[PassedOut]

luke warm, on Mar 28 2010, 07:47 AM, said:

most of those 32 million have never been to an emergency room, so yes costs should increase dramatically...

It does not matter that many of the 32 million have not yet been to the emergency room. What matters is that most will have to do so at some critical point in their lives.

The reason that many of the 32 million uninsured have not been to an emergency room is that they've not yet been ill enough to force it. Over time, most people, even the uninsured, do need serious medical care. It is cheaper to treat illnesses early on, before they become catastrophic.

Those of us who pay for insurance have been subsidizing the care for those people whose health situation has become intolerable, and we have also been on the hook for the large group whose situations will at some point become intolerable. Now 32 million will be added to the insurance roles and their medical problems will be treated in a more cost-effective way. There will be a short-term cost spike (accounted for in the legislation), but long-term savings.

Lamar Alexander and the republicans are correct only if many of those 32 million would never have made it to the emergency room even under life-threatening conditions. And even then, only if there are enough such people to eat up all of the insurance money that will now be contributed by that group as well as the savings resulting from earlier treatment.

Note that Alexander's argument directly contradicts the other frequent republican claim that "no one who needs treatment goes without it." And, in fact, first-responders bring the sick and injured to emergency rooms whether they are insured or not. So I doubt very much that the known savings from insuring the 32 million and providing earlier care will be overwhelmed over the long term by treating people who would otherwise never receive treatment.

But if treating those who now die without the care they need is going to be so very expensive that health care reform will not save money, let's get those facts out so we can all see them. Do you have any hard numbers to support that claim?

It will surely be important for voters to have this information for the elections in November.

[Winstonm]

I have no data only personal observation. I have worked in the hospitals and emergency rooms. From what I have seen, emergency rooms have metamorphasized into clinics for the uninsured. Lack of insurance also does not prevent physicians from admitting ER patients to the hospital when needed.

In my opinion, we are making a mistake by retaining the "for profit" model of healthcare. At the very least, we need a buy-in to Medicaire option to compensate for lack of competition.

[PassedOut]

Winstonm, on Mar 28 2010, 10:13 AM, said:

I have no data only personal observation.  I have worked in the hospitals and emergency rooms.  From what I have seen, emergency rooms have metamorphasized into clinics for the uninsured.  Lack of insurance also does not prevent physicians from admitting ER patients to the hospital when needed. 

In my opinion, we are making a mistake by retaining the "for profit" model of healthcare.  At the very least, we need a buy-in to Medicaire option to compensate for lack of competition.

Although I don't have the personal experiences that you have, what you related matches what I have heard from others and what I have read. I'm sure that there are a few people who never get really sick before they drop dead, and some folks who just can't negotiate the health care system well enough to obtain treatment no matter how sick they get.

In my situation (possibly too insulated from the reality many face), I don't encounter such folks, and if I met someone who did not get the care he or she needed I'd take action to see that care was made available. Honestly, I don't think I know anyone who would behave otherwise.

So the argument that we can save huge amounts by denying such folks care just doesn't ring true to me, although I could be convinced by hard numbers. But even it it were true, I'd find it repugnant to deny people health care.

My guess is that a majority of voters are with me on that. So it's important that the facts about this see the light of day and that the issues presented to voters in November are framed along the lines I've outlined. I plan to do my bit to help do that.

I suppose that no one really considers the modest health reforms just passed to be ideal. But even those modest reforms -- which will both extend health care to many uninsured people and reduce the ballooning federal deficit substantially -- aroused rabid opposition from many quarters.

I've never much liked the approach that, "If I can't have my way, I'll just take my bat and ball and go home!" We need to do much more, but the alternative was to accept a much worse status quo.

[helene_t]

PassedOut, on Mar 28 2010, 09:55 PM, said:

So the argument that we can save huge amounts by denying such folks care just doesn't ring true to me, although I could be convinced by hard numbers. But even it it were true, I'd find it repugnant to deny people health care.

Well there must be something to save by denying people treatment for non-lifethreatening conditions. Yes I know it may end up being more expensive if an easy-to-treat condition is allowed to escalate to something less easy to treat, but then again, it might not. We have similar discussions here in Europe about the economics of waiting lists. Certainly there are examples of patients becoming much more expensive because of the waiting lists, but as I understand it, most experts think it would cost money to get rid of the waiting lists. This is largely because waiting lists avoid losses due to idle capacity so it is not applicable to the US situation. But waiting lists also save money when people die or recover before they get treated (how often this actually happens is difficult to know because some of the "recovering" patients in fact never needed treatment but just asked the GP to refer them in case they develop an indication while being on the waiting list).

In the Netherlands, they have a similar problem, though at a smaller scale: people go to the ER for conditions that could be taken care of by the GP, not because of finances (both are covered 100%) but because of convenience (the ER is open 24/7, the GP clinic is not). So some hospitals have arranged for a GP clinic near the hospital to have wide opening hours, then the ER staff can refer non-urgent patients to them.

[Winstonm]

Quote

I suppose that no one really considers the modest health reforms just passed to be ideal. But even those modest reforms -- which will both extend health care to many uninsured people and reduce the ballooning federal deficit substantially -- aroused rabid opposition from many quarters

Perhaps it is simply the cynisism of age, but I do not view these two parts of the bill equally. IMO, and from what I have seen from JFK until now is that the insurance companies will treat this forced insurance bonanza as windfall profits, finding a billion and a half reasons not to lower any price for anything, while the inroads provided by the bill, i.e., the parts about guaranteed coverage and pre-existing conditions will be utilized as cause of rate increases.

Any actual cost savings in this bill was DOA when Rahm and co. agreed to toss out importation of Pharma and any type of real competition.

Isn't it curious how globalization is good for America when we want to outsource jobs to lower costs but it is treason when we want to import cheaper drugs. Buy American just doesn't have the same ring it used to.

[PassedOut]

In a sad, but perhaps inevitable postscript to healthcare reform in the US, anti-abortion terrorists have started crawling back out of their holes to threaten my congressman: Father and son threaten to kill Bart Stupak.

Quote

You wanted to get some Washington paint for the bridge? Not to worry, I will paint the Mackinaw Bridge with the blood of you and your family members. I will not say when and with who but I will save your blood for the high towers toward the end of this project. You will live long enough to truly experience the unfortunate but definite consequences of your decision.

The elder terrorist is dumb as a post. Although from Michigan, he nevertheless misspelled the name of our iconic Mackinac Bridge. And although supposedly a christian, he also misspelled the word "soul" as "sole." But stupid people can be deadly.

Still, as of this writing I have not heard of anyone calling for these terrorists to be denied their civil rights as US citizens. Nor have I heard anyone demand that they be jailed as enemy combatants. Were they Muslims, I suspect it would be different...

Note: Here is the complaint with a copy of the letter: You sir, have sold your sole to the devil.

This post has been edited by PassedOut: 2010-June-08, 12:29

[Winstonm]

PassedOut, on Jun 8 2010, 01:22 PM, said:

In a sad, but perhaps inevitable postscript to healthcare reform in the US, anti-abortion terrorists have started crawling back out of their holes to threaten my congressman: Father and son threaten to kill Bart Stupak.

Quote

You wanted to get some Washington paint for the bridge? Not to worry, I will paint the Mackinaw Bridge with the blood of you and your family members. I will not say when and with who but I will save your blood for the high towers toward the end of this project. You will live long enough to truly experience the unfortunate but definite consequences of your decision.

The elder terrorist is dumb as a post. Although from Michigan, he nevertheless misspelled the name of our iconic Mackinac Bridge. And although supposedly a christian, he also misspelled the word "soul" as "sole." But stupid people can be deadly.

Still, as of this writing I have not heard of anyone calling for these terrorists to be denied their civil rights as US citizens. Nor have I heard anyone demand that they be jailed as enemy combatants. Were they Muslims, I suspect it would be different...

Note: Here is the complaint with a copy of the letter: You sir, have sold your sole to the devil.

Now THAT is STUPID: I"ll prove to you I'm pro-life by killing you.

[y66]

If Truman Capote were still around, he could probably do justice to this story, not just the psychopath element, but its progression in this guy, possibly as a result of dementia, and the weird way in which guys like this come to see themselves as servants of the neocults to which they claim to belong. Sad really.

By the way, what is the water cooler position on Bart Stupak? Is he a friend of bridge? Just asking.

[cherdanno]

I hope bridge has more intelligent friends than Bart Stupak.