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Except mandatory "maintenance" doesn't lead to fewer repairs in this case. Google Oregon Medicare study and Emergency Room usage. A comment from reason.com sum

by webXL 13y ago

Except mandatory "maintenance" doesn't lead to fewer repairs in this case. Google Oregon Medicare study and Emergency Room usage. A comment from reason.com sums it up nicely: "Emergency rooms are required by law to treat it. If you are poor, they are unlikely to ever collect the bill for doing so. So why would a poor person wait days or weeks to see a doctor then they can go down to an emergency room and see one in hours? Moreover, if you are being forced to pay for health insurance, you are more likely not less likely to seek treatment since you will rationally think "well I am paying for it so I might as well use it.". The idea that making people buy insurance will reduce overall healthcare costs has always been an insane one." http://reason.com/blog/2014/01/02/no-obamacare-wont-reduce-emergency-room#comment_4219297 http://reason.com/blog/2014/01/02/no-obamacare-wont-reduce-e...

d23 13y ago
> So why would a poor person wait days or weeks to see a doctor then they can go down to an emergency room and see one in hours? Because if you don't have a life threatening condition, you're not going to see a doctor in "hours" in the emergency room. You're going to be triage'd to the lowest possible slot, and it's my understanding that if they believe you can just be sent on your way, they'll do that. You can't go in for an ear ache. > Moreover, if you are being forced to pay for health insurance, you are more likely not less likely to seek treatment since you will rationally think "well I am paying for it so I might as well use it." The idea that making people buy insurance will reduce overall healthcare costs has always been an insane one. First of all, there are plenty of respected folks who don't think that's "insane". Presumably more respected than "John" from the comments section. But regardless, that's what co-pays and deductibles are for. Let's also not forget that going to the doctor is still not a joy ride. There's forms, and there's a wait. I have health insurance, and I don't take a trip to the doctor's office like it's the local candy shop. Why would the poor, who feel the impact of a co-pay even more than I do?
- DrStalker 13y ago
  In Australia you can go in to emergency for anything, but you'll be waiting until there's nothing more urgent in front of you. If you are triaged as having a trivial condition and you insist on a doctor instead of the triage nurses advice you're in for a looooong wait. You're spot on about doctor visits not being fun. We also have free GP access and people will see a doctor if they have a reason but most people would rather stay home and rest than go out to the Doctor's just because they have a sniffle.
- webXL 13y ago
  My wife has had a couple mysterious illnesses that sent her to the ER. She saw a doctor within a couple hours. In both instances, there wasn't any life threatening issue. Granted the ER was pretty empty, but waiting a few more hours rather than weeks wouldn't have been a big deal. Copays aren't that big of a deal when you're in extreme pain. Ours was $100 per ER trip. Surely that would dissuade people with ear aches. Had it been a 20% coinsurance charge, then we probably would have tried urgent care first, or waited longer. But you can see how having insurance (or a certain type of insurance) can affect your behavior, in a way that's not so predictable. Many policy makers were surprised by the results of the Oregon Medicare Study as are many people learning about moral hazard for the first time. It's counter-intuitive.
GFischer 13y ago
I can't believe how incredibly bad healthcare is in the United States, as exemplified by your comments. I live in a country FAR less wealthy than the U.S. (Uruguay), yet basic healthcare here must sound like a science fiction future for the average American. U$ 50/month gives me access to a doctor that goes TO MY HOUSE in hours in case of ilness (including something like a flu, ear ache or whatever), or I can go to a clinic of said private emergency service, and get a doctor in minutes (yes, they're the least trained and paid doctors, but every single one has at least 7 years of university training). Every single freaking Uruguayan can be treated for free, and most have access to decent hospital services. Yes, there are some big downsides - getting an operation scheduled takes months, and if you don't have money, quality of life stuff is practically ignored, but not a single Uruguayan has gotten bankrupt due to a severe or life threatening condition, you get stuff up to and including cancer and HIV treatments for free. And you wouldn't believe how cheap the very best health coverage is, I'm paying for the 2nd best one.. U$ 150/month. If you have a difficult operation or strange disease, there's no place like the U.S., but for everyday healthcare the U.S. sounds like a Medieval country.

by webXL 13y ago

d23 13y ago

> So why would a poor person wait days or weeks to see a doctor then they can go down to an emergency room and see one in hours? Because if you don't have a life threatening condition, you're not going to see a doctor in "hours" in the emergency room. You're going to be triage'd to the lowest possible slot, and it's my understanding that if they believe you can just be sent on your way, they'll do that. You can't go in for an ear ache. > Moreover, if you are being forced to pay for health insurance, you are more likely not less likely to seek treatment since you will rationally think "well I am paying for it so I might as well use it." The idea that making people buy insurance will reduce overall healthcare costs has always been an insane one. First of all, there are plenty of respected folks who don't think that's "insane". Presumably more respected than "John" from the comments section. But regardless, that's what co-pays and deductibles are for. Let's also not forget that going to the doctor is still not a joy ride. There's forms, and there's a wait. I have health insurance, and I don't take a trip to the doctor's office like it's the local candy shop. Why would the poor, who feel the impact of a co-pay even more than I do?

DrStalker 13y ago
In Australia you can go in to emergency for anything, but you'll be waiting until there's nothing more urgent in front of you. If you are triaged as having a trivial condition and you insist on a doctor instead of the triage nurses advice you're in for a looooong wait. You're spot on about doctor visits not being fun. We also have free GP access and people will see a doctor if they have a reason but most people would rather stay home and rest than go out to the Doctor's just because they have a sniffle.
webXL 13y ago
My wife has had a couple mysterious illnesses that sent her to the ER. She saw a doctor within a couple hours. In both instances, there wasn't any life threatening issue. Granted the ER was pretty empty, but waiting a few more hours rather than weeks wouldn't have been a big deal. Copays aren't that big of a deal when you're in extreme pain. Ours was $100 per ER trip. Surely that would dissuade people with ear aches. Had it been a 20% coinsurance charge, then we probably would have tried urgent care first, or waited longer. But you can see how having insurance (or a certain type of insurance) can affect your behavior, in a way that's not so predictable. Many policy makers were surprised by the results of the Oregon Medicare Study as are many people learning about moral hazard for the first time. It's counter-intuitive.

GFischer 13y ago

I can't believe how incredibly bad healthcare is in the United States, as exemplified by your comments. I live in a country FAR less wealthy than the U.S. (Uruguay), yet basic healthcare here must sound like a science fiction future for the average American. U$ 50/month gives me access to a doctor that goes TO MY HOUSE in hours in case of ilness (including something like a flu, ear ache or whatever), or I can go to a clinic of said private emergency service, and get a doctor in minutes (yes, they're the least trained and paid doctors, but every single one has at least 7 years of university training). Every single freaking Uruguayan can be treated for free, and most have access to decent hospital services. Yes, there are some big downsides - getting an operation scheduled takes months, and if you don't have money, quality of life stuff is practically ignored, but not a single Uruguayan has gotten bankrupt due to a severe or life threatening condition, you get stuff up to and including cancer and HIV treatments for free. And you wouldn't believe how cheap the very best health coverage is, I'm paying for the 2nd best one.. U$ 150/month. If you have a difficult operation or strange disease, there's no place like the U.S., but for everyday healthcare the U.S. sounds like a Medieval country.