Comments on: Health Care Policy and Reality

By: EMichael

EMichael — Tue, 08 Nov 2016 14:48:26 +0000

1) Yeah, exploding healthcare costs did not exist before the ACA, therefore the ACA is responsible for exploding healthcare costs.

2) Yeah, it is far cheaper to let people use emergency rooms with no insurance and no ability to pay cause everyone knows providers just write it off and there is no cost to anyone.

I could go up to 20 or so, but damn.

By: Arnold Kling

Arnold Kling — Tue, 08 Nov 2016 14:08:57 +0000

My bad. I should have included all forms of government spending on health care. I updated the post.

By: Charlie

Charlie — Tue, 08 Nov 2016 13:36:47 +0000

Do you have a source for #2? It doesn’t seem right that the US spends that much on Medicare (or even Medicare & Medicaid). A quick good search seems like we spend 7% of GDP on Medicare/Medicaid, which is less than what many western countries spend on healthcare. But if you are thinking of a specific study I would like to see it. I imagine it depends on how you count up the money.

Thanks.

By: Ed Renfro

Ed Renfro — Mon, 07 Nov 2016 23:45:03 +0000

“Did the EMTALA create a bigger problem?”

It’s a good question. I would like to think that very few emergency providers shirked their duty, but it only takes one really bad case to make the front page of the NYT. That’s why I think the existence of something like EMTALA is inevitable.

“Do people who go to an emergency room w/o a means to pay get turned away if the need is determined to not immediate or, at least, could have been handle much cheaper at an urgent care or Minute Clinic?”

In my experience, they receive treatment regardless of the presence of an emergency medical condition, and the hospital tries (often unsuccessfully) to collect after the fact. This exacerbates the free rider problem, but on the other hand, where are these folks gonna go if they don’t have any money?

By: Seth

Seth — Mon, 07 Nov 2016 23:30:10 +0000

It’s always tough to imagine what can evolve in a market if you let it.

I’d be interested to know how big of a problem people being turned away from emergency care was before EMTALA and how big of a problem it is after. Did the EMTALA create a bigger problem?

I’d also be interested to know how things are handled now. Do people who go to an emergency room w/o a means to pay get turned away if the need is determined to not immediate or, at least, could have been handle much cheaper at an urgent care or Minute Clinic?

How many times should people get to receive free “immediate” emergency care before they can be reasonably expected to make better arrangements?

By: Jeff R.

Jeff R. — Mon, 07 Nov 2016 23:21:55 +0000

Just to further this point, here’s something a stumbled upon in a hospital’s financial statement’s this afternoon:

The assets of Newberry County Memorial Hospital (MCMH…increased by approximately $2,536,000 in 2014. This increase is due to the net income for the year, including capital grants and county appropriations. In fiscal year 2010, the NCMH Board negotiated a settlement of $6,250,000 with Palmetto Health to settle a Certificate of Need appeal. The settlement will allow Palmetto Health to construct a hospital 32 miles southeast of Newberry. NCMH received $1,250,000 in the fiscal year ended June 30, 2010 and $2,500,000 in the fiscal year ended June 30, 2012. The remaining $2.5 million was received in fiscal year 2014.

So they were able to finagle $6.5 million out of another healthcare provider that wanted to build a hospital 32 miles away. Yeesh.

By: asdf

asdf — Mon, 07 Nov 2016 22:14:42 +0000

“New forms of health insurance, such as “insurance against becoming uninsurable,” need to be tested in the market.”

Just a quick note, this has been tried and failed. The demand for it is obvious, but nobody can solve the underwriting problem.

By: freetofu

freetofu — Mon, 07 Nov 2016 21:11:07 +0000

Couple more things occurred to me: I don’t know what Arnold’s current income is, but I’m pretty sure he has massive wealth, so I can’t help wondering (assuming) that that 40% of income is from an expensive plan that he chose because he can afford it for that reason.

The other thing is occurred to me that I might have misremembered the thing about Hayek, but apparently not. Here’s the tweet.
https://twitter.com/FriedrichHayek/status/792147509183295488

By: Lord

Lord — Mon, 07 Nov 2016 18:27:43 +0000

It isn’t that more market orient policies (reduce demand, increase supply) don’t exist, but that Republicans are even more opposed to them than Democrats, being large constituents for them.

By: Ed Renfro

Ed Renfro — Mon, 07 Nov 2016 18:15:59 +0000

What is your vision for emergency care? Should EMTALA be repealed? I find myself often struggling to reconcile the unambiguous personal duty to assist a person in need of immediate medical care with the plague of free ridership in our emergency departments.