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For costs: medical service + profit + profit accounting overhead + cost shifting overhead > medical services There was a period in time where there were very h

by dv_dt 9y ago

For costs: medical service + profit + profit accounting overhead + cost shifting overhead > medical services There was a period in time where there were very high losses in emergency rooms because there are legal obligations for conferring care in that setting. Many emergency rooms were getting closed down and that's also a big problem for communities. So it's in a way understandable (not necessarily excusable), because some of this I would infer is cost shifting to meet those obligations. Maybe it's shifted to too much profit now. Both sides of the problem, IMHO come from completely disconnected cost/profit transaction loops in America's healthcare. It's one big reason why single payer systems cost so much less. There is a much more straightforward relation between costs, care, and budgets in those systems so you can actually manage the direct problems instead of managing multiple red-tape layers each trying to competitively maximize, minimize different areas.

wahsd 9y ago
Sorry, but "single payer systems" "cost so much less" because they externalize and obscure and obfuscate the costs in many different ways and the whole accounting of the system is totally inaccurate. You are also trying to compare an American system agains single payer systems that are made up of generally healthy people. There is simply no easy way to determine how the single payer systems would deal with things like the huge black obesity rates and accompanying diabetes and dialysis and associated complications. And that doesn't even address the fact that, of course single payer systems "cost so much less" when the government sets the qualifications for care AND the government further obscures the true cost by heavily subsidizing it with tax money that is involuntarily taken from lip service citizens. I find it rather baffling that ostensibly intelligent people simply cannot seem to wrap their minds around the fact that the true costs of single payer systems are not at all easily detectable. And that doesn't even go into the far greater issue of the authoritarian nature of single payer systems where you are forced to not only pay for something, but you don't even have control over it.
bluGill 9y ago
We are talking about ER rooms here: people who need ER services are not in a position to do any sort of shopping around. When seconds count you cannot afford the minutes needed to get to the next ER. In theory it is possible that one is significantly better and so it would be worth the time, but in practice all the ERs in any given area are going to be not very different in ability to provide care. Even if the closer ER transfers you to the other getting to the first in time started care sooner.
- megaman22 9y ago
  If you're using ERs for what they should be used for, then yeah, you're in shock, or bleeding out, or in mortal peril. Many people do not use them correctly; I can't blame them sometimes, when that's the only option around, but there's a whole host of issues people drift into ERs for that ought to be solved by an aspirin and a night's sleep, or an urgent care clinic. In the past five years, there's been a huge explosion of Convenient MDs and the like springing up everywhere; honestly, if you just had a nurse practitioner or PA assigned or on-call at Rite-Aids or CVSs to write scripts for no-brainer prescription medications, you'd solve half the healthcare problems people deal with.
  - donarb 9y ago
    And you have conservatives in this country saying that the poor have access to health care anytime they want by using the emergency room. These are the same people who complain about the poor buying steaks with food stamps and still suggest the poor use the most expensive form of health care rather than ensuring a basic minimum of care be allowed for all citizens.
  - bluGill 9y ago
    Be careful of that though. I recently went to the ER for "chest pain" it wasn't a heart attack, and I had every reason to believe before I went that it was just a listed side effect of my medication. However since it was chest pain I couldn't ignore it. This is not unusual, ~60% of ER chest pain visits are nothing. (I suspect that increasing that number to 75% would be a good thing as it would mean a few more people come in when it is something)
- Waterluvian 9y ago
  It's a perfect candidate for a socialized program. We all pay a tax to guarantee that ERs are available and equipped for everyone at a moment's notice.
  - __sha3d2 9y ago
    Not to mentioned it's already a socialized program... who foots the bill when nobody pays? Me & you.
stevula 9y ago
Emergency departments are still loss leaders, at least at the hospitals I’ve worked with as a consultant. The hospitals make up for it through the referrals and imaging procedures generated by it.
- goialoq 9y ago
  If you can't choose to get your referrals and imaging done at a different hospital, then it's a bundle deal, not a loss leader. If you can transfer to a different hospital/clinic for referrals and imaging, it's a loss leader.

by dv_dt 9y ago

wahsd 9y ago

Sorry, but "single payer systems" "cost so much less" because they externalize and obscure and obfuscate the costs in many different ways and the whole accounting of the system is totally inaccurate. You are also trying to compare an American system agains single payer systems that are made up of generally healthy people. There is simply no easy way to determine how the single payer systems would deal with things like the huge black obesity rates and accompanying diabetes and dialysis and associated complications. And that doesn't even address the fact that, of course single payer systems "cost so much less" when the government sets the qualifications for care AND the government further obscures the true cost by heavily subsidizing it with tax money that is involuntarily taken from lip service citizens. I find it rather baffling that ostensibly intelligent people simply cannot seem to wrap their minds around the fact that the true costs of single payer systems are not at all easily detectable. And that doesn't even go into the far greater issue of the authoritarian nature of single payer systems where you are forced to not only pay for something, but you don't even have control over it.

bluGill 9y ago

We are talking about ER rooms here: people who need ER services are not in a position to do any sort of shopping around. When seconds count you cannot afford the minutes needed to get to the next ER. In theory it is possible that one is significantly better and so it would be worth the time, but in practice all the ERs in any given area are going to be not very different in ability to provide care. Even if the closer ER transfers you to the other getting to the first in time started care sooner.

megaman22 9y ago
If you're using ERs for what they should be used for, then yeah, you're in shock, or bleeding out, or in mortal peril. Many people do not use them correctly; I can't blame them sometimes, when that's the only option around, but there's a whole host of issues people drift into ERs for that ought to be solved by an aspirin and a night's sleep, or an urgent care clinic. In the past five years, there's been a huge explosion of Convenient MDs and the like springing up everywhere; honestly, if you just had a nurse practitioner or PA assigned or on-call at Rite-Aids or CVSs to write scripts for no-brainer prescription medications, you'd solve half the healthcare problems people deal with.
- donarb 9y ago
  And you have conservatives in this country saying that the poor have access to health care anytime they want by using the emergency room. These are the same people who complain about the poor buying steaks with food stamps and still suggest the poor use the most expensive form of health care rather than ensuring a basic minimum of care be allowed for all citizens.
- bluGill 9y ago
  Be careful of that though. I recently went to the ER for "chest pain" it wasn't a heart attack, and I had every reason to believe before I went that it was just a listed side effect of my medication. However since it was chest pain I couldn't ignore it. This is not unusual, ~60% of ER chest pain visits are nothing. (I suspect that increasing that number to 75% would be a good thing as it would mean a few more people come in when it is something)
Waterluvian 9y ago
It's a perfect candidate for a socialized program. We all pay a tax to guarantee that ERs are available and equipped for everyone at a moment's notice.
- __sha3d2 9y ago
  Not to mentioned it's already a socialized program... who foots the bill when nobody pays? Me & you.

stevula 9y ago

Emergency departments are still loss leaders, at least at the hospitals I’ve worked with as a consultant. The hospitals make up for it through the referrals and imaging procedures generated by it.

goialoq 9y ago
If you can't choose to get your referrals and imaging done at a different hospital, then it's a bundle deal, not a loss leader. If you can transfer to a different hospital/clinic for referrals and imaging, it's a loss leader.