I guess we're not supposed to be mad about all the preventive care that got built into Obamacare, because it's just a nice thing to do anyway. But we don't generally pay to improve each other's quality of life. We expect you to work and pay for your own quality-of-life improvements.
From the article:
Let’s begin with emergency rooms, which many people believed would get less use after passage of the Affordable Care Act.We believed it, because the fake-news press and the lying politicians told us so.
The opposite occurred. It’s not just the A.C.A. The Oregon Medicaid Health Insurance experiment, which randomly chose some uninsured people to get Medicaid before the A.C.A. went into effect, also found that insurance led to increased use of emergency medicine. Massachusetts saw the same effect after it introduced a program to increase the number of insured residents.ADDED: It is so irritating that this article blames us the believers — "Sorry, It’s Too Good to Be True," "many people believed...." This is the same newspaper that will turn and blame us for doubting what it tells us, as though we're a bunch of yokels when we don't adopt the beliefs it serves up as true.
Emergency room care is not free, after all. People didn’t always choose it because they couldn’t afford to go to a doctor’s office. They often went there because it was more convenient. When we decreased the cost for people to use that care, many used it more.....
Posts
141 comments:
Althouse said "But we don't generally pay to improve each other's quality of life. We expect you to work and pay for your own quality-of-life improvements. "
Woah! That's some full-throated conservatism emanating from Meadehouse this morning!
Hey, I remember reading that that Iraq war wouldn't cost the U.S. any money, because we'd pay for it with the oil.
We've all known about the over-use of the emergency room for decades.
Leave it to a free market, that would have led to the rise of more urgent care and no-appointment clinics with expanded hours. Certainly, there are some of those around today, but not as many as needed. And why they do not have more of these type of clinics at the hospitals, perhaps right next door to the ER, is questionable.
As for preventive care, all ObamaCare did in this respect was to feed the entitlement mentality and to encourage people to go to the doctor for anything and everything.
To my mind, the most efficient and "fair" way to provide care for indigents would be charity hospitals. People who felt strongly about providing such charity would donate. End the mandatory emergency room care for all, and costs could decline sharply. As an alternative to a wall, deliver a bill for care for illegal immigrants to the consulate of their native country. Mexico makes enough money off of Texas to fund Mexican charity hospitals for Mexicans in Houston, Dallas, Austin and San Antonio. Let Mexicans pay for Mexicans.
It's the number available Doctors stupid. And severe limits on fee reimbursements under Medicare and Medicaid has made MDs look for real jobs.
So enjoy Emergecy room medicine . That is all that will even available soon.
"There is a lot of money to pay for this that doesn’t have to be US taxpayer money, and it starts with the assets of the Iraqi people. We are talking about a country that can really finance its own reconstruction and relatively soon."
And Mexico will pay for The Wall.
If only we had stolen the oil! As it is, we bid the oil contracts out to foreign companies and the Iraqis shook them down for $25 Billion of training funds to rebuild the oil industry but it never got spent because Obama abandoned Iraq. Who the hell knows what will happen there now?
So from your links, if a politician says something will pay for itself, it is a lie?
Can we simplify this to 'If a politician says X, X is a lie.'? I thought this general knowledge.
What we quibble about now it that if 'If a politician says X, then X, Y and Z are lies, P, Q are now unconstitutional BECAUSE he said X and we should impeach him/her/xer for R.'
To my mind, the most efficient and "fair" way to provide care for indigents would be charity hospitals.
And some more charitably-minded doctors and administrators who were willing to take less than $400,000 to treat people.
Mexico (Mexicans) could pay for the wall if the U.S. withheld say 20% on every funds transfer back to Mexico from a Mexican working (or whatever) in the U.S.
I'm less upset by the lies of politicians than by the media that covers up the lies. We can vote the politicians out of office. We're stuck with press.
The curiosity of the press is highly selective and convenient.
In my area of France, people (who would go to the Emergency in a US hospital) to to their doctor's open clinic time. Usually three afternoons or mornings, MD's in France are required to have these days. People come, sit in long lines, and see the doctor for all sorts of reasons. The Medical Service picks up the costs. I pay out of pocket on principle. Twenty-five Euros now for a full service consult and chest thumping listen with blood pressure reading thrown in. Tests are separate but a full cardiac test, from echogram to cycle, was under 300 Euros.
Yes those prices are subsidized; but treatment and MD consultation is affordable. The Doctor makes housecalls although I prefer to wait in his office: he's got LOTS of journals where I look at the latest photostyles.
Another news flash: Green energy doesn't create more jobs. And if it did, everyone would pay more for energy.
All it takes is a rudimentary understanding of economics to figure this out.
When we decreased the cost for people to use that care, many used it more...
Holy carp, what a revelation! When we lower the price of something people consume more of it.
I think this is day three in Ec10.
Althouse, no one at the NYTimes parroted that idea that the Iraq War would pay for itself, because that idea came from Republicans. Of course, Dreamy Obama's Supporters' assertion that Preventive Care would cut costs was loudly trumpeted by that same NYTimes, because Democrats.
If someone in the Government says X will save money, and X involves the Government in any way, do not believe.
Politicians want to make statements/promises that are politically popular. No politician wants to tell the truth if people don't want to hear it. So "we can cut health care costs in the aggregate, without reducing the level of care" is what any politician will say, and "in order to cut health care costs in the aggregate we need to reduce the aggregate amount of health care" is what no politician will say.
So let's get government more involved in health care, so that no decision makers will tell us the truth.
Hey; does anybody here know of anyone who, like, voted for Obama?”
True preventive care is what people do proactively for themselves. Diet and exercise. Washing your hands. Etc. that shit works. But fuck it. Give me a pill and check my blood pressure once a year for “free”.
Entire ruling elite of the country now lives by the Otter Rule:
"You fucked up - you trusted us."
And they're not incorrect.
But remember: If you opposed the ACA on the grounds that it was going to cost us all a bunch of money and make health care worse overall, it's because you hate poor people and want them to die.
As it turns out, the ACA cost us a bunch of money and made health care worse overall. But don't think for a second that vindicates you, you racist Nazi.
Chuck asked: "Hey; does anybody here know of anyone who, like, voted for Obama?”
Is this relevant to the topic? Probably not, but I will answer it. I have two friends who voted for the Big O. Both regretted it.
A common perverse side effect is moral hazard.
Blogger Ann Althouse said...
Hey, I remember reading that that Iraq war wouldn't cost the U.S. any money, because we'd pay for it with the oil.
1/29/18, 6:55 AM
Up through Mission Accomplished:
The Mission Accomplished speech (named from a banner displayed above the speaker) was a televised address by United States President George W. Bush on the aircraft carrier USS Abraham Lincoln on May 1, 2003.
Mission Accomplished speech - Wikipedia
Wikipedia › wiki › Mission_Accomplished_speech
Or even the capture of Saddam Hussein:
Operation Red Dawn was an American military operation conducted on 13 December 2003 in the town of ad-Dawr, Iraq, near Tikrit, that led to the capture of Iraqi president Saddam Hussein. The operation was named after the 1984 film Red Dawn. Wikipedia
Date: December 13, 2003
Result: Successful operation; Capture and arrest of former Iraqi president Saddam Hussein
The numbers look pretty good. Even, perhaps, with a cool occupation along the lines of Germany or Japan. We could have recouped our "investment" simply through the stabilization of energy markets (or if you like the destabilizion of OPEC-pump till your ass hurts, boys!) and Iraq could certainly have afforded to fix itself.
That said, we had a hot occupation. I lay the primary blame on Paul Bremer, but there's plenty to go around.
If you want to reduce medical costs across the board, have people die young. How to do that? Quite simple. See example below.
Want your car to die young? Don't check or change the oil.
Remember, Otter's next line to Flounder, after telling him he "fucked up" for trusting Otter, is:
"Hey, maybe we can help!"
And Flounder reluctantly goes along, because he has no better choices left.
A perfect distillation of the current insane relationship between the self-selected elites and everyone else.
Delta pledges grew up to run the world, badly. As InstaPundit might say, "Animal House" morphed so slowly from satire to government policy manual I hardly noticed.
I want to pay for my own healthcare. I want the government 100% out of it. decades of government creep have removed competition and replaced it with graft.
Obama lied, but the seal clapping hiveminders on the left say "we had to do something!"
arf arf arf!
Of course the next argument, if you say you want to pay for your own health care, is that "well that's nice if you are so well-off you can afford it. What about the poor?"
What they don't mention is that everything in health care costs approximately 100-500% more than it needs to, because of government meddling in the marketplace. And that if we fixed this underlying problem, fewer people would need help because they can't afford healthcare, and it would cost far less money to help those who still do.
Again, if you take this position it is clearly because you hate poor people and want them to die.
"This is the same newspaper that will turn and blame us for doubting what it tells us, as though we're a bunch of yokels when we don't adopt the beliefs it serves up as true."
Business as usual at the Gray Lady. They do think we are yokels, Ann.
Sad.
Whatever you subsidize, you always get more of. Whether that is homelessness, unemployment, or use of ERs.
"Humperdink said...
Chuck asked: "Hey; does anybody here know of anyone who, like, voted for Obama?”
Is this relevant to the topic? Probably not, but I will answer it. I have two friends who voted for the Big O. Both regretted it."
He's making fun of Althouse.
"Humperdink said...
Chuck asked: "Hey; does anybody here know of anyone who, like, voted for Obama?”
Is this relevant to the topic? Probably not, but I will answer it. I have two friends who voted for the Big O. Both regretted it."
He's making fun of Althouse.
I thinks it's called an involuntary response. Some might say knee jerk.
Being a Democrat means never having to say you're sorry.
> Let’s begin with emergency rooms, which many people believed would get less use after passage of the Affordable Care Act.
No, I didn't believe that. Why the heck would anyone with a smidgen of experience believe that? College students, faculty, and journalists, sure, but they are special.
"Althouse, no one at the NYTimes parroted that idea that the Iraq War would pay for itself, because that idea came from Republicans. Of course, Dreamy Obama's Supporters' assertion that Preventive Care would cut costs was loudly trumpeted by that same NYTimes, because Democrats."
I have no idea whether the NYT reported on the idea, but I think I originally read it in The New Republic. I believed it at the time, and that was back when the money we were afraid it would cost was something like $50 billion. What has the Iraq war cost? Donald Trump went around saying $6 trillion.
Obama raided the treasury (our money) to pay-off mega insurance corporations. The very corporations who are vilified by Obama and his trained seal-clappers. "CEO's make too much money! arf arf arf!"
Strange, blogger removed my original comment @7:34. What I said was:
Entire ruling elite of the country now lives by the Otter Rule:
"You fucked up - you trusted us."
And they're not incorrect.
Of course, the NYT didn't "parrot" that idea (in the sense of pushing us to believe it) because the NYT was against the war.
The argument that X, which looks expensive, will save you money in the long run is only made by people who like X.
Too bad that they didn't listen to all the people who said this or warned it was possible and still needed study.
"He's making fun of Althouse."
I didn't vote for Obama because of health care. I voted for him for 2 reasons: The Democratic Party needed to be roped into taking responsibility for the war on terror and McCain seemed utterly flummoxed by the financial crisis.
I'd like to go on record as supporting P and Q because I don't know what they are even though I've been minding them.
"McCain seemed utterly flummoxed by the financial crisis."
And he has remained in a flummoxed state.
Henry said...
Another news flash: Green energy doesn't create more jobs. And if it did, everyone would pay more for energy.
All it takes is a rudimentary understanding of economics to figure this out.
If you are at all familiar with the usual suspects that post here the " rudimentary understanding of economics" to which you refer is called "conservative horseshit". To a select few it is republican mind games. To one of them you might as well be making playing cards disappear.
Precautionary principle, nothing more, nothing less. That, alone, makes lots of people feel better. Small price to pay, amiright?
-sw
"it's just a nice thing to do anyway." For women and some beta men.
"But we don't generally pay to improve each other's quality of life." Huh? The welfare state has extracted and spent trillions doing precisely that.
"We expect you to work and pay for your own quality-of-life improvements." Huh? Who dat we? From rural electrification to national parks to Obamaphones to Social Security for spouses who never contributed a penny, that expectation has been dead for more than a century.
"So from your links, if a politician says something will pay for itself, it is a lie?"
-- I mean, yeah. The race doesn't always go to the swift, but you should still bet that way.
"You fucked up! You trusted us!"
Kristian Holvoet said...
The general saying is:
How do you tell a Politician is lying?
His lips are moving...
Most reporters are lazy and stupid. Reading the Chicago Tribune every day is an insult to one's critical faculties and a masterclass in telling half the story.
Free markets do a better job of meeting people's needs than government programs. The question is, how to treat people who can't afford catastrophic medical costs. Well, we could try a socialized insurance program at the top end...people are responsible for their own medical costs up to some individual or family limit and then a government insurance program kicks in. People would be careful about spending their own money below the catastrophic coverage. Health savings accounts and insurance programs with benefit ceilings coordinated with the catastrophic coverage could help people prepare for inevitable health crises. Medicaid could help people truly in need.
Instead, Obamacare went at the bottom end with the prepaid medical expense model (think of all the mandated benefits that every policy must provide), which is not insurance against a catastrophic loss but rather a way of socializing routine medical costs. The prepaid medical expense model was sold as a way to control costs, which may or may not happen, but for sure created distortions.
For some reason the Dems and the media were in a panic to recreate the British NHS here in America. Here's the latest at the NHS from a patient's perspective:
https://www.spectator.co.uk/2018/01/from-a-war-zone-ae-to-hellhole-wards-my-dispiriting-week-in-an-nhs-hospital/
We believed it, because the fake-news press and the lying politicians told us so.
You seem a little bitter, ma’am.
"Ann Althouse said...
"He's making fun of Althouse."
I didn't vote for Obama because of health care. I voted for him for 2 reasons: The Democratic Party needed to be roped into taking responsibility for the war on terror and McCain seemed utterly flummoxed by the financial crisis."
That may be but he was making fun of you.
"and McCain seemed utterly flummoxed by the financial crisis."
-- Which is weird since the reason he appeared that way is that Reid and other Democrats asked him to come back to Congress to help make a deal -- note that they didn't ask for Obama's leadership or return to Congress with a halt to campaigning -- and then when he arrived, made fun of him and ignored him. The reason he appeared flummoxed is because he *trusted Reid and the Democrat leadership."
He bleeped up, he trusted them.
Hey, Animal House is double relevant!
The worst thing about American politics is the complete inability to admit that an idea failed. Failures are forgotten. We don't learn.
"I voted for him for 2 reasons:" I remember it well.
"The Democratic Party needed to be roped into taking responsibility for the war on terror" They sure did, didn't they? No matter that O encouraged the rise of ISIS by the precipitous departure from Iraq and bolstered Iran with the nuclear deal. Other than that, all good!
"and McCain seemed utterly flummoxed by the financial crisis." By contrast with "pragmatic" Barry! Witness the marvelously effective stimulus, the doubling of the national debt, and the new unflummoxed financial regulations that unleashed economic growth.
Because reasons.
People believe what they want to believe, and they especially want to believe that others believe they have good reasons for their actions.
"The worst thing about American politics is the complete inability to admit that an idea failed."
-- This was the best thing about both the stimulus and the ACA. They both provided metrics to measure against. The stimulus was so bad that with it, the economy did worse than the projected numbers for "no stimulus." A clear, unmitigated disaster. The ACA has not bent the cost curve down, though, the number of people insured has shifted around, so, on one of the two key metrics, it is, a wash to a minor success, while being a disaster on the other.
As weak as I was with flu this go around, I do believe that if I had gone to the hospital emergency room with it, they would have killed me.
How many people here were called racist at the time when you pointed out these obvious flaws?
"By contrast with "pragmatic" Barry! Witness the marvelously effective stimulus, the doubling of the national debt, and the new unflummoxed financial regulations that unleashed economic growth."
Those failures along with his failures in the war on terror probably had a lot to do with her not voting for Obama a second time.
As I recall, the idea that Iraqi assets and income would pay the costs of liberating the country from Sadaam was based on the assumption that the war would be over once the Iraqi Army was defeated. It didn’t anticipate the lengthy guerrila war. Bad prophecy indeed.
I'm old enough to remember when everyone paid for doctor visits out of their own pocket. I still remember when the small company that my father worked for started to provide Blue Shield, which paid for hospital costs. If you google Blue Shield today, you get results for Blue Cross Blue Shield, which is comprehensive medical insurance.
The problem started when we bastardized the concept of "insurance" in the field if healthcare. Insurance is designed to cover catastrophic costs. It provided a pool of money paid by the many to provide for the catastrophic costs of the few. Many paid a little so that large benefits could be paid out for the benefit of the few who really needed it due to a true medical "catastropy". Kind of like how fire insurance works now.
Today we have a system where "insurance" is expected to pay for routine care for everyone. And everyone is expected to receive benefits exceeding their cost. By definition, a system like this can't work. The only way it can be sustained is either by charging some more than others through taxes and subsidies (redistribution of wealth), or by borrowing to make up the difference. Or a combination of both as we do now.
I don't really think that many thinking people believed that a system like this could ever work. Even Obama's flunkies admitted after the fact that they relied on the stupidity of the electorate to get it passed. But that doesn't excuse the Democrats who voted for it or the press that promoted it. They knew better.
I voted for him for 2 reasons: The Democratic Party needed to be roped into taking responsibility for the war on terror and McCain seemed utterly flummoxed by the financial crisis.
McCain got played by Reid, which is not a good sign, I admit, but then it turned out that Obama was even more economically ignorant than McCain, and even today, after eight years of Obama and one year of Trump, the Democrats are voting “absent” on the war on terror. You might, if you’d thought about it, considered the fact that Chicago politicians boast about how crooked they are.
Both McCain and Obama were/are economic illiterates. Obama is and was a much better actor.
Have the Dems taken ownership of the WoT? Or did they just make it much harder by ignoring ISIS for so long? And of course Obama encouraged the Muslim Brotherhood in Egypt and elsewhere.
There is no free lunch.
There is no free medical care.
There is no free government program.
Stop living the lie.
Ann's annoyed at her Bible the NYT - looking for love in all the wrong places.
All of you non 2nd term voters claiming "Gee I didn't know" obviously didn't pay attention to his history as a senator prior to his presidency. He was voted as the most liberal senator in 2007! Either that or the fact that you are true liberals who can't face reality. According to
Hicks that failure in the past is the reason why we have postmoderism.
Liberalism is a failure just like 2nd wave feminism.
Mark suggests: Leave it to a free market, that would have led to the rise of more urgent care and no-appointment clinics with expanded hours. Certainly, there are some of those around today, but not as many as needed. And why they do not have more of these type of clinics at the hospitals, perhaps right next door to the ER, is questionable.
When people really need to see a provider, they can't get in, which is why they head for the ER. Most ER visits could be handled in a clinic setting. I'm all for WalMart and other major chains opening up walk-in clinics. Perhaps they should be insurance-free to minimize the staffing requirements.
For several years I volunteered in a free walk-in clinic for the indigent and uninsured and which was literally right across the street from the hospital. Only a handful of cases had to be sent to the ER.
Not defending the decision to go to war in Iraq but I don't remember any mainstream Repubs claiming the war would pay for itself. In fact, I don't remember any Repubs claiming that. Yeah there were a few radio talkshow and internet kooks saying we should take their oil but they were true fringe.
Unlike Chuck I am truly a LLR. I worked on Goldwater's campaign in 1964 when I was in high school.
I definitely remember Republican congressmen claiming that Iraq would pay for its liberation with oil.
@Meade: "Those failures along with his failures in the war on terror probably had a lot to do with her not voting for Obama a second time."
I know. And I appreciate the course correction. And I appreciate whatever nudging you may have done.
But the problems with evidence, reasoning, and bias were clear prior to the '08 vote.
Not unique to your spouse by any means: she just happens to present the facts more honestly than most. Which I admire.
Besides being willing to recognize an error, the deeper problem, to put it in Althousian terms, is whether and how, in view of contrary evidence, we can change how we come to believe what we think we believe.
Psycho-philosophical speculation aside, the actual case at hand is complicated, of course, by the fact that McCain was a lousy candidate. For rational voters who simply choose the candidate most likely to pursue policies they agreed with, that was not a big issue. For "cruelly neutral" "independents" trying to discern who is less "flummoxed" or who might make the Dems a "responsible" party, or think of other such "reasons," his failings did matter.
Not defending the decision to go to war in Iraq but I don't remember any mainstream Repubs claiming the war would pay for itself. In fact, I don't remember any Repubs claiming that. Yeah there were a few radio talkshow and internet kooks saying we should take their oil but they were true fringe.
On of Bush's advisers [can't recall which] apparently convinced him that the Iraq War would pay for itself. In any case, it's the post-war expenses that are killing us. But the reconstruction business has been very lucrative for some contractors. As my mother was fond of saying, "The whole thing stinks to high heaven."
Re: The war/Obamacare will pay for itself
I always think of that great strategist Mike Tyson, who said, "Everyone has a plan [to fight me] until they get punched in the mouth."
"On of Bush's advisers [can't recall which] apparently convinced him that the Iraq War would pay for itself."
-- I vaguely recall this being something bandied about, but was ultimately a, "It could, if we'd do something we'd never do," which is, treat Iraq as a conquered feudal state instead of rebuilding it.
The Democratic Party needed to be roped into taking responsibility for the war on terror and McCain seemed utterly flummoxed by the financial crisis.
So (1) fail and (2) no difference.
Well, I work in an ER......and the reason people DON'T use the urgent care right next to the hospital; is they have to pay a co-pay for that service.
Hospitals are forced to care for people due to EMTALA rules. We can't turn anyone away; whether they can pay or not. Urgent cares are not subjected to EMTALA rules and they can turn patients away.
So my ER has people WITH insurance waiting upwards of 5-6 hours for their sniffles because they don't want to pay their co-pays.
Whatever happened to people having a "rainy day fund" socked away to help pay for their unexpected expenses?
Steve
Oh, and by the way, my co-pay for an ER visit is $150; the visit to the urgent care is $25......
If the wall is built Mexico will end up paying for it. The fewer people it can export to the USA means that they will be forced to deal with their own economy and problems. Plus remittances being sent back.
"To my mind, the most efficient and "fair" way to provide care for indigents would be charity hospitals."
In 1965, charity and county hospitals in big cities did a pretty good job of caring for the poor. Thy had no frills care with wards of 20 patients and were usually attacked to medical schools and used as teaching hospitals
Medicaid destroyed that system by refusing to pay for care if it was delivered as part of a teaching program by MDs who were in training.
As a result, those hospitals were starved of finances and patients were diverted to small poorly run hospitals that offered semi-private rooms and poorly trained doctors. I watched some residents quit residencies to go off and run "Medicaid Mills."
Obamacare has made it worse by destroying private practice.
Preventive care doesn't save [the people paying medical costs] because ACA didn't reduce emergency room use? That's just silly. The most that demonstrates is that (1) in early years, (2) making preventive care cheaper doesn't reduce population utilization of expensive care. No mention of actual use (by the ER visitors) of preventive care, nothing about whether the ER users had cheaper alternatives (or appropriate alternatives), etc.
Over time, catching conditions early is cheaper for everyone. Managing the process helps, of course.
"I don't remember any mainstream Repubs claiming the war would pay for itself."
This was the point of the "No war for oil" propaganda.
Wolfowitz told reporters that sanctions wouldn't work because "Iraq floated on a sea of oil" and the left took it from there.
Blogger Jersey Fled said...
"I'm old enough to remember when everyone paid for doctor visits out of their own pocket. I still remember when the small company that my father worked for started to provide Blue Shield, which paid for hospital costs. If you google Blue Shield today, you get results for Blue Cross Blue Shield, which is comprehensive medical insurance."
The old system was known as "major medical" coverage.
"And Mexico will pay for The Wall."
Not sure why this is such a sticking point with folks. If we want Mexico to pay for the wall, Mexico will pay for the wall.
Tax remittances to Mexico. That's $25 billion a year. 4% tax would be $1 billion a year. 15-25 years to pay for it that way. And or increase immigration fees. And or count money saved through reduced illegal immigration. We're paying $100 billion+ a year right now.
Just don't see the kerfuffle.
"And or count money saved through reduced illegal immigration."
-- Walls saved or created.
”It is so irritating that this article blames us the believers ”
I do blame the believers (as well as the people who pushed it). That preventive care costs, rather than saves money, has been known for awhile. Certainly during the run up to ObamaCare. Any well read person should have known it.
I think US medical care was thoroughly screwed up before Obamacare. What drove this I do not know, but suspect that tax policies on employer provided medical "insurance" had a lot to do with it.
Obamacare I think is ideologically driven by the idea that everyone should be ground between the same millstones - except congress critters and their staffs, of course.
Quality of medical care, not so much.
Must have provided a bonanza for the HMO companies.
Democrats are Hugo Chavez type socialists and economic illiterates. Why would be want them in charge of our healthcare?
It is more quality of life than you think.
My wife, who is now a hospital administrator but has worked ED (Emergency Department, it is more than a room don't ya know) as a nurse, tells me the busiest time for the ED is Sunday night/early Monday morning as people seek doctor excuse notes to miss work (not so much the cold/flu that developed over the weekend, but the, umm, migraine headache that developed after a Friday/Saturday night party).
And then there is the people that come in to get a refill on their prescriptions, that their pharmacy or doctor will no longer refill. What medicine is that? Opioid painkillers.
Get rid of the partiers and addicts, explain to a few others that a stuffy head or soar throat is best treated at a walk-in clinic rather than as an emergency; and you might see a 90% drop in the wait time at any ED.
"Just take a pain pill."
-Barack Obama
Believers should be blamed. You (the royal you) wanted it to be true so you stopped trying to understand why it might not have been. You wanted to believe the pretty man who lied so smoothly. You were and likely are the suckers born every minute.
The rest of us are blameless but racist because we disagreed with a policy doomed to fail because it assumed a freaking can opener.
Not all preventative care measures are money savers. Medical policy geeks knew this damn well before 2010. This was not a surprise. And even a moment's consideration by a layman would come to the same obvious conclusion: Where screening or prevention costs are high and incidence is low, providing free preventative care/screenings is a net money loser.
But libtards were willing to go to the mat parroting an obvious and transparent lie. It was insane. Obamacare was a mass delusion.
One of the biggest lies and scams of Obamacare was propagandizing Medicaid as healthcare insurance that was on a par with private insurance. One can only imagine their surprise when people discovered the truth.
Why would anyone go to an ER if it wasn't a matter of life or limb?
My family used it twice in the last 10 years, and in both cases, we paid over $1200 out of pocket. And we have insurance, which is supposed to be pretty good. In the second case, (A cut hand that the EMT advised me to go to the ER immediately for, and there was no alternative ) I had met my deductable for the year, and still walked out $1300+ lighter in the wallet.
You pay for the ER, then you pay for the Doctor in the ER. Big bucks.
I'm not whining about the high prices (at least not too much) -- I understand there is a lot of expensive equipment and infrastructure that you are using when you walk in the doors. I just don't know why anyone would use it to treat a cold.
In both cases, I thought there was significant chance of permanent injury to the limb. Now, I am not going back unless I am absolutely sure there would be major medical consequences for not going, and there is no alternative.
What am I missing here?
Althouse totally rationalized her vote for Obama. She had to know deep inside her that his tabula rasa background was more foreboding than any innumeracy that she saw in McCain.
But she's smart and a truth-seeker and is capable of overcoming,or at least mitigating against her own biases. She has grown in the years I've visited this site.
Althouse 8 years ago would have had a very different take on Trump than she does today.
It seems she used to challenge us more on supporting 'liberal' (leftist) ideas. These days I feel she is more open to the conservative perspective.
I have to believe that her Verwandelung is largely due to the high quality of conservative commentary here...and the very low-quality of our Leftist cadre level of analysis and discourse. He sees who is intellectually honest and who is not. And she is able to view the world with much better acuity than she possessed a decade ago.
I admire Althouse. She can learn and grow. If we all did that we'd end up with a pretty decent world.
So for the mis-use of the pronoun in my post above.. It as either a typo or deliberate provocation.
I can't remember.
@ Hagar "Obamacare I think is ideologically driven by the idea that everyone should be ground between the same millstones - except congress critters and their staffs, of course."
Exactly. An instant fix for this one-size-fits-all/single payer nonsense would be to place all Federal employees and Congress critters on VA care and their children on CHIPS.
Just a hunch , Ann voted for Stein this past election.
The issue is single-payer schemes ("monopoly" and practices) that prevent the market from curbing progressive costs. Also, poor but expensive education, and an established state religion that normalizes/promotes/encourages Choice (e.g. irresponsible behavior).
Mr. Chairman, we do not have a crisis at Freddie Mac, and in particular at Fannie Mae.
A medical finance scheme in lieu of affordable medical care, let alone health care.
Self-moderating, responsible behavior is not only the prerequisite for liberty, but also an imperative orientation for personal and community health.
I think I remember several prominent politicians of both parties being large stockholders in HMO's.
The truly maddening thing is that this is old news. While the linked article mentions that a 2009 review of 500 peer reviewed studies concluded that almost all forms of preventive care added costs instead of reducing them, it does not mention that those 500 studies did not suddenly come into being. The data had been accumulating for decades, but if you dared to suggest that preventive care as a general approach did not reduce costs, you'd most likely be dismissed as a crank.
The most charitable explanation of this is that people familiar with the data would accept that a particular type of preventive care in a particular study might raise costs instead of lowering them, but believed in their hearts (not their heads) that preventive care as a whole would be cost effective. A more cynical explanation includes an element of cui bono: preventive care programs tend to be designed and administered through large academic medical centers, "accountable care" organizations, insurance companies, and other large institutions. You can fund a lot of bureaucracy by building programs that promise to reduce costs and develop a lot of prestige by running seemingly noble, large-scale initiatives at cost-effectively improving public health.
Even the "recent report" about cigarette smoking mentioned in the NYT article is derivative of old news. While I don't have the citation handy, a European study about a decade ago came to the conclusion that smoking cessation programs increased healthcare costs because smokers tend to die young of acute causes (like heart attacks), while non-smokers and smokers who quit tend to live longer and consume more healthcare as they age, especially if they end up suffering or dying from chronic conditions. Now that was an "inconvenient truth," and it was almost rude to mention it in some public health circles.
Again, all of this was known during the Obamacare "debate." Precisely none of it mattered, and you risked being called an obstructionist at best and a racist at worst if you brought it up at the time.
Ann and Jill Stein don't work for me.
I have thought that she voted for Hillary on some combination of "the devil you know" and "she knows Washington and the global leaders, so she's a safe choice." But I really can't figure it out, because she really dislikes Hillary. She said she voted on a lesser of two evils theory.
Nobody knew how Trump was going to do the job. He has done much better than I ever dreamed he would.
The same people who lied so loudly & thoroughly about Obamacare then are lying loudly now about DACA/Dreamers/Immigration Reform. The infuriating part is that the same nice centrists who believed the utter horseshit the Left & Media were selling then will buy it again.
That's why I get so angry at nice centrist people--they're the ones who will, or who have, doomed this nation. They buy the Left's line every time.
Obamacare will save tons of money, "bend the cost curve," and anyway is the only compassionate thing to do--anyone who opposes it must be a ugly hateful bigot. Sold! And we can't ever get rid of it.
Gay rights are just about personal rights & dignity and don't involve any demands on anyone else's beliefs or actions--gay people just want to be treated like everyone else and if you oppose that you're a hateful ugly homophobic bigot. Sold! And now it's "bake the fucking cake" and "donate $100 to the wrong cause and you're unemployable forever you deplorable troglodyte."
We fucking had an amnesty already! 1986 is not some ancient date--someone born in 1986 is a Millennial for fuck's sake. How is it in this current debate no one seems to mention that all the promises that were made around THAT "comprehensive reform" somehow, as though by magic, were not honored...but that these NEW promises, of course, will be? Oh, see, we CAN'T ask that, because the premise of the question marks one as a hateful racist bigot, somehow.
Fucking NPR had a story last week about how the "Republican stance on immigration reform" sure has changed over the years. They played clips of a Reagan speech (and some from Bush & W Bush as well) and contrasted that with a clip from a Trump campaign speech. Reagan sounded so open and willing to help those poor (law-breaking) aliens living in the shadows--isn't it nuts how bigoted and hateful and ugly the Republicans have become? Nevermind that the utterly failed to mention that REAGAN APPROVED THE FUCKING AMNESTY back then...which if the promises the Left made as part of that grand bargain had held/meant anything at all would have meant there would BE no problem today! It's ridiculous.
But watch--nice centrist people will buy it, everytime.
Seriously: as you read this article now ask yourself who will pay any kind of political price for being wrong? Even if you think they just "got it wrong" and weren't lying from the start (which, yeah, they were), shouldn't someone pay some price for being so very wrong? No one will, and the Left will march on with the enthusiastic support of nice centrists everywhere.
Thanks assholes.
Like Haman, they are building their own scaffold. Like the EU official whose daughter was raped and killed by a Muslim migrant, they are not immune just because they pander.
Anne probably voted for Hillary but probably wouldn't do so today.
Can we simplify this to 'If a politician says X, X is a lie.'? I thought this general knowledge.
As long is X is not "I am lying."
Essentially Obamacare was rationalized by two ideas that might have been true but were not: That it would be cheaper overall if everyone got insurance in a common risk pool (it would be more expensive for healthy people, but cheaper for people with health problems, and the net would be cheaper overall); and that subsidizing preventive care would save money. While it is theoretically possible that these two things are both true, the reality is that they are not, and this was almost surely foreseeable. Thus the real reason for Obamacare was to redistribute income and expand government.
I spent a long time. talking w my fren. about healthcare. The optimal strategy. Is to make policy with ur brain. and not with ur heart
Ann Althouse said.... But we don't generally pay to improve each other's quality of life.
The hell "we" don't, by the way. The big NPR story this morning was about the push to include LGBTQ in the set-asides municipalities and states reserve for women- and minority-owned businesses. It's the trend, understand. What are affirmative action and similar programs if not "us" paying (directly & indirectly) to improve the quality of (some special) others' lives? How about AFDC, TANF, or any other welfare-type program? "We" pay to improve others' quality of life all the time. If the objection is that the Obmacare costs are (in theory) paying to improve a wider/less targeted group of people's lives...then I'm not sure what point that sentence is trying to make.
This will PAY FOR ITSELF!!!!!
I can not think of a single instance where that is true.
Of course I am one of those that believes increasing taxes does not equate to self-funding.
The hell "we" don't, by the way.
Well, yes, we do for things like roads and traffic lights. And national defense. But not where most of the benefit is private. Or at least there's no reason to.
James K said...Well, yes, we do for things like roads and traffic lights. And national defense. But not where most of the benefit is private. Or at least there's no reason to.
Affirmative action isn't a public good (like roads, national defense, etc). Most welfare programs aren't public goods. A public good must be non-excludable. Affirmative action is most definitely excludable--if you're not a member of the group being favored you don't get any benefit.
That's why I added "Or at least there's no reason to."
But in those things you mention, we aren't paying to "improve each other's quality of life," we're improving one person's at the expense of another's.
This will PAY FOR ITSELF!!!!!
I can not think of a single instance where that is true.
Remember how Amtrak and the US Postal System were supposed to become self-supporting?
P. T. Barnum was the smartest guy alive. People will believe whatever it is they need to believe, all you have to do is figure out what that something is and you can live easily off of them.
There is now building evidence that the opiod crisis is a direct result of the Obamacare and its massive subsidies to the poor.
Is the Times even trying, anymore?
That's been known for years. Of course, "preventive care" provides a consistent revenue stream and endless possibilities for bureaucrats to involve themselves in deciding what all gets done.
That said, one shouldn't throw the baby out with the bathwater; a lot of screening tests and immunizations fall under this rubric. My own area of HPV does show benefits from regular screening and vaccination.
"Wellness visits" are just revenue-generating BS.
That said, one shouldn't throw the baby out with the bathwater; a lot of screening tests and immunizations fall under this rubric. My own area of HPV does show benefits from regular screening and vaccination.
No doubt, but are the "external" benefits sufficient to warrant the sorts of subsidies and insurance treatment that are in Obamacare? Or is this just more paternalism?
How much of this fake news did the NYT feed us on the run up to Obamacare? Tons and tons.
Now they have the audacity to tell us quite blatantly that they allowed Obama to lie, they never fact checked him, and they perpetuated the lies.
Do you still consider yourself a liberal, Ms. Althouse? How do you stomach what that ideology is connected to?
There are good reasons we call the NYT Pravda on the Hudson.
"...the NYT was against the war."
Judith Miller would disagree, as would a quick review of their editorials in 2003. They were wishy-washy and didn't like the lack of international support but I can't find a clear statement of opposition at the beginning of the conflict.
What has the Iraq war cost? Donald Trump went around saying $6 trillion.
You are seriously citing the incredibly hyperbolic and inaccurate Donald Trump as a source?
Am I missing a /sarc tag?
The New Republic will accurately report what Republicans assert about as well as Mother Jones: they might find ONE idiot who says something and then ascribes it to the entire body politic. It is this 'thing' they do.
Saying what you said is notoriously dishonest. One 'may' have had tiny support in the R side, but was widely questioned, mocked, and derided publically.
THIS is something that Obama himself said, many Democrats asserted and the Times itself gave unquestioning credence to.
The two are in no way comparable.
consider yourself a liberal
To be fair, liberalism is a divergent ideology with thresholds, typically generational, and recurring.
Could this just be Lefties prepping the ground to argue for euthanasia and selective abortion? "Preventative care is so expensive that the best choice is to make sure people don't need it!".
Works for all those Down Syndrome kids in Europe.
"we don't generally pay to improve each other's quality of life. We expect you to work and pay for your own quality-of-life improvements"
I'm sympathetic to frustration with politicians lying about the costs and benefits of their policy ideas (N.B. Iraq Debacle), but the above sentiment is one of the howlers that makes me think I might not be a conservative after all (insofar as that represents a real conservative belief).
We do generally pay to improve each other's quality of life. Every day, all the time. Schools and roads and tax breaks and medical care. I haven't called the police in years, but I pay for other people to interact with them every single day, much to their benefit. If there's an expectation everyone will pay their own way, it's not clear to me who can claim to have it without being a hypocrite.
James K:
A politician saying "I am lying" is the political equivalent of dividing by zero.
And I was told the science was settled.
"We believed it, because the fake-news press and the lying politicians told us so." I am not part of "we" precisely because The New York Times reported it. The Times has earned a level of mistrust such that what they report merits prima facie disbelief of the reader, subject to verification of the report. "This is the same newspaper that will turn and blame us for doubting what it tells us, as though we're a bunch of yokels when we don't adopt the beliefs it serves up as true." Prof. Althouse, you're a lawyer; I'm a lawyer. No doubt you have many regular readers who are red state lawyers that don't think much of the Times either. We (fully inclusive) need not give a second thought to whether the journalism majors at the Times who didn't get into law school think we're yokels.
One does not need to be a lawyer to realize that the Times is selectively accurate and curious. They blatantly display it all the time.
What gets my particular panties in a bunch is when moderates who realize this (like lawyers) but don't call them out on it since it isn't THEIR particular ox gored...but then deride Fox News.
TestTube said:
Why would anyone go to an ER if it wasn't a matter of life or limb?
Several answers, few very reassuring. For 9 years, as EMT/medic, I ran with the volunteer-staffed EMS station in my urban area; I got very familiar with our hospitals and especially their EDs, both before and after ObamaCare. We have a fair number of urgent-care units in the city which function in part as triage for hospitals -- we often got calls from them for patients who needed the full array of hospital treatment and in my opinion they were rarely wrong. Problem: they were, with few exceptions, not open 24/7, and when patient sees a need for medical services after 7 pm the options are limited to calling 911 for an ambulance or going direct to the ED.
Further Problem: a substantial portion of any ED patient population is fully aware that they can't be turned away, especially if they recite certain "trigger" symptoms or conditions. Street people looking for 3 hots and a cot are not rare, they are common. Most have no financial resources, could not, or would not, pay for services at urgent care: some frequent fliers use ambulances as taxis to get wellness checks at EDs regardless if their financial status. Drug-seekers are common, often chagrined to learn that EDs don't hand out opiates like candy, and the best they get is a prescription to be filled elsewhere.
Life or Limb: A case like yours, a hand injury, is typically a per-protocol transport-to-ED call by the medic in charge: too many things can go wrong with hands and if not dealt with early a bad outcome can be life-changing. I would have done exactly as your guy did, ED stat. There are MANY other conditions that are handled on the same basis -- it's what EDs are for, and why they're staffed 24/7 w/ lots of gear and personnel. That's why they cost what they do.
But everyone in EMS knew there was NO way Obamacare would lower the frequency of ED visits: it was guaranteed to increase them. Don't feel like going through the process to get coverage and then finding a doctor who will see you? Don't feel like waiting for an appointment, want/need to be seen NOW? Don't have any compunctions about system abuse? The ED is your first, not last, resort.
My doctor is required to have medicare patients have a "wellness checkup" every year. I do not know at what age this kicks in, but I know mine started at age 80. It is a silly requirement he will be fined if he doesn't do it, it is done by the Nurse Practitioner in his office.
My husband and I have the same primary physician. He sees us each every three months, we have blood tests before the visit, we are very well looked after without wellness visits. In addition to seeing him I see a rheumatologist every 6 months and an endocrinologist every 6 months. My husband sees a cardiologist and urologist yearly.
Medicare is billed $80 for each wellness visit. A visit I suppose is classified as preventive care. She checks our ears, ask have we seen our other doctors, listens to our hearts, and makes recommendations for diet. Nothing that is not done by other physicians 4-7 times a year.
I suspect the hand of the ACA in it, although Medicare is supposedly in no way connected to the ACA. They ideas are from the same minds.
10 and a half hours into the thread and still no ARM.
Leave it to a free market... And why they (hospitals) do not have more of these type of (urgent care and no-appointment clinics) at the hospitals, perhaps right next door to the ER, is questionable."--Mark 6:55 AM
The answer is that we don't have a free market, we have a slave market in health care provision. And we have it because good intentions!
Do-gooders didn't want hospitals turning people away from the Emergency Department. So do-gooders made a federal rule that hospitals may not do that. Period. Refer someone to "urgent care and no-appointment clinics" literally next door even if operated by the hospital itself will get your hospital fined and cut off from Medicare reimbursements. Result: hospital goes bankrupt.
Do-gooder-ism should be a felony. An aggravated felony.
All those nagging nannies in the press who go on about how such-and-such is good for you blah blah blah are also do-gooders. Felonious do-gooders. Imprison 'em.
Jason @ 11:37 for the win.
the US Postal System were supposed to become self-supporting?
I never recall that claim, particularly since the USPS is established via a clause in the US Constitution. The purpose was not to be self-supporting in and of itself, but to give the government a means of sending posts to the citizenry on what it was doing.
"As it turns out, the ACA cost us a bunch of money and made health care worse overall."
How did it make health care worse overall?
"That said, we had a hot occupation. I lay the primary blame on Paul Bremer, but there's plenty to go around."
Yes, particularly for those who decided to invade Iraq in the first place!
I suggest that one contributing cause to overuse of Emergency Rooms is that many people do not have regular doctors they see regularly. With the rise of specialization, garden variety GPs are fewer and harder to find, and people who did not have insurance prior to ACA almost certainly never had a regular GP and don't know where (or how) to find one now. Also, with the rise of HMOs, so many GPs still have to refer their patients to specialists for almost anything that requires actual medical attention.
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