Everyone is yelling and screaming about the government shutdown over the Democrat's and Republican's refusal to come to an agreement regarding the funding of ObamaCare. So.....what are we going to do about all of this. As a health care provider, I agree with some of the basic ideas. Patients should be covered by insurance regardless of previous medical conditions. I agree that everyone should be able to be covered by some form of medical coverage. We must make it affordable. How do we do this?
The problem universally is two fold.
1. Can and should we force people to be covered? Some say that we live in a free society and that to force us to pay for something we might not want is against our inherent rights. Some say that if they don't want to pay for insurance that they should not have to. When they get sick, they will pay for services then. Ideally, patients should be able to pay cash for services rendered but some provider's offices do not take cash pay patients. The worry is that if you accept them and they cannot pay, you are still obligated to take care of them. I don't believe this is true. If you give a patient 30 days of emergent care and a notarized letter stating that you will no longer accept them, it's a done deal. We don't live in a prison society where medical providers are forced to care for patients that they may not gel with just as patients have a right to change providers as well.
In a utopian society, everyone would feel obligated to pay their debts. Years ago, people would feel severe shame for going to the hospital or a medical provider and not pay the bill. They would feel less of a human being and would make the effort as soon as possible. If they couldn't pay in money, it would be done in trade for goods. Ah the good old days! But that was the time when we didn't have such high costs for medical care. Medicine is big business. Why should we make it more affordable for people to be diagnosed and treated? I can see a treatment being more expensive when it first comes out. We have to pay for innovations. But years later, we are still paying thousands of dollars for technology that has been out such as CTs and MRIs. Why should it cost thousands of dollars now for those diagnostics? Because medical imaging is big business, because research is big business. What would happen if we cured the common cold? How many shelves of cold remedies would not be needed and how many pharm companies would lose millions of dollars? My gosh! Add any the other medical ailments that may actually be cured and we could almost have a conspiracy theory. But, I digress.....
Who will pay for this coverage?
Everyone who works at a legitimate job. Yes, this means you and me. People are telling me that the new plans are expensive and that they cannot afford them. Some are saying that they are going to opt out but are finding out that the penalties are too high. So they will be forced to buy the insurance in order not to be penalized. Great.
What about all the other patients who are below the poverty range and cannot afford to pay for their insurance. They get it for free. Wait! It's free to them but it's not to us who have to pay higher taxes in order to maintain the Medicaid system. So we're getting doubly slammed. We HAVE to pay for ours because we have a legitimate job.
My solution? Do away with the ability to walk into any ER and get care for free, ESPECIALLY when it's not an emergency. If they show up via private vehicle with a complaint that did not just happen within the last 24 hours, send them out to their new primary care providers who will take care of the regular issues that are not emergent. The same goes for the bogus EMS transports. If the patient is determined to be using the EMS system in order to get into the ER for quick issues that are not emergent, PENALIZE them by taking away some of their... Oh wait! They don't have a job so they have nothing to give as a penalty...BINGO! By Jove I think I've got it! If they have two legs and two arms and can follow directions, they can work on the side of the roads and in the fields right next to everyone else. Disability should only be given to those with HARDCORE, REAL medical problems!
If you can walk, talk, sit, stand, bend over and breath without oxygen support, you can do something. I know! They can be trained to be sitters and caregivers for our elderly so that their families can get back to their jobs and become productive in their own lives. They can be trained to help take care of animals in the shelters and the zoos and National Parks. They can be trained to work at the homeless shelters and to help with childcare for those who are out there working for a living.
What say you?
The problem universally is two fold.
1. Can and should we force people to be covered? Some say that we live in a free society and that to force us to pay for something we might not want is against our inherent rights. Some say that if they don't want to pay for insurance that they should not have to. When they get sick, they will pay for services then. Ideally, patients should be able to pay cash for services rendered but some provider's offices do not take cash pay patients. The worry is that if you accept them and they cannot pay, you are still obligated to take care of them. I don't believe this is true. If you give a patient 30 days of emergent care and a notarized letter stating that you will no longer accept them, it's a done deal. We don't live in a prison society where medical providers are forced to care for patients that they may not gel with just as patients have a right to change providers as well.
In a utopian society, everyone would feel obligated to pay their debts. Years ago, people would feel severe shame for going to the hospital or a medical provider and not pay the bill. They would feel less of a human being and would make the effort as soon as possible. If they couldn't pay in money, it would be done in trade for goods. Ah the good old days! But that was the time when we didn't have such high costs for medical care. Medicine is big business. Why should we make it more affordable for people to be diagnosed and treated? I can see a treatment being more expensive when it first comes out. We have to pay for innovations. But years later, we are still paying thousands of dollars for technology that has been out such as CTs and MRIs. Why should it cost thousands of dollars now for those diagnostics? Because medical imaging is big business, because research is big business. What would happen if we cured the common cold? How many shelves of cold remedies would not be needed and how many pharm companies would lose millions of dollars? My gosh! Add any the other medical ailments that may actually be cured and we could almost have a conspiracy theory. But, I digress.....
Who will pay for this coverage?
Everyone who works at a legitimate job. Yes, this means you and me. People are telling me that the new plans are expensive and that they cannot afford them. Some are saying that they are going to opt out but are finding out that the penalties are too high. So they will be forced to buy the insurance in order not to be penalized. Great.
What about all the other patients who are below the poverty range and cannot afford to pay for their insurance. They get it for free. Wait! It's free to them but it's not to us who have to pay higher taxes in order to maintain the Medicaid system. So we're getting doubly slammed. We HAVE to pay for ours because we have a legitimate job.
My solution? Do away with the ability to walk into any ER and get care for free, ESPECIALLY when it's not an emergency. If they show up via private vehicle with a complaint that did not just happen within the last 24 hours, send them out to their new primary care providers who will take care of the regular issues that are not emergent. The same goes for the bogus EMS transports. If the patient is determined to be using the EMS system in order to get into the ER for quick issues that are not emergent, PENALIZE them by taking away some of their... Oh wait! They don't have a job so they have nothing to give as a penalty...BINGO! By Jove I think I've got it! If they have two legs and two arms and can follow directions, they can work on the side of the roads and in the fields right next to everyone else. Disability should only be given to those with HARDCORE, REAL medical problems!
If you can walk, talk, sit, stand, bend over and breath without oxygen support, you can do something. I know! They can be trained to be sitters and caregivers for our elderly so that their families can get back to their jobs and become productive in their own lives. They can be trained to help take care of animals in the shelters and the zoos and National Parks. They can be trained to work at the homeless shelters and to help with childcare for those who are out there working for a living.
What say you?
You are spot on re: the ER. Right now, our medics are not allowed to refuse transport to anyone - even the stubbed toe or runny nose patient who tries to use them for transport. The number of actual emergencies we see (or urgent, could-be-emergencies) is a fraction of the total number of patients.
ReplyDeleteNow, supposedly this is because people do not have medical doctors. But the vast majority of our patients DO have regular doctors, it just is not convenient to make an appointment and wait. Even patients on Medi-Cal are assigned primary clinics. It is the rare patient who is not covered (already) by Medi-Cal or private insurance.
Of course, get ready to be told that you lack compassion for the poor because you do not feel like forking over hundreds of dollars for mandated insurance. Been there, called that.
I think that the ER should be able to refuse treatment on obvious simple illnesses such as colds and refer them back out to primary care. If they are charged on the front side and required to pay, they will leave and make appropriate appts.
ReplyDeleteCompletely agree with you both. Also, drug screening would be very helpful. Personally, "Medical marijuana" stops being medicinal if you get completely stoned & stay that way. Oh, no money for decent food & aspirin? Then why are all the windows & doors open when it is under 30 degrees at 8am & the sodas & chips are bought by the multiple large sackfuls in a home with multiple diabetics?
ReplyDelete