August 12, 2009

Why National Healthcare is a Bad Idea, from one who oughta know

This is from Ambulance Driver, who has one of the finest blogs I have ever laid eyes on.  The guy is an absolutely fantastic writer.  He’ll make you laugh, he will make you cry, and he will make you think.  It is not political, but it is awesome.

Welcome To MY World

Lest you think ER and EMS abuse is a fairly uncommon occurrence and a mere drop in the bucket of health care costs, comes this little tidbit from the Austin American-Statesman:

In the past six years, eight people from Austin and one from Luling racked up 2,678 emergency room visits in Central Texas, costing hospitals, taxpayers and others $3 million, according to a report from a nonprofit made up of hospitals and other providers that care for the uninsured and low-income Central Texans.
Hospitals in every corner of this country can quote comparable figures. It's not even a purely urban phenomenon; it happens on a daily basis at PGHNSTRACH, and thousands of other small hospitals in every little hamlet in the United States.
And the vast majority of all those ER visits are paid for by you and me with our tax dollars. Now, the authors of the report would rather be horsewhipped than draw conclusions about the socioeconomic status of the most egregious abusers, but I am under no such constraints.

Let's just say that Aetna and Blue Cross ain't footing that three million dollar bill, shall we?
No privately insured patient visits an ER that often. If they did, one of two things would happen: They'd either lose their coverage or it would capitate, or they'd die shortly from their catastrophic illness.
No, that three million dollar bill, in Austin alone, is footed by the taxpayers. Proponents of a national health care plan would have you believe that the problem is one of access, that the 15% of uninsured in this country have nowhere to turn but the ER for their care.
Horse. Shit.
All nine of these people that racked up this bill - and I'll quote the figure again just because it's so disgusting: three. frickin. million. smackeroons. - got 24/7 access to quality health care. An average of 50 ER visits per year, per person, in fact.
Anywhere in this country, if you want an inappropriate antibiotic prescription for your viral respiratory infection, or a pregnancy test that you can purchase at Walgreens for $12, you can go to your ER for it, at 3:00 am if you like, and not be asked for payment.
And people do. After all, it's their right. Right?
No, the problem isn't one of lack of access. The problem is the entitlement mentality run amok. If you've got private insurance, an ER visit comes after a simple decision: "What's more important - my ER copay, or my utility bill/groceries/mortgage/car payment?"
And generally, they make a reasonable decision about which is more important.
When you have no financial stake in your own health care, such decisions aren't necessary. If politicians want to cause health care in this country to collapse under its own weight, there's a simple way to go about it:
Make it free to all citizens.
Except of course, it isn't free. Anyone who has ever gaped in disbelief at their paycheck stub knows that.
If you want to fix health care in this country, I can tell you how to do it in six easy steps, taken straight from AD's Simple in Concept, but Complex in Execution Files:
1. Strengthen primary care by shifting reimbursement away from the current procedure-based model, and forgive medical school loans to any medical student entering a primary care field. In twenty years, maybe less, the problem of primary care access will be solved.
2. Repeal or drastically overhaul EMTALA. Put an end to the indentured servitude of ER doctors who are forced to provide a substantial portion of their services to people who don't need to be in an ER in the first place.
3. Institute a copay system for ER visits for Medicaid recipients. As long as the care is free, there will be no incentive to use it intelligently. And by taking the steps in #1, there will be far more primary care clinics willing to see Medicaid patients.
4. Institute a review system for ER visits by Medicaid recipients who also receive food stamps or other forms of public assistance. Anything determined not to be an emergency, take the copay out of their other benefits. If a citizen who pays for their insurance is forced to decide between other bills and their ER copay, why shouldn't we expect the same of people on Medicaid, who aren't required to pay premiums of any sort?
5. Come to some sort of compassionate, but reasonable, standard of how much futile care we are willing to subsidize. 27% of Medicare expenditures are spent on people in their last year of life. I'm not advocating feeding Grandma to the coyotes after she breaks her hip, but any nurse, doctor or EMT who has ever cared for a nursing home patient knows that, for a great many of them, we only prolong their suffering, not their life by any reasonable measure.
6. Once we've implemented Steps 1-5, we should have eased the burden on Emergency Departments, stopped the exodus of primary care physicians to more lucrative fields like plumbing and commercial landscaping, improved access to primary care, and forced Medicaid recipients to take some financial responsiblity for their health care, I figure that only leaves the non-productive malingerers in our society who refuse to modify their behavior.
For those guys, I say let PETA shelter 'em.

A Day In The Life Of An Ambulance Driver

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