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Sorry for your loss, nobody should have to go through that. How do people in the US who don’t have insurance get treatment for themselves or their family membe

Sorry for your loss, nobody should have to go through that. How do people in the US who don’t have insurance get treatment for themselves or their family members in situations like this? It seems inconceivable to me that they or their kids are just expected to die?

lotsofpulp 5y ago
They will get treatment, assuming the hospital has capacity: https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_an... And generally, if you have nothing, the government will pay for you. However, quality and quantity of healthcare will likely not be as high. The rough spot is in the middle when you have some assets, but not enough for a secure life, but do not have insurance, then you will have to forfeit your assets in order for the government aid to kick in, and then you are poor.
- Ntrails 5y ago
  The interesting concern for me is always "i won't go see anyone about medical issue X because the copay/deductible structure dissuades me from checking". Even if you have a spare $800 for [insert tests here] you're going to be reluctant to spend it unless you're pretty confident it's necessary. Is this the source of significant delay in diagnosis? Does it increase or decrease overall costs of treatment? Does it meaningfully alter expected prognosis of the middle income US patients etc
  - lotsofpulp 5y ago
    Depends on the individual’s finances. Preventative care such as annual wellness exams are mandated to be covered (i.e. free for insured) and you get a blood test with that. So presumably, you are catching most lifestyle or inherited or long term ailments there. By law, annual out of of pocket expenses are capped: https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/ https://www.healthcare.gov/glossary/out-of-pocket-maximum-li... However, based on the median income in the US, many Americans would have to think twice about scheduling a doctor’s appointment and being on the hook for an unexpected hundreds or thousands of dollars. It is all a form of rationing healthcare, so having people think twice about going to the doctor at the expense of some people’s health is part of the system.
- actually_a_dog 5y ago
  > The rough spot is in the middle when you have some assets, but not enough for a secure life, but do not have insurance, then you will have to forfeit your assets in order for the government aid to kick in, and then you are poor. Which is where a lot of elderly people who need long term care end up.
gumby 5y ago
> It seems inconceivable to me that they or their kids are just expected to die? Basically, yes. Hospitals are required by law to treat anyone who presents themselves to the emergency room (thus the ER is the primary entry point for many people, regardless of symptom) but they get triaged to the bottom of the queue. Hospital insurance administrators can and do intervene in doctor decisions on care. Medical debt in the US was already a crisis before the pandemic. It can push people out of their homes and pretty much destroy them. Even some with insurance make gofundme pleas to try to cover their medical bills.
- actually_a_dog 5y ago
  > ...they get triaged to the bottom of the queue. I can't find any evidence of this happening using Google. Do you have any?
  - gumby 5y ago
    Just talk to anyone who works in an ER. Or read the first link returned by DDG: https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/ https://www.kff.org/uninsured/issue-brief/key-facts-about-th... which looks at the more general case. Key paragraphs to read (in this regard) are “ How does not having coverage affect health care access?” and the immediately following “ What are the financial implications of being uninsured?” Worse is the hospital revenue people intervening in care decisions. There was an expose about this in the NYT a few years ago; as far as I can tell nothing has since changed.
    - actually_a_dog 5y ago
      Those two sections say nothing about getting "triaged to the bottom of the queue." As far as "hospital revenue people intervening in care decisions," that doesn't mean people don't get care. It means they may not get super expensive treatments. That certainly may not be the best care, because, all the ER needs to do, legally, is ensure that the patient's condition is non-emergent before they discharge them, but it's completely unrelated to triage. It is, however, a predictable result of hospitals needing to make a profit. Do you have any hints or keywords I could search to find the NYT article?

lotsofpulp 5y ago

They will get treatment, assuming the hospital has capacity: https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_an... And generally, if you have nothing, the government will pay for you. However, quality and quantity of healthcare will likely not be as high. The rough spot is in the middle when you have some assets, but not enough for a secure life, but do not have insurance, then you will have to forfeit your assets in order for the government aid to kick in, and then you are poor.

Ntrails 5y ago
The interesting concern for me is always "i won't go see anyone about medical issue X because the copay/deductible structure dissuades me from checking". Even if you have a spare $800 for [insert tests here] you're going to be reluctant to spend it unless you're pretty confident it's necessary. Is this the source of significant delay in diagnosis? Does it increase or decrease overall costs of treatment? Does it meaningfully alter expected prognosis of the middle income US patients etc
- lotsofpulp 5y ago
  Depends on the individual’s finances. Preventative care such as annual wellness exams are mandated to be covered (i.e. free for insured) and you get a blood test with that. So presumably, you are catching most lifestyle or inherited or long term ailments there. By law, annual out of of pocket expenses are capped: https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/ https://www.healthcare.gov/glossary/out-of-pocket-maximum-li... However, based on the median income in the US, many Americans would have to think twice about scheduling a doctor’s appointment and being on the hook for an unexpected hundreds or thousands of dollars. It is all a form of rationing healthcare, so having people think twice about going to the doctor at the expense of some people’s health is part of the system.
actually_a_dog 5y ago
> The rough spot is in the middle when you have some assets, but not enough for a secure life, but do not have insurance, then you will have to forfeit your assets in order for the government aid to kick in, and then you are poor. Which is where a lot of elderly people who need long term care end up.

gumby 5y ago

> It seems inconceivable to me that they or their kids are just expected to die? Basically, yes. Hospitals are required by law to treat anyone who presents themselves to the emergency room (thus the ER is the primary entry point for many people, regardless of symptom) but they get triaged to the bottom of the queue. Hospital insurance administrators can and do intervene in doctor decisions on care. Medical debt in the US was already a crisis before the pandemic. It can push people out of their homes and pretty much destroy them. Even some with insurance make gofundme pleas to try to cover their medical bills.

actually_a_dog 5y ago
> ...they get triaged to the bottom of the queue. I can't find any evidence of this happening using Google. Do you have any?
- gumby 5y ago
  Just talk to anyone who works in an ER. Or read the first link returned by DDG: https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/ https://www.kff.org/uninsured/issue-brief/key-facts-about-th... which looks at the more general case. Key paragraphs to read (in this regard) are “ How does not having coverage affect health care access?” and the immediately following “ What are the financial implications of being uninsured?” Worse is the hospital revenue people intervening in care decisions. There was an expose about this in the NYT a few years ago; as far as I can tell nothing has since changed.
  - actually_a_dog 5y ago
    Those two sections say nothing about getting "triaged to the bottom of the queue." As far as "hospital revenue people intervening in care decisions," that doesn't mean people don't get care. It means they may not get super expensive treatments. That certainly may not be the best care, because, all the ER needs to do, legally, is ensure that the patient's condition is non-emergent before they discharge them, but it's completely unrelated to triage. It is, however, a predictable result of hospitals needing to make a profit. Do you have any hints or keywords I could search to find the NYT article?