Thursday, April 22, 2010

Thoughtful Discourse On Obamacare

Sometimes you find the most stimulating conversations on social networking sites. I have taken the liberty of lifting this conversation and posting it here because of it's verified accuracy and its relevance to today's national conversation.

SH1: I hate doctors who think NOTHING of keeping you waiting for over an hour. There is no excuse for not letting you know that they are running so far behind. It's just rude.

SH2: When I had my last colonoscopy, the jerk doctor told us to be there close to 0700. We were there and waited and waited. I was last in his pre-determined line-up. He makes all his patients show up at the same time. We left after noon. It was obviously all right that we waited
Mary S. was the pre-op nurse who attempted to push me up the line, but the doctor makes his lineup and will allow no changes. We were stuck because of this rude dude.

SH1: Yes -- same thing happened to me with my colonoscopy. We either had the same doctor or they all do it the same way. Inexcusable.The problem is not going to get better. There is already a doctor shortage in many locations and in many specialties and with Obamacare adding another 30,000,000-plus patients to the mix (without adding any more doctors), physicians are unlikely to feel the need to be more concerned about patient wait times. :/

Now the plot thickens...

CW: I agree it's inexcusable for doctors to keep you waiting for over an hour, but I can't get upset that more sick people are going to be able to get necessary care.

SH1: Well, not necessarily. Very few people in this country do not get "necessary care" whether they have insurance or not (who dies because a doctor or hospital would not treat them?). What is likely to happen in the short run is doctor shortages and waiting lists for all but lifesaving procedures. Health care is rationed now and will always be rationed because it's not an infinite good. Central planning, however, is usually the least efficient method of allocating scarce resources.

CW: While it is usually true that people don't die because a hospital wouldn't treat them, it is more expensive for all of us if people with no insurance use the emergency room for their primary care. And I have seen news articles about doctors who will not treat people without insurance, even if it is lifesaving care. There was one such article recently in the St. Pete Times.

SH1: Studies have shown that the rate of emergency room usage is the same in the uninsured as it is in the insured. The "emergency room as primary care" argument has been used for a while, but after inspection it's not really valid.

CW: Having been in charge of a study of ER usage at Bayfront (years ago), I am surprised by the results of the study you quote. That was certainly not the case at Bayfront.

SH1: "Only about 17 percent of E.R. visits in the United States in the last year studied were by uninsured patients, about the same as their share of the population."And "'What surprised us was that uninsured patients actually pay a higher proportion of their emergency department charges than Medicaid does,' reported co-author ReneĆ© Hsia, a specialist in emergency medicine at the University of California at San Francisco. 'In fact, 35 percent of charges for uninsured visits were paid in 2004, compared with 33 percent for Medicaid visits.'”Here's the link to that article (the data is from a Journal of the American Medical Association study that was done in 2008): ... See MoreAlso, from this Wall St. Journal editorial about what has happened in Massachusetts now that everybody has insurance ( ): "The difficulties in getting primary care have led to an increasing number of patients who rely on emergency rooms for basic medical services. Emergency room visits jumped 7% between 2005 and 2007. Officials have determined that half of those added ER visits didn't actually require immediate treatment and could have been dealt with at a doctor's office—if patients could have found one."The insurance rates in Massachusetts are the highest in the nation and state regulators just turned down requests for rate increases of up to 32% by insurers. There's a doctor shortage, costs (which was your original issue) are higher than anyplace else in the country...all in all, a horrible solution to the problem.

Nuff said.

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