to repeal this law and let these people die at the hospital door, and I can't help thinking that is what the Pubs really want to do, as they've offered no real alternative and have in fact rejected what was essentialy their plan in the first place.

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                      • #12
                        Re: Should we let people die in the street

                        I voted for alternative. I support catastrophic coverage only. It could even be single-payer. It would cover all health care costs above 15% of a person's annual income. This would cause most people to drop their insurance coverage. It would create a more free market system for most health care purchases, while making sure that no one goes bankrupt because of health care costs.

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                        • #13
                          Re: Should we let people die in the street

                          Originally posted by John Drake View Post
                          And these federal funds are a large reason why we pay twice as much as nearly any country in the world for healthcare and get a lousy 17 in global ratings for overall services. If we treated the chronic conditions that landed these people in the ER they'd probably never get there, let alone end up costing 10x as much when they do. The only way to really cut our cost of healthcare as the Republicans seen to want is to repeal this law and let these people die at the hospital door, and I can't help thinking that is what the Pubs really want to do, as they've offered no real alternative and have in fact rejected what was essentialy their plan in the first place.
                          LOL

                          You can't help thinking that because it is what you want to think. Any other positon means your insulting stereotype goes away.

                          Besides, I thought you were already tripping over huge piles of bodies...

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                          • #14
                            Re: Should we let people die in the street

                            Um, John, no health care system treats chronic conditions well. Universal health care is primarily for regular checkups and emergencies. People with chronic conditions don't get much help, because treating chronic conditions is enormously expensive.

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                            • #15
                              Re: Should we let people die in the street

                              Originally posted by Mrs. M View Post
                              Anyone with a medical emergency can go to any hospital that accepts Medicare/Medicaid and they will be treated whether they have Medicare/Medicaid or not because these hospitals are required, by law, to keep the patient until they are stabilized and can be sent to a charity hospital. If no charity hospital is available, the hospital must keep them until they are well enough for discharge. They can be billed after discharge but many hospitals receive federal funds in exchange for treating a percentage of uninsured patients each year so the patient can apply for this and have the majority of his bill wiped out in many cases.
                              Originally posted by John Drake View Post
                              And these federal funds are a large reason why we pay twice as much as nearly any country in the world for healthcare and get a lousy 17 in global ratings for overall services. If we treated the chronic conditions that landed these people in the ER they'd probably never get there, let alone end up costing 10x as much when they do. The only way to really cut our cost of healthcare as the Republicans seen to want is to repeal this law and let these people die at the hospital door, and I can't help thinking that is what the Pubs really want to do, as they've offered no real alternative and have in fact rejected what was essentialy their plan in the first place.
                              But that was not the question, your poll has to do with "should we let people die in the street." Mrs. M, rather well, pointed out how that is not a realistic question. Where are Republicans trying to repeal laws having to do with what Mrs. M pointed out? (I am legitimately interested.) Repealing Obamacare is one thing (which by the way will do nothing to influence our 17th ranking with or without Obamacare) but to then go to the next step of repealing out other existing healthcare legislation having to do with what hospitals that accept Medicare / Medicaid have to do with emergencies is another matter.
                              Last edited by Sluggo; 02-10-2012, 06:04 AM. Reason: typo

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