The Wave of the Future
The wave of the future is the free-standing Emergency Department.
By requiring insurance coverage or full payment at time of presentation, these facilities are able to offer reduced waiting times, concierge-style amenities, and a full array of emergency diagnostic and therapeutic services. And if they refuse to accept Medicare or Medicaid, then they are not forced to follow the restrictive rules of EMTALA.
EMTALA applies only to "participating hospitals" -- i.e., to hospitals which have entered into "provider agreements" under which they will accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program for services provided to beneficiaries of that program.
So these "free-market" emergency facilities can not only refuse treatment of patients who are unwilling or unable to pay, but they can also transfer patients at will without negotiating with a receiving hospital or jumping through a lot of regulatory hoops. Realistically, however, hospitals love receiving transfers from these types of facilities because they know they are getting fully-paying patients. Do you think that a hospital might accept an otherwise healthy well-insured young woman with a gallstone attack in transfer, perhaps causing the cirrhotic Medicaid patient to wait a few more hours in their own ER? I think they just might. The bottom line is a powerful incentive.
As this business model becomes more widespread, hospital-based emergency departments will be faced with an increasingly problematic payer mix, because the higher-paying patients will be siphoned off the top, leaving only the most undesirable trauma and Medicare/Medicaid populations to fill their overcrowded waiting rooms. And when emergency physicians have a broader selection of practice environments to choose from, I suspect the hospital-based ERs will soon have some difficulty filling their schedules as well, thereby compounding their problems even further.
Guess what?
Healthcare isn't a right after all.
Thanks to KevinMD for the link!
And David Catron nails it.
By requiring insurance coverage or full payment at time of presentation, these facilities are able to offer reduced waiting times, concierge-style amenities, and a full array of emergency diagnostic and therapeutic services. And if they refuse to accept Medicare or Medicaid, then they are not forced to follow the restrictive rules of EMTALA.
EMTALA applies only to "participating hospitals" -- i.e., to hospitals which have entered into "provider agreements" under which they will accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program for services provided to beneficiaries of that program.
So these "free-market" emergency facilities can not only refuse treatment of patients who are unwilling or unable to pay, but they can also transfer patients at will without negotiating with a receiving hospital or jumping through a lot of regulatory hoops. Realistically, however, hospitals love receiving transfers from these types of facilities because they know they are getting fully-paying patients. Do you think that a hospital might accept an otherwise healthy well-insured young woman with a gallstone attack in transfer, perhaps causing the cirrhotic Medicaid patient to wait a few more hours in their own ER? I think they just might. The bottom line is a powerful incentive.
As this business model becomes more widespread, hospital-based emergency departments will be faced with an increasingly problematic payer mix, because the higher-paying patients will be siphoned off the top, leaving only the most undesirable trauma and Medicare/Medicaid populations to fill their overcrowded waiting rooms. And when emergency physicians have a broader selection of practice environments to choose from, I suspect the hospital-based ERs will soon have some difficulty filling their schedules as well, thereby compounding their problems even further.
Guess what?
Healthcare isn't a right after all.
Thanks to KevinMD for the link!
And David Catron nails it.
posted by scalpel at 7:42 PM
48 Comments:
And as soon as one opens within driving distance I am there.
I went to one of these a few weeks back with an asthma attack. I was not only amazed at how well maintained it was and how nice the facilities were, but how quickly I was brought back, nebbed, and CXR'ed. It was impressive compared to a typical ER.
If you got the skrill to pay the bill then we can treat what makes you ill!
If you don't, then we won't.
You can just die. That green stuff (or the electronic numbers in my bank account) is more important than your life.
It seems WRONG to me.
So how do you suggest that the problem be fixed? I am interested in the opinions of those "in the trenches" like ER doctors and nurses and what they think should be done to reform things. We definatley need reform. I don't think that universal health care is the answer either.
How about starting with a co-pay for medicaid patients? When we lived in Arizona, the government tried to put a copay with medicaid of like $2, but someone sued about the right to care, so that got scrapped. People would be less likely to show up at an emergency room for a pregnancy test if it cost them 20 bucks or so.
What else can be done? I am sure other people (aka non-politicians) have great ideas.
If these become too common, the government will likely regulate them out of existence.
Whoa.
That's crazy! But also genius.
What the docs need is receiving docs at hospitals, so that the patients that need to be admitted can be directly admitted to the hospitals without being transferred through the ED. That way people at the hospital ED don't wait longer to be seen (although they may wait longer for a bed.)
Y'know what's also kind of, slightly sucky?
Dying because you don't have the money to pay for X. (Say, my appendix exploded and I have don't the money to pay for the operation.) I'm sorry, your right to life is lacking because you can't afford it.
Seriously, I get so sick of people making judgments who've /never been in the position/ to absolutely need treatment, do-or-die. Same people who will eagerly point out that under a socialist healthcare system, some people will never receive the very best in medicine. Yeah, we get it, /you're/ that person who wouldn't receive top-notch cancer treatments; obviously, the fact that many more people will receive absolutely no care does not matter. Selfish, greedy bastards.
Hannah, Scott
no one is suggesting that the poor be allowed to die, just that they go to the public ER with its single loud blaring TV, uncomfortable chairs, long waits for non-emergent cases, etc (not that I necessarily agree with this, I am just pointing out that no one is suggesting that the poor be left to die).
I think that state govs will move to crush these freestanding ER's by 1) pressuring commercial insurance companies not to let them be in network and 2) through certificates of medical need laws.
Well, of course. And 95% of ER cases are non-emergent -- at least, right?
I mean, I'd certainly be willing to pay a fee to get treatment; $10, $100, certainly something that most Medicaid abusers do not want to pay.
Mostly, I just get nervous when people mention a pay-only (see: vet care) system of healthcare. Those of us without insurance that simply cannot afford certain things; and I'm not talking, cheap OTC meds or whatever.
Amy, my solution to the healthcare problem is here (4 parts). Skip to part 4 for the bottom line.
Scalpel,
Only problem with the idea is that a free-standing such as you describe is that they can only bill using clinic codes -- 99281-99285 are only permissible for the ER setting, a definition which includes accepting the EMTALA mandate. The differential between the two code sets is at least a third of the value, if not more.
Similarly, if you want to bill on the facility side using ED APCs, which you would need to do to support the infrastructure of a free-standing ED, again, you are obligated to take all comers (and subject yourself to Joint Commission, etc).
It's nice that Texas law requires non-par payers to pay at full in-network rates, and that you can balance bill. The examples you cite will probably be successful for that reason. Most states have a less-friendly regulatory climate, though, and I know that they have not succeeded in other instances.
More's the pity.
Damn, you beat me to this, I was going to write about it!
On a different note: I was looking at your left-wing robot rant thing and it said "down with guns!!!"
HAHA
Shadowfax- you are incorrect. these facilities are not urgent care centers, they are full-service emergency departments, and they bill ER charges and ER facility fees.
EMTALA has nothing to do with billing codes. In fact, if a hospital decided to stop accepting Medicare and Medicaid (which I could see happening in the future if the full cuts go into effect), then their ER could refuse nonpaying patients and ignore EMTALA as well, while still charging full ER fees.
The second facility I linked has earned the Joint Commission Gold Seal of Approval, by the way. They do not accept Medicare, Medicaid, or TriCare, and they charge full Emergency rates.
The bottom line is that once you decide to take the plunge and stop accepting government slag, then you can charge whatever the market will bear for your services. In fact, you could hypothetically stop using those government-designed billing codes altogether if you wanted to, but so far I think they are still being used as a concession to the insurance companies.
Hannah, if your appendix were to burst and you had no insurance, you would go to the ER, be seen (likely in a timely fashion since you would have a real concern), be taken to surgery, and likely be kept in the hospital for a few days for IV antibiotics. Just like everyone else whose appendix bursts, with or without insurance.
"Although I think it would be difficult to implement, I think mothers on Medicaid should be required to take mandatory depoprovera shots as long as they are receiving public assistance."
I like your suggestions except for this part. I can't use hormonal birth control.
Forgot to add:
My idea for tort reform:
I think that all medical malpractice law suits should go up before a panel who decide their worthiness. The panel should be run by the government and staffed with industry and everyday individuals such as: a few doctors, some professors, some scientists, some disabled people, some soccer moms, and maybe an ex-grocer store clerk and a construction worker. Ok well, you get the idea. You need an gamut of people who all can't be accused of being biased to staff the panel. You need doctors, scientists, and professors to provide scientific balance to the emotional knee jerk response of throwing someone a wad of cash because they have a good and dramatic attorney. Each case should have an abstract stating each side's position and the panel can make a determination as to which ones have merit and aren't just a waste of doctor's and taxpayer dollars. Allow the good ones to go foreward, and trash the frivolous ones.
I haven't seen these and I'm not sure about the concept under certain circumstances.
Do these free standing EDs (FSED) accept ambulance runs? If so, what happens if the ambulance brings them someone who can't pay? Does the FSED then call another ambulance to transport to a traditional ED?
What happens if an "emergency" that requires heart cath/surgery shows up? Do they have transfer arrangements with a given hospital or do they just call 911?
I just foresee problems if a patient comes to this "emergency department" with an emergency and the FSED calls 911 for a transfer to a different ED just because the patient has no means of paying. Then what happens?
Then the patient is dumped on the other ER. Again, EMTALA does not apply to these facilities.
I would think they would accept paying patients from ambulance crews, but they probably wouldn't even let the paramedics offload a nonpaying patient, they'd turn them away at the front desk. I know some folks who work at a couple of these, I'll ask them.
from a patient perspective, why is this better than another urgent care facility? i'm sorry i can't read the articles because work has a filter that blocks the sites.
let's say 90% of patients don't need admissions. why don't they just send the 10% that do or sound like they do on to the emergency room?
In my humble opinion, the liability risk of these EMTALA liberated free standing ERs is greatly reduced.
These facilities are better equiped and provide far higher quality and speed of service (the have to, or they fail).
People have no real respect for you when they know they can freely steal from you. This only encourages jackpot justice litigation from low lifes and free loaders, people generally absent at the free standings.
To anon 12:06,
These facilities are staffed by Emergency physicians and ER nurses who typically have more expertise in managing critical or complicated illnesses and injuries than most Urgent Care Centers would be comfortable with. For a stuffy nose or a sprained ankle, you might as well go to an Urgent care facility. For acute abdominal pain, chest pain, or serious injuries, you would probably be better off visiting one of these facilities.
If a patient requires admission, they will probably be transferred directly to a hospital as a direct admit, bypassing the hospital ER altogether. I also wonder if it might be easier to get a consultant (like a plastic surgeon, for example) to come evaluate a patient in one of these free-standing ERs than in a hospital-based ER given the better payer situation.
I was wondering if people who needed -say- emergency surgery, would have to be transferred from the free standing ED to a regular one and go through triage all over again, then be seen by the hospital ED Dr before being treated.
That would be a great waste of time. And money. Double billing.
Your sentence:
"If a patient requires admission, they will probably be transferred directly to a hospital as a direct admit, bypassing the hospital ER altogether."
makes me think you are not too sure about that.
Overall, it is a great idea, but there are some grey areas still, that they conveniently do not address on their website, such as transfers.
can you imagine how great it would be to work there?
I am all over the depoprovera for the medicaid moms...and if they can't use hormonal birth control, then we go straight to the complete sterilization. We will never escape from the crushing burden of the welfare society while those living off the system are allowed to procreate like rabbits.
"I am all over the depoprovera for the medicaid moms...and if they can't use hormonal birth control, then we go straight to the complete sterilization. We will never escape from the crushing burden of the welfare society while those living off the system are allowed to procreate like rabbits."
That kind of makes you an insensitive ass anon. Not to mention that it makes your mindset interestingly like the Nazis who were all for forced sterilization of "lesser" individuals. Can you imagine how many people on the road to success i.e. college etc., would be forcibly sterilized under your regieme. Can you imagine our population demographic? Who will take care of the burgeoning population of old folks?
Sorry ma'am, since hormonal birth control causes you migraines and puts you at a risk for stroke, we'll just have to clip your tubes. NO worries, if you ever make any money, you can go through IVF to have children and pay it at your own expense.
Oh sorry, your birth control causes you to have intractable depression and insomnia, too bad, lets just give you the big fix. Imperfect people like you shouldn't breed.
We'll just steal your future ability to have a family because it sucks to be you, you unlucky bitch who can't use hormonal birth control. We don't care if you become less functional on birth control. Take it or get the big chop.
I have known some people who have been seriously f-ed up due to depo provera. I actually have never met anyone that it didn't cause significant problems for. I suppose that's all anecdotal right?
If there were a better NON-PERMANENT solution to birth control for the poor, sure. But that's a slippery slope. Why don't we just abort the children of those who are on medicaid too. Little bastards are just drains on the system anyway.
I would have made that comment anonymously too you coward.
Doctors' offices used to do what the freestanding ER's now do. Even specialists took care of emergencies when I started practice. The hospital ER was mostly for ambulance cases. We had X-ray, lab, minor OR, and were very cost-effective. I can't do some of that now, but we still see emergency cases in the office, and send just a few with more complicated problems to the hospital as direct admissions.
Amy, you are mostly right. I also wish the anonymous commenters would get a pseudonym and an avatar so we could sort out the ones we agree with and the ones we want to flame.
Oh, I love these ER's. We have three in my area, and we've had to use them from time to time with after-hour emergencies. Great care, great diagnostics.
amy- there are other options other than hormonal birth control and sterilazation, IUDs are wonderful without the chemicals and once they are out you are able to concieve again, maybe this would work. Anon 604, since you are forced to have insurance, I see hospitals jumping at the chance to take emergency cases that need admission or surgery from these stand alone places. Truth is, if the wait is shorter than our ERs wait, you could probably have your workup complete and get transffered to a bed via ambulance in a shorter time than if you came thru our waiting room (except for chest pains). All you would need would be an admitting physician to get you a bed, also not hard because off your reimbursement
"amy- there are other options other than hormonal birth control and sterilazation, IUDs are wonderful without the chemicals and once they are out you are able to concieve again, maybe this would work. "
I am allergic to metal. So I haven't tried a copper IUD. I suppose that Medicaid might want to have me allergy tested to see if I can handle copper?
I used the Mirena and it almost drove me literally crazy. So I had it removed. Apparently there aren't any statistically significant results in studies from the hormones actually causing problems, but it really messed me up. It took me about 10 months of steadily increasing mental problems before I started breaking out in cold sweats at night, identical to those I have when pregnant, and just having given birth. Then the light bulb went off and I realized that maybe just maybe I had a hormonal problem and wasn't actually going crazy. I got it out and in about 5 days, I felt like the sun had come out from behind the clouds and I was a new person.
The point of my sharing this very personal information is that if you are going to force birth control on the poor segment of the population, you need options available that work for everyone and that AREN'T permanent.
I thought I'd add that for my family personally, Medicaid will be done in exactly 6 days!!!
My husband's insurance from his job starts then!!! I'm glad to be done with it, but I must add that it was a real blessing considering that almost every member of my family has a condition which makes insurance companies deny deny deny.
amy...
There isn't any force implied.
It is a choice.
You could always CHOOSE to not get the assistance checks from your neighbors and instead make your own way in the world.
> Scott said...
>That green stuff (or the electronic numbers in my bank account) is more important than your life.
Well, certainly not TO YOU.
Scott, what do you do for a living? Do you work for free? Do you expect to be paid for your labor? Do you expect a fair rate?
Would it, say, be fair for the hungry to take food from farmers, grocers, or restaurants without paying? Or to just pay $0.05 because that is what they could afford?
I don't think so.
And those of us who sell healthcare for a living have no interest in being enslaved by your need.
ohh, man, nice posts everyone, i love these discussion.
I love the idea of free standing ER's. Its segregation, but I don't care, I want good care, I can pay for it and i will pay for it. With people like me out of the regular ER wait times will decrease so those w/o insurance can still get better care. No one deserves to die because they can't pay, no more than I deserve to wait 4 hours while I slowly loose blood from a gapping wound so X can demand antibiotics for her kids viral infection or the drunk guy to detox. We, i mean my side of the argument, are not saying that the unemployed, poor should be cast out, sterilized (well most of us on that issue). Unfortunately those who abuse the system on both ends ruin it for the masses. The unemployed welfare slacker with 5 kids with 5 fathers, who used drugs, and believes the government owes me for slavery (ps my family fought and lost their lives to free the slaves in the civil war, just want to point that out, and no one owned slaves, in fact my family was part of the underground railroad, so drop that prejudice shit right now!)people abuse the system and cost tax payers billions in unnecessary expenses. Example, just because you are on utility assistance does not mean you should run your AC in every window at 60* or heat at 80*, or leave every light on 23 hours a day! Back on topic now. On the other extreme is the rich bitch with the BMW who wants her husband seen for a vague stuffy nose and itching in front of the wounded child or person. Thus triage! We need balance, QUIT abusing the system and you won't be ragged on, simple as that. There is no perfect answer as things stand now, there is too much regulation on stupid stuff and not enough on cutting down on abuse of all sorts of the system. Less regulation on the stupid stuff leaves more time and energy to weed out the abusers and benefit the system. I have no problem with government assistance when it is used as just that assistance not the sole income for capable people who are making and effort to better themselves.
"There isn't any force implied.
It is a choice.
You could always CHOOSE to not get the assistance checks from your neighbors and instead make your own way in the world."
Once again, Anon, your short-sightedness shows your ingorance. I have never recieved an assistance check.
My husband makes a great paycheck now that we are done with grad school and we will pay into the system for the rest of our lives. My husband will be in the top tax bracket in a few years, so we will feel our share of the sting of paying for others. This will still not make me regret being able to get government health insurance so that my family could be healthy and PRODUCTIVE.
If there were the possiblity for us to buy health insurance we would, but due to various medical conditions, we can't. In the current state of affairs, if you don't have health insurance and you're not a millionaire, you're gonna get screwed. This is why we need system reform, so that everyone has access to health care, and the cost isn't prohibitave to those who have no insurance.
In the case of someone popping out crack babies, you have a legitimate reason for forced sterilization.
Anon, you're a coward. Why don't you let people know who you really are. If you're going to spew such crap, grow some balls and show your face.
I think that these are a brilliant idea. Unfortunately, I'm also sure that states will try to regulate them out of existence.
The impact of EMTALA is not to be understated.
My teaching's hospital's ED (along with our wards) are at/near the saturation point on more days than not. (We are also the only level 1 trauma center for hundreds of miles.)
As a potential patient, I'd welcome such a facility in our city, though such a place would certainly skim off the tiny remainder of "paying customers" using our facilities.
Amy..
>This is why we need system reform, so that everyone has access to health care, and the cost isn't prohibitave to those who have no insurance.
Well, lawyers are expensive. And many people, if sued, couldn't afford a decent attorney. Yet I see no such hand wringing for free or taxpayer funded legal services at fixed prices.
On another note, how about instead of considering public paid healthcare a GIFT, it were a LOAN? With modern debit card and ID tech, we could keep track of how much taxpayer paid healthcare one consumed, and require repayment to the US Govt/Taxpayer.
This would have the benefit making people spending other people's money on healthcare consider how much they are spending.
And it would help the treasury too.
And we could get rid of price fixing by govt.
"Yet I see no such hand wringing for free or taxpayer funded legal services at fixed prices."
This is because people don't die if they can't find a lawyer to take their case, or if they can't afford one. Unless of course, you're that girl who needed the liver transplant, but that's an isolated case.
"With modern debit card and ID tech, we could keep track of how much taxpayer paid healthcare one consumed, and require repayment to the US Govt/Taxpayer."
This might be a workable idea, if the government could argue prices for people like insurance comapines do. One problem with being self pay is that the hospital, will make you pay whatever they want to cover the costs for people who don't pay their bills, i.e. EMTALA users, and illegals, and those who give false info.
I keep hoping that somehow there can be tort reform, so that doctors and caregivers costs can go down, so that individuals can pay for their own health care and the individuals won't be carrying an enormous burden that ruins them financially. I don't know how many of you have ever paid for services as self pay, but it is pretty ugly. My husband got charged $278 for a CMP and a CBC, and the lab I worked at before we moved would have charged him about $75.
If we stick with medicaid, it needds major reform. Providers need to be payed more, and people SHOULD be responsible for their insurance premiums, or copays, or some of their care. We just need a system that won't financially cripple those who have no insurance or who are struggling to provide for their families.
Student loans are so crippling now, we are going to see a lot less people going to college, or maybe more people defaulting on their student loans. This is going to make the medicaid situation much worse in my opinion, with less people working jobs that provide insurance.
Tort reform, while happily accepted, wouldn't help cut costs that much. And raising the Medicaid rates would mean raising taxes. No thanks.
No, the big problem is entitlement. The Happy Hospitalist says it most succinctly with his FREE=MORE phrase. When people feel entitled to free healthcare, they demand more of it. When nonpayers demand the same level of care as the paying customers, costs skyrocket.
The poor in this country don't live in gated mansions, they live in the projects. the not-so-poor live in apartments. The poor don't drive Mercedes, they ride the bus, or maybe they can afford a beat-up old Chevy.
Why the hell should they expect a freaking liver transplant or an AICD? Why should they expect to be seen in the same hospital as the paying customers? But we give them these things, expecting nothing in return, and then whine about our national healthcare expenditures and bray that we aren't getting as much for our healthcare money as the Europeans. And we listen to idiots claiming that our system is worse than those in other countries.
Maybe it is, but not in the way that they are suggesting.
Yeah, but if we had tort reform, that could help lower your malpractice insurance, and also lower the amount of cya medicine that has to happen? Couldn't we go with the whole less is more theory if it was very hard to sue competent doctors? Would you still go ahead and order the u/s on the chick who is faking pain, and having no bleeding, who comes in every month if you knew she couldn't sue you because you had covered the basics of care for what was REASONABLE in that situation?
I don't think tort reform is "the answer." I just think it is a piece in the puzzle. And no, I don't want European or Canadian medicine.
I'm not arguing that special clinics and hospitals for the poor arent' a good idea. If that's where I could get the PT and OT that my kid needed, or the vaccines, or the strep swab, and I had to wait all day to do it, then so be it.
Whatever we do, I don't think it's right to have a "free ride" system. But at the same time, it's not right for a kid from the projects to grow up with a cleft lip and palate because his parents don't make enough, or don't have a job that provides insurance. Or for my kid to never learn to walk because we couldn't afford the therapies necessary to help her.
>This is because people don't die if they can't find a lawyer to take their case, or if they can't afford one.
How about food? Shelter? Those are far more proximate to life than healthcare, and there is no mandate that farmers or grocers or restaurants or apartment owners provide their products for free to those who need them. Nor does govt fix prices for those things.
>This might be a workable idea, if the government could argue prices for people like insurance comapines do.
You have identified a problem, but have the wrong solution.
What you argue for is the current "network" model of pricing. There are 2 problems with network pricing:
1. When neither buyer nor seller know the price know the price at the time of the transaction, MANY TEDIOUS AND EXPENSIVE steps are required to complete the transaction. We spent $2.1 Trillion(!) on healthcare last year, and the average claim was for $77. That is a lot of claims!
Claims adjudication in the network model is the prime reason why admin costs are 30% of the healthcare dollar.
2. Flat rate network prices reward only volume. Vendors aren't paid more for providing products with better quality, service, convenience, or value....just volume. When you build a machine that rewards only volume, what is it you think the machine will produce?
>I don't know how many of you have ever paid for services as self pay, but it is pretty ugly.
I have, including the births of my two children. Since it was self pay, we comparison shopped. For the first, we used a nurse midwife, and for the second a home birth. Both outcomes great...and saved me over $15,000
>My husband got charged $278 for a CMP and a CBC, and the lab I worked at before we moved would have charged him about $75.
How would you like a website with comparison shopping tools including open and transparent pricing and consumer feedback ratings for the vendors?
So if you need a treadmill test, you could find everyone in your zip code that sells them, and sort the list by either price or feedback rating in terms of quality, service, convenience, or value?
This website exists at www.healthmatch.com
Labs, for example, compete for the consumer's dollar just like any other industry...and I think you can find a BMP and CBC for about $7 to $10 each, depending on your location.
Open competition will also reward more than volume. For example, the surgeon who has top ratings will be able to demand a higher price point than one with middling ratings.
And is that not fair? After all, a Mercedes costs more than a Chevy.
Pricing takes the market's pulse. And free floating market prices provide an incentive for vendors to improve their products so as to achieve better ratings and thus to be able to raise prices.
Wouldn't you like a comparison shopping tool for healthcare like that?
Anon, those are great suggestions and I didn't know they existed. I will absolutely check them out!
Look, I dont' claim to have the answers. I just want to have the dialogue and be informed. I want to be part of the solution.
Until we get more reforms though, people and the country are going to get stuck in the Medicaid trap.
Also, I'm not personally concerned with what is fair. Life isn't fair.
How does the HealthMatch thing work if you have a catastrophic type of illness? Like cancer, or one of your kids is born with some type of heart condition?
I tried calling them to ask these questions, but no one was answering their phone. How does it work if you have pre-exisiting conditions?
I think the free market system is absolutely the best, I just don't quite know how our country is going to get from point A to point B, or if politicians would ever be able to pull it off. (I don't even think they want to really.)
Sorry one more question and then I'm done. Are you advocating HSA's instead of insurance for the uninsurable? If you live paycheck to paycheck, how does that work (not that we do, but it's a legitimate question).
If you get a catastrophic illness, and you have no insurance, what do you do once the HSA is gone? Do you just stop treatment?
Scalpel: Another interesting thing, about the previously mentioned right to a liver transplant. In Japan, they don't do transplants on anyone younger than 12. It's the whole organ shortage thing and that adults are valued more than children there.
I'm diggin' this discussion.
Amy says:
"Student loans are so crippling now, we are going to see a lot less people going to college, or maybe more people defaulting on their student loans. This is going to make the medicaid situation much worse in my opinion, with less people working jobs that provide insurance."
What exactly do you mean, Amy? Did you try getting a private loan for any of your husband's schooling? Those are quite a bit more expensive. I'm almost a year and 28k into a 6.5% loan (and if your husband is finishing school right now, there is a good chance you have one of those adjustables that is about to bottom out!) and I carefully considered my post-school income potential before deciding to do it.
If you think that your gov't-subsidized school loan "costs" more than your husband's education will "benefit" you... why'd you do it?
When I referred to the student loan problem, I wasn't referring to my family specifically. I was just thinking of kids headed off to college and grad school.
My husband's degree was absolutely worth it and will contribute significantly to his earning potential.
AS for the private loans, we didn't get any. I hope that the rate on the federal ones bottoms out like you said.
What I was referring to was a recent piece I saw on the news about how student loans are going to become much much harder to get. I didn't get to catch all of it.
What my family has done to pay for grad school doesn't really matter in the discussion of medicaid. Because we have the degree he got a good job, and will soon get health insurance from his employer.
As far as other people being able to get loans to go to school, I dont' know. With the funds becoming less available, there will be less people able to go and less people able to get jobs that offer insurance won't there? Compounding the medicaid problem? Or the EMTALA problem?
It's just another side issue and I probably shouldn't have included it.
>How does the HealthMatch thing work if you have a catastrophic type of illness?
HealthMatch isn't an insurance company. It is a virtual healthcare marketplace...a shopping tool
I suspect most HealthMatch members have a high deductible insurance with a $5K deductible or so to take care of the catastrophic illness stuff.
>How does it work if you have pre-exisiting conditions?
You can still use the tools to find the best deals on the care you want.
>I think the free market system is absolutely the best, I just don't quite know how our country is going to get from point A to point B, or if politicians would ever be able to pull it off. (I don't even think they want to really.)
Which is why real solutions come from the private sector, not from govt...
>Are you advocating HSA's instead of insurance for the uninsurable?
Not instead of, in addition to...besides, by law you CAN'T have an HSA unless you have high deductible (at least %1500 for a family) insurance.
i will work there, for less, and be more happy.
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