3 ms·

The article says we need to take a wider perspective than just healthcare spending, but gives only one example of this with smoking, which happens to be one of

by Gatsky 9y ago

The article says we need to take a wider perspective than just healthcare spending, but gives only one example of this with smoking, which happens to be one of the few 'preventative' interventions which both costs money to implement, and reduces revenue at the same time. As such, I am unconvinced of the entire thesis. It also uses a silly example of emergency room use after the ACA - of course after drasticallly changing the number of people with health insurance, there will not be efficient or ideal use of healthcare services. Many of the previously uninsured people probably aren't even aware of the concept of primary care. The link between health and labour productivity only gets stronger as the population ages. Given this, I would need to see some compelling arguments that keeping people healthier for longer does not actually save money, but none are forthcoming in this article.

gbacon 9y ago
The point of the ER example is it runs counter to one of ACA’s important justification claims, viz. requiring all manner of preventive care coverage — even from low-premium, high-deductible plans — would reduce ER usage by giving the formerly uninsured the option of primary care. Even though now the ER isn’t “the only place they can go,” the author asserts that some choose to visit the ER as a matter of convenience. Reality isn’t likely to be quite this simple, e.g., another likely factor is a shortage of physicians accepting Medicaid. The example isn’t silly at all. Central to ACA advocacy was how high American healthcare spending was relative to other countries and that costs would fall with ER-as-primary gone.
- Gatsky 9y ago
  I still maintain it is a lazy example, and indeed probably just wrong[1]. The last insurance expansion was as recent as 2014, yet there is no discussion of trends over time. [1]https://m.medicalxpress.com/news/2017-07-impact-patient-emergency-department.html https://m.medicalxpress.com/news/2017-07-impact-patient-emer...
analog31 9y ago
In my view the use of emergency rooms was a red herring -- blaming the poor for being wasteful. I've been to the ER a couple times for relatively non emergency care. When you walk in the door, you go to a window, and if you don't have a real critical emergency, they direct you down a hallway into a facility on site that looks and operates exactly like a regular "urgent" or "primary" care facility. It seems no less efficient to provide primary care in the same building as an emergency room, as to provide it in a separate building down the street. If you're having a heart attack, then you get the real thing: Eight attendants, machine that goes "ping" and so forth. Now, of course the billing process may be different. With free health care, there would be no billing process.

by Gatsky 9y ago

gbacon 9y ago

The point of the ER example is it runs counter to one of ACA’s important justification claims, viz. requiring all manner of preventive care coverage — even from low-premium, high-deductible plans — would reduce ER usage by giving the formerly uninsured the option of primary care. Even though now the ER isn’t “the only place they can go,” the author asserts that some choose to visit the ER as a matter of convenience. Reality isn’t likely to be quite this simple, e.g., another likely factor is a shortage of physicians accepting Medicaid. The example isn’t silly at all. Central to ACA advocacy was how high American healthcare spending was relative to other countries and that costs would fall with ER-as-primary gone.

Gatsky 9y ago
I still maintain it is a lazy example, and indeed probably just wrong[1]. The last insurance expansion was as recent as 2014, yet there is no discussion of trends over time. [1]https://m.medicalxpress.com/news/2017-07-impact-patient-emergency-department.html https://m.medicalxpress.com/news/2017-07-impact-patient-emer...

analog31 9y ago

In my view the use of emergency rooms was a red herring -- blaming the poor for being wasteful. I've been to the ER a couple times for relatively non emergency care. When you walk in the door, you go to a window, and if you don't have a real critical emergency, they direct you down a hallway into a facility on site that looks and operates exactly like a regular "urgent" or "primary" care facility. It seems no less efficient to provide primary care in the same building as an emergency room, as to provide it in a separate building down the street. If you're having a heart attack, then you get the real thing: Eight attendants, machine that goes "ping" and so forth. Now, of course the billing process may be different. With free health care, there would be no billing process.