Is access to health care a basic human right: or a privilege?

[InTheLight]

Our youngest son just had to have a physical for football. Cost $15. Under Obamacare, on top of the 140% increase in premiums, the deductible would have been 10x that.

One yearly physical exam is included under ObamaCare. No out-of-pocket costs.

 

[777]

Wow, cash-only really is growing:

These Doctors Accept Only Cash

does sound retro, before my parents' time (advent of HMOs). What I wonder about it if they have malpractice insurance, if not, what, waivers? That, insurance companies, and the federal government were the three things they complained about the most.

 

[Gold Dragon]

A new kind of doctor's office charges a monthly fee and doesn't take insurance -- and it could be the future of medicine

Here is a pretty good article about direct primary care outlining some potential pros and cons. It looks like a good niche option for physician care in areas where patients can afford it. It works in pockets of the current system because the more expensive aspects of medical care are still covered if needed by existing systems.

I question how effective this model will be in managing lower socioeconomic regions where even their modest fees would be a significant burden, especially when other options do not exist.

There is also the issue of hospital care.

 

[JohnDeereFan]

That is great that cash only doctors can work in areas that can pay*

It's even better than they can work in poor areas.

I'd like to see their numbers and what services they offer. But there are still fees and many folks that cannot pay even those fees. What about them?

I doubt very seriously that people wouldn't chip in to help them pay the $45 or $50 fee, unless they're Leftists, like you, who believe the poor should be left to the government.

It isn't the government's responsibility to pay their way.

A new kind of doctor's office charges a monthly fee and doesn't take insurance -- and it could be the future of medicine

Here is a pretty good article about direct primary care outlining some potential pros and cons. It looks like a good niche option for physician care in areas where patients can afford it. It works in pockets of the current system because the more expensive aspects of medical care are still covered if needed by existing systems.

I question how effective this model will be in managing lower socioeconomic regions where even their modest fees would be a significant burden, especially when other options do not exist.

Actually, that's concierge medicine, which, while still cheaper than Obamacare, is not what we're talking about.

 

[Gold Dragon]

It's even better than they can work in poor areas.
...
I doubt very seriously that people wouldn't chip in to help them pay the $45 or $50 fee

Can you outline how this will happen? This is the key part of making a private system work. How to those in poor areas pay for these services? Who are these generous people that can chip in and continually chip in every time those services are needed for the millions of folks who cannot pay?

And then there is coverage for expensive hospital and surgical care and medications. Who are the charitable ones that will carry that burden?

 

[Gold Dragon]

Actually, that's concierge medicine, which, while still cheaper than Obamacare, is not what we're talking about.

Please direct me to information about the system you are describing. I'd like to learn more.

 

[JohnDeereFan]

Can you outline how this will happen?

Well, first, you tear off a couple of squares of toilet paper and then you stick your hand...Seriously, what is wrong with you that you need this explained? Do you go into a MacDonalds and say, "So, can you explain to me how this works? I tell you what food I want and then how do with complete this transaction?"

Honestly, the level of tolling here has really gone downhill.

 

[Gold Dragon]

Well, first, you tear off a couple of squares of toilet paper and then you stick your hand...Seriously, what is wrong with you that you need this explained? Do you go into a MacDonalds and say, "So, can you explain to me how this works? I tell you what food I want and then how do with complete this transaction?"

Honestly, the level of tolling here has really gone downhill.

This is a serious question and has been my question from the beginning. How are poor people who cannot pay going to pay for medical services in an all private system? If it is charity, who are these charitable people and what happens when they run out of money too?

 

[JohnDeereFan]

This is a serious question and has been my question from the beginning. How are poor people who cannot pay going to pay for medical services in an all private system?

Why can they not pay? This is so inexpensive there is no excuse for them to not be able to pay?

Capitalism, which you decry, makes things less expensive and more affordable. Socialism, which you champion, makes things more expensive and less efficient.

Why don't you explain to us how you expect the poor to pay the premium and deductible of Obamacare before you demand that I explain how they're going to be able to pay $30-$40.

 

[church mouse guy]

No, it's not. Medicare is funded by a payroll tax. It is an entitlement. It is not funded from general fund taxes.



I think it is awesome that you can speak for all leftists worldwide and the three-quarters of non-leftist Americans. That's quite a feat.

You then go on to say that the Medicare is funded by general funds, so yes it is insolvent.

 

[church mouse guy]

This is a serious question and has been my question from the beginning. How are poor people who cannot pay going to pay for medical services in an all private system? If it is charity, who are these charitable people and what happens when they run out of money too?

The United States has medical welfare for the indigent. No one in America goes without medical treatment. Here in the Indianapolis area, the Marion County Hospital provides superb medical care administered by Indiana University Medical School, considered one of the better medical schools in the country.

The American people do not want a Canadian, English, or Australian system.

 

[Gold Dragon]

The United States has medical welfare for the indigent. No one in America goes without medical treatment. Here in the Indianapolis area, the Marion County Hospital provides superb medical care administered by Indiana University Medical School, considered one of the better medical schools in the country.

The American people do not want a Canadian, English, or Australian system.

JohnDeereFan is proposing to eliminate Medicare.

 

[Gold Dragon]

Why can they not pay? This is so inexpensive there is no excuse for them to not be able to pay?

Capitalism, which you decry, makes things less expensive and more affordable. Socialism, which you champion, makes things more expensive and less efficient.

Why don't you explain to us how you expect the poor to pay the premium and deductible of Obamacare before you demand that I explain how they're going to be able to pay $30-$40.

I'm talking about people on Medicare/Medicaid

 

[InTheLight]

You then go on to say that the Medicare is funded by general funds, so yes it is insolvent.

There are lots of opinions on when Medicare will go insolvent; none of them say it is now.


Social Security, Medicare Face Insolvency Over 20 Years, Trustees Report

Trustees' report says Medicare will be insolvent by 2028

Medicare on track for insolvency in 2026

Date for Medicare's insolvency remains 2030

 

[Gold Dragon]

The United States has medical welfare for the indigent. No one in America goes without medical treatment. Here in the Indianapolis area, the Marion County Hospital provides superb medical care administered by Indiana University Medical School, considered one of the better medical schools in the country.

Thanks for pointing me in the direction of the questions I am trying to have answered. I found an interesting article about what happens to the uninsured in the US.

Who Bears the Cost of the Uninsured? Nonprofit Hospitals.

...But in new research—based on decades of previously confidential data—Kellogg School assistant professor of strategy Craig Garthwaite and his coauthors find that when the population of uninsured Americans increases, hospitals end up bearing the cost by providing uncompensated care. In fact, their results suggest that each additional uninsured person costs local hospitals $900 per year.

That means hospitals are effectively serving as “insurers of last resort” within the American healthcare sector by providing care to uninsured patients who cannot afford to pay their medical bills. “People are still going to the emergency room,” Garthwaite says, “and they are still receiving treatment—so the cost is still there. When governments do not provide health insurance, hospitals must effectively provide it instead.”
...
Interestingly, nonprofit hospitals end up absorbing the bulk of this care. A majority of private hospitals in the United States—more than 70 percent—are nonprofit firms and therefore expected to provide a “community benefit” in exchange for tax relief. One key component of this community benefit is charity care for indigent patients. For-profit firms do not face a similar community-benefit standard.

This means that when there are changes in the supply or demand of healthcare services to the poor, most of the burden—in terms of uncompensated care costs—falls on nonprofit hospitals, a finding that sheds new light on the role nonprofits play in the healthcare industry.
...
To demonstrate this, he and his coauthors Tal Gross of Columbia University and Matthew Notowidigdo of Northwestern University looked at 359 hospital closures from 1987 through 2000. Whenever a hospital closed, the uncompensated care costs for nearby hospitals rose significantly, suggesting that there was a nearly complete spillover effect. “Again, the cost does not go away,” Garthwaite says. “It’s passed on to the remaining hospitals.”
...
In 2005, citing severe budget constraints, Missouri and Tennessee both chose to cut back their public insurance programs. The disenrollments had a significant impact on local hospitals. In Missouri, whose program mostly supported low-income parents, the cost of uncompensated care was estimated at $556–786 for each newly uninsured citizen. In Tennessee—where four percent of the non-elderly population lost its public insurance—the uncompensated care cost reached $1,048–1,678.

I'm trying to understand the idea of a fully privatized health care system. Would all the Medicare and Medicaid patients have to wait until they are sick enough get their health care through emergency departments in non-profit hospitals? How will you keep these hospitals from going bankrupt?

 

[Gold Dragon]

A few great articles by the American College of Emergency Physicians on this topic.

Fact Sheets

Hospitals and physicians shoulder the financial burden for the uninsured by incurring billions of dollars in bad debt or “uncompensated care” each year. Hospitals provided over $50 billion in uncompensated care in 2013. [xiii]

In the past, hospitals shifted uncompensated care costs to insured patients to make up the difference. However, cost shifting no longer is a viable option because managed care and other health plans have instituted strict price controls, leaving little margin to shift costs. More than one-third of emergency physicians lose an average of $138,300 each year from EMTALA-related bad debt, according to a May 2003 American Medical Association study.[xiv]

With projections that health care costs will double the nation is faced with how it will continue to provide care for all Americans, not just the disadvantaged. Emergency departments provide an essential community service, similar to fire departments, police departments, and public utilities. The nation cannot afford to allow the emergency care system to collapse because of a lack of funding. It is too high a price to pay in terms of public health effects and human suffering.

The Impact of Unreimbursed Care on the Emergency Physician // ACEP

The cost of EMTALA mandated care is substantial for the emergency physician. According to a May 2003 American Medical Association (AMA) study, emergency physicians annually incur, on average, $138,300 of EMTALA-related bad debt. Approximately 95.2% of emergency physicians provide some EMTALA mandated care in a typical week and more than one-third of emergency physicians provide more than 30 hours of EMTALA-related care each week. Physicians in other specialties provide, on average, less than six hours per week of care mandated by EMTALA, and each incurred, on average, more than $25,000 of EMTALA-related bad debt in 2001.

According to the CDC's annual summary of hospital emergency visits--as prepared by the CDC's Center for Health Statistics, Americans made 110.2 million visits to emergency departments in the United States during 2002, a 23% increase over the 90 million visits made in 1992. This total represents 39 visits per 100 people and 61 visits per 100 individuals over 75 years of age. During the same period, the number of emergency departments has decreased by 15 %.9According to The Centers for Medicare & Medicaid Services, 55% of an emergency physician's time is spent providing uncompensated care.10Emergency physicians face the difficult challenges of increasing emergency department visits with fewer hospital inpatient beds, subsequent ED crowding, and eroding reimbursement.

If Medicare and Medicaid go, emergency departments and physicians are going to collapse under the weight. How is this going to be managed in an private-only health insurance system?

https://aspe.hhs.gov/system/files/pdf/139226/ib_UncompensatedCare.pdf

Hospital Uncompensated Care – Uncompensated care is the unreimbursed cost of the care provided by hospitals to people who are uninsured or underinsured. Hospitals provided over $50 billion in uncompensated care in 2013. By greatly reducing the numbers of Americans who are uninsured through the establishment of the Health Insurance Marketplace and by facilitating States’ expansions of Medicaid, the Affordable Care Act has reduced hospitals’ uncompensated care costs.

Medicaid Expansion –Analysis of hospital financial reporting and member surveys from hospital associations indicates that, through 2014, payor mix is shifting in ways that will likely reduce hospital uncompensated care costs. Moreover, a projection model developed by ASPE suggests that the large observed declines in the uninsured and increases in Medicaid coverage have led to substantial declines in hospital uncompensated care in 2014. Medicaid expansion states account for $5 billion of the estimated $7.4 billion reduction in uncompensated care costs attributed to ACA coverage expansions.

 

[FollowTheWay]

Your ignorance of capitalism is duly noted.

If you honestly believe capitalism and liberty are based on greed, you should try to find an adult to help you read Milton Friedman's Free To Choose.

Why is it that you anti-American Leftists always insist that capitalism is based on greed, but refuse to acknowledge the greed that motivates your lust for government control?



Precisely why we need to dump your failed Marxist ideas and return healthcare to the free market where it belongs.



And we Christians believe that you don't do right by one person by sinning against another.



Tell that to the family of Charlie Gard. You know, the child your precious socialized medicine bureaucrats are fixing to let die in Great Britain.



The problem, Princess, is that we came to America to be Americans, not to be Japanese, Singaporian, or Korean. We came here for liberty, not for government regulation over every area of our lives.

If you hate America and our ideas of liberty so much, then go to some other country.

Every time you call me a Marxist, I'll call you a Fascist. OK? Fair enough? "We Christians?" The "Christian Right" is neither Christian nor right. You're destroying America but worse than that you're doing great harm to Christ's Church.

 

[FollowTheWay]

We are always looking at white socialism and not other socialistic countries where the failures are even more total than they are in the white countries, who cannot deliver what is promised. The doctor under socialism now becomes a government employee and must tell his fellow citizen that he can only do what the authorities allow him to do and that he himself is not so well-paid anyway. Socialism is evil. Some Fox commentator tried to say that Cuba had a world-class healthcare system under communism. Cuba is a racist communist pit as poor as North Korea and you are lucky to find water clean enough to drink and more than a couple of eggs a month--even potatoes are rationed to a handful a month. Yet Cuba just in our lifetimes was the richest country in Latin America and had a per capita income comparable to Europe. I suppose the Fox commentator would be happy under another Stalin, the master of state-run everything.

Sounds like an excellent white supremacist remark. The Bible does not support any form of government, neither capitalism nor socialism. Everything depends on a person's relationship with Jesus and following Him and His example.

 

[FollowTheWay]

It's a sad state of affairs when people consider possession of assault weapons to be a human right but not universal access to healthcare free at the point of delivery. Even sadder when it's Christians espousing such a viewpoint.

The underlying problem is that professing Christians follow the Republican Party first and (maybe) Jesus second. Did Jesus ever say if you're a Samaritan you cannot become a Christian. The Jews hated the Samaritans who who of mixed Jewish and Gentile blood. Jesus met the Samaritan woman at the well, forgave her sins if she would repent and gave her the living water of His truth.

 

[FollowTheWay]

There are lots of opinions on when Medicare will go insolvent; none of them say it is now.


Social Security, Medicare Face Insolvency Over 20 Years, Trustees Report

Trustees' report says Medicare will be insolvent by 2028

Medicare on track for insolvency in 2026

Date for Medicare's insolvency remains 2030

GW Bush fought two wars "off budget" by raiding the Social Security funds. Now there's nothing in there except IOU's. If the Supreme Court hadn't given him the election we would have been far better off. Senator Gore was mocked for saying he would "put the Social Security funds in a lock-box." Under Gore we would have simply taken out bin Laden the way Obama did and neither of those two needless wars would have been fought. Now what do we have as a result? About $6T in debt from the wars and the "rebuilding" which was simply done to line the pockets of the Republican elite (like Cheney for example) and the world is a much more dangerous place. Those wars resulting in the current hatred of radical Muslim groups for America and provided a training ground for ISIS. All this was done in the name of "freedom and democracy." Another result was the destruction of Iraq, Iran's natural enemy for hundreds of years. Now we say that Iran is the enemy. We gave them a great advantage by taking out Iraq.