Drudge Retort: The Other Side of the News
Wednesday, February 26, 2014

"If they really want to get serious about lowering the cost of health care in this country, they would revisit another federal statute that has been there for a long time," Georgia Gov. Nathan Deal (R) said at a University of Georgia political science alumni gathering. "It came as a result of bad facts, and we have a saying that bad facts make bad law." The Emergency Medical Treatment and Labor Act is a 1986 law that requires hospitals to provide emergency health care treatment to anyone who needs it, regardless of citizenship or their ability to pay. It's provided life-saving care to countless people, but it's also strained hospital resources and turned emergency rooms into the first stop, instead of a last resort, for some.

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tonyroma

 

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This is an important topic for Deal, given that many hospitals in rural Georgia are caught in the financial pinch caused by the governor's refusal to expand Medicaid rolls, and the Affordable Care Act's reduction of federal cash for indigent care.

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Uninsured Georgians in rural parts of the state have shown up for medical care at emergency rooms that can't turn them away. The hospitals provide care, as required by law, but the financial strain ultimately proves to be too great a burden for some facilities.

Deal's solution isn't to extend coverage to struggling families, thereby creating paying health care consumers for the hospitals; Deal's solution is to make it easier for the hospitals to deny care to the struggling families.

Well, if you expand access to insurance and guarantee easy access to preventive care, unnecessary visits to the emergency room would go down. Too bad Deal opposes expanded access to insurance and guaranteeing easy access to preventive care.

To be sure, I should emphasize that as a matter of hospital financing, Deal's argument is not without merit – if medical facilities were able to simply deny care to the uninsured, those hospitals would definitely save lots of money.

But on the other hand, people would die from treatable ailments, paying with their life because they had the nerve to be poor. -- Steve Benen
www.msnbc.com


Well, someone has finally done it. They called for slamming the ER doors to those who don't have the money to pay for healthcare services even after the federal government has made these same taxpayer's dollars available to pay for care for millions of people currently bankrupting our broken system.

When I can't believe the GOP can get anymore 'me-centric' they up the ante and break new ground in chutzpah and callousness - at least until tomorrow.

#1 | Posted by tonyroma at 2014-02-26 01:28 PM | Reply | Flag: | Newsworthy 1

Gov Deal said he wants to limit access to ERs for "non emergency situations".

what does that mean? I don't know but I have to assume it doesn't mean cutting off the ER for folks in an actual emergency.

If this were to lead to more deaths as a result of denying medical care, then it's a bad idea and it would go against the purpose of the EMLA act and what it serves to accomplish.

#2 | Posted by eberly at 2014-02-26 01:36 PM | Reply | Flag:

So who decides what is and what is not an emergency? How can they determine that without examining the patient?

#3 | Posted by danni at 2014-02-26 01:41 PM | Reply | Flag: | Newsworthy 1

#2

Legislative supporters in the 1980s cited cases of pregnant women being turned away from emergency rooms because they couldn't pay. Deal, who long served on a key House health panel, said lawmakers can build in protections for pregnant women and others while tightening access to ERs in other ways. Said the governor: "I think we should be able in this passage of time to figure out ways to deal with those situations but not have the excessive costs associated with unnecessary visits to the emergency room."

To me it sounds like Deal wants the ER personnel to make judgment calls as to whether accept patients as emergencies or to send them packing unless the severity of their symptoms can be discerned by a simple examination.

Regardless, its one of the most asinine arguments to hit the public airwaves in some time and only underscores to what extent some people will go to undermine the ACA's attempt to provide a solution to the very problem being addressed without throwing the patient's concerns out the window. Rural hospitals are hemorrhaging money and being forced to close making access to healthcare even more difficult than it already is. And the majority of these hospitals tend to serve many more poorer whites than they do blacks or Hispanics, so race shouldn't be a factor in the decision-making process.

It's simply one party's anti-life Waterloo to champion the return of poor people being denied care at every level if they don't have the money to pay for healthcare, regardless of how it's framed in the debate. And it's a sad reflection on our society if this type of movement takes hold.

#4 | Posted by tonyroma at 2014-02-26 01:50 PM | Reply | Flag:

Interesting paradox. The federal government determined what is or is not coverage that everyone requires (pregnancy coverage for men, for instance)..and they are going to determine what medical conditions will be "worth treating" (the 'death panels')..I presume that if the all-knowing politicians could decide those, they would figure out what constitutes an emergency.

All that aside, it seems to me that this is a law that could have been folded into the ACA and trimmed in the process. If everyone is covered, it's moot and barely needs to exist. If everyone isn't covered then we have to ask ourselves why not, given the warm sunny goodness of Obamacare? Are they just saving money by not paying for insurance, forking over a pittance in annual fees, and going to the emergency room instead?

#5 | Posted by MUSTANG at 2014-02-26 01:56 PM | Reply | Flag:

Are they just saving money by not paying for insurance, forking over a pittance in annual fees, and going to the emergency room instead?

The majority of people affected by this would be covered under the expanded Medicaid if the GOP governors take the lead of Jan Brewer and others and realize the money coming from the federal government means the literal difference between life and death for both rural hospitals and millions of uninsured poor people.

I have always understood that as long as EMLA remains on the books, some mechanism like ACA HAS to be put in place to force people to be responsible for their right to seek care in the ER as befits their financial ability to pay for it while protecting taxpayers from providing primary care for the uninsured in the most expensive manner possible.

#6 | Posted by tonyroma at 2014-02-26 02:07 PM | Reply | Flag:

keep in mind that ERs were already making determinations as to what was an emergency. They always have to make judgement calls on who to see before someone else.

Honestly, I thought the left was all concerned about folks with non-emergencies jamming ERs all over this country and how Obamacare was going to address that.

Folks who go without insurance weren't going to be going to the ER anymore for their sore throat.

wait....I guess not...they are still going to do that, huh?

whatever.....I laugh at the cheerleaders who believed ACA was going to address this problem.

Personally, just to piss off the cheerleaders, I'm going to SUPPORT this notion (it's really just a notion....a speech and nothing more).

#7 | Posted by eberly at 2014-02-26 02:15 PM | Reply | Flag:

"The majority of people affected by this would be covered under the expanded Medicaid"

link please.

Basically you have to prove that rural hospitals in states that did expand Medicaid won't have the same ER problems as in Georgia.

#8 | Posted by eberly at 2014-02-26 02:16 PM | Reply | Flag:

Har~Har~

EMTALA? Part of the COBRA act of 1985? You mean the one that came with a subsidy for hospitals (aka like the one in Georgia)? The same act that mandated employers continue health coverage after leaving employment?

Sounds like a commie socialist wealth spreader was president.

Who was president in 1986?

It's his fault!

#9 | Posted by ChiefTutMoses at 2014-02-26 02:29 PM | Reply | Flag:

I think the Repug plan is gradually leading to us digging a very deep hole in every city and directing the local poor to jump into it instead of asking for help.

#10 | Posted by BruceBanner at 2014-02-26 02:29 PM | Reply | Flag:

I can't believe that Deal a republican would criticize a Reagancare initiative.If he would allow Obamacare in GA he could really help people. GRADY HOSPITAL, the largest public hospital in Southeast has one of the best trauma/burn ER rooms in the country. If you intern there you can make it anywhere.

#11 | Posted by bigblackie at 2014-02-26 02:38 PM | Reply | Flag:

How about putting a free clinic outside the emergency room, so that anyone who has an ailment can go into the clinic, and if they are deemed to be an emergency, then they can go into the emergency room.

this would be a better use of all those billions wasted on INSURANCE!

If the government wants everyone to have Insurance, then they should simply issue it to them. Take the money out of the general fund and raise taxes. That is what Dems do, isn't it?

#12 | Posted by Marty at 2014-02-26 02:48 PM | Reply | Flag:

I don't see anybody criticizing the EMLA. I see a governor suggesting that the E in EMLA be accepted and that only emergency related visits being accepted....rather than non-emergency visits.

The other issue small rural communities face is the lack of an urgent care facility which will lead many folks, insured or not, to seek attention at the local ER as the clinics are closed and there isn't anything else.

That's not a right vs left nor a Medicaid expanded state issue.

It's just an issue of economics in small, rural communities.

#13 | Posted by eberly at 2014-02-26 03:05 PM | Reply | Flag:

I see Tony took off for the library to find some sort of substantiation for this assertion...

"The majority of people affected by this would be covered under the expanded Medicaid if the GOP governors take the lead of Jan Brewer and others and realize the money coming from the federal government means the literal difference between life and death for both rural hospitals and millions of uninsured poor people."

I'll check back

#14 | Posted by eberly at 2014-02-26 03:07 PM | Reply | Flag:

Who do you thin are the ER frequent flyers, Eberly?
I think it's the mentally ill drug/alcohol abusing/seeking population.

#15 | Posted by snoofy at 2014-02-26 03:12 PM | Reply | Flag:

I don't know Snoofy.

maybe you're right.

so?

#16 | Posted by eberly at 2014-02-26 03:13 PM | Reply | Flag:

Since Obamacare was enacted emergency room use has gone up, not down as predicted.

Once you give over the management of your healthcare services to the government (Obamacare) then there's no end to the regulation that will follow.

Regulating emergency room use is small potatoes and just the tip of the iceberg.

Since YOUR health is now a federal issue, everything you do will be regulated. Risky sex, fast food consumption, smoking, drug use, exercise, stress at work, stress at home, parenting, etc, etc, etc.

GET USED TO IT!

#17 | Posted by Huguenot at 2014-02-26 03:27 PM | Reply | Flag:

#14

Don't wait for me Ebs, I don't have the time right now to look up what I already know to be true. Google works on your computer too.

#18 | Posted by tonyroma at 2014-02-26 03:29 PM | Reply | Flag: | Funny: 1

Since Obamacare was enacted emergency room use has gone up, not down as predicted.

It's been online for all of 57 days and open enrollment hasn't been completed yet, but go ahead and know what you know as absolutely correct.

#19 | Posted by tonyroma at 2014-02-26 03:30 PM | Reply | Flag:

www.forbes.com

Emergency use has gone up because of Obamacare, not down.

#20 | Posted by Huguenot at 2014-02-26 03:34 PM | Reply | Flag:

So,
Why shouldn't they regulate emergency room use? You thought Obamacare was going to be a one way street? That would have been extremely foolish and naive if you did.

#21 | Posted by Huguenot at 2014-02-26 03:37 PM | Reply | Flag:

Ask most any doctor or nurse in an ER and they will tell you that the '1st stop' has put ER's in a strain of actually and efficiently giving out REAL emergency care because everyone from homeless to others without insurance are jamming the places for anything from the sniffles to any excuse which are not real emergencies at all... they know they cannot be turned away and try to use this as a method to get prescriptions that they do not need... the time to triage these deadbeats alone eats into staff time and the prevention on a timely basis of those are really needing emergency care..

#22 | Posted by drsoul at 2014-02-26 03:40 PM | Reply | Flag:

what's funny is that if this were a provision included in ACA, the same folks whining about this would be cheering to the heavens over it.

#23 | Posted by eberly at 2014-02-26 03:41 PM | Reply | Flag:

#21

That is for Oregon ONLY, and it also does not consider the wellness programs that will move patient care to wellness from treating sickness. Rome wasn't built in a day and no one said that every single positive change from ACA would manifest itself overnight after it was passed regardless of what detractors like you continue to insist.

No program attempting to shift such a tremendous part of our GDP can be accurately judged before it has been fully implemented, but I'm sure you'll keep trying.

#24 | Posted by tonyroma at 2014-02-26 03:42 PM | Reply | Flag:

www.kaiserhealthnews.org

Advocates of universal health coverage have long argued that better access to primary care will lead to a reduction in costly emergency room visits. But a new study conducted in Oregon has found the reverse is true. Researchers poring through hospital administrative records found that expansion of the Medicaid-funded Oregon Health Plan in 2008 led to a 40 percent increase in emergency department usage by people in the 15 months after they enrolled, according to a study released Thursday in the journal Science (Budnick, 1/2).

This doesn't address Tony's assertion that the majority of folks affected would be covered under the current Medicaid expansion under obamacare.

I can't find anything on that.

#25 | Posted by eberly at 2014-02-26 03:45 PM | Reply | Flag:

ER services for undocumented immigrants. That is where the moral rubber hits the road. Do you care more about saving lives or saving money?

#26 | Posted by moder8 at 2014-02-26 03:50 PM | Reply | Flag:

#21

That is for Oregon ONLY, and it also does not consider the wellness programs that will move patient care to wellness from treating sickness. Rome wasn't built in a day and no one said that every single positive change from ACA would manifest itself overnight after it was passed regardless of what detractors like you continue to insist.

No program attempting to shift such a tremendous part of our GDP can be accurately judged before it has been fully implemented, but I'm sure you'll keep trying.

#24 | Posted by tonyroma at 2014-02-26 03:42 PM | Reply | Flag:

LOL,
You missed my point all together. This is just the tip of the iceberg. EVERY aspect of YOUR health is now open to scrutiny. STARTING with your use of the emergency room.

#27 | Posted by Huguenot at 2014-02-26 03:51 PM | Reply | Flag:

Tony, obviously do you do have time to find it and you're trying right now, when you're not posting deflections.

It's simple logic that if you expand Medicaid that ER visits will increase. You have to consider who you're giving health coverage to before you believe otherwise. It's not the end of the world as the upside is that the ERs are being paid more often.

My point is that a rural hospital in Georgia and a rural hospital in a Medicaid expanded state are going to experience the same problems this article focuses on. Expanding Medicaid is not going to solve their problems, as you clearly believe.

#28 | Posted by eberly at 2014-02-26 03:51 PM | Reply | Flag:

what's funny is that if this were a provision included in ACA

The provisions in the ACA that cover this ARE the Medicaid expansion and the insurance mandate.

The entire point is that unless something is in place to compensate for care mandated by the EMTLA, taxpayers and providers will continue to fund the most expensive primary care patients can receive, not to mention the cost-shifting placed within ACA that pays providers for keeping their patients healthy instead of just treating them when they're sick.

Of course, the most important changes have to happen with those who use the ERs as their personal clinics and that will take time and education as well as a shifting of resources to provide greater access to clinics and primary care facilities.

#29 | Posted by tonyroma at 2014-02-26 03:51 PM | Reply | Flag:

"See a governor suggesting that the E in EMLA be accepted and that only emergency related visits being accepted"

Well that makes sense. Especially from an ahat who campaigns on the notion the "gubment" should stay out of the patient/provider relationship.

Anyway, I am amused by the usual's here who seem to not know that this mandate is also dictated by the state "gubment".

#30 | Posted by ChiefTutMoses at 2014-02-26 03:52 PM | Reply | Flag:

My point is that a rural hospital in Georgia and a rural hospital in a Medicaid expanded state are going to experience the same problems this article focuses on.

Eb, the problem is that the hospitals in GA AREN'T being paid for the care they provide and the hospitals in Medicaid-expanded states ARE because they're treating INSURED patients, not uninsureds.

If you can't understand the entirety of the problem, then why ask for details?

PS: I am not your teacher. If you want to learn something, look it up yourself.

#31 | Posted by tonyroma at 2014-02-26 03:55 PM | Reply | Flag:

^
You libs are the ones who wanted your healthcare regulated.
Get used to it.

#32 | Posted by Huguenot at 2014-02-26 03:55 PM | Reply | Flag:

"Its simple logic that if you expand Medicaid that ER visits will increase"

Yes, because everyone knows waiting 5 hours for a preventative doctor visit is more fun than spending an hour going to a PCP that accepts Medicaid

#33 | Posted by ChiefTutMoses at 2014-02-26 03:55 PM | Reply | Flag:

"Since Obamacare was enacted emergency room use has gone up, not down as predicted."

And it's not like there wasn't evidence to show this would happen. Studies of the Massachusetts plan showed ER visits went up after implementation. When compared to neighboring states without "Romneycare" there was no difference in ER visit rates except that ER visits that resulted in admission went up at a much higher rate in Mass.

To dispute Tony's point about Medicaid expansion, a study of expanded Medicaid in Oregon show not only increased ER visits, but increased primary care visits; more healthcare usage across the board.

Granted, the length of those studies is relatively short; over time those stats could change I suppose...

#34 | Posted by jwil72 at 2014-02-26 03:56 PM | Reply | Flag:

EVERY aspect of YOUR health is now open to scrutiny. STARTING with your use of the emergency room.

And when hasn't this been the case for anyone carrying health insurance?

Every aspect of anyone's health has ALWAYS been open to scrutiny by the companies that write the checks for coverage! When has there ever been a blank check without any input into what and why healthcare spending occurs?

#35 | Posted by tonyroma at 2014-02-26 03:59 PM | Reply | Flag:

Again,
It doesn't matter if ER visits went up or down. It's now within the scope of government scrutiny. Just like every other aspect of one's personal healthcare costs are.

#36 | Posted by Huguenot at 2014-02-26 04:02 PM | Reply | Flag:

EVERY aspect of YOUR health is now open to scrutiny. STARTING with your use of the emergency room.

And when hasn't this been the case for anyone carrying health insurance?

Every aspect of anyone's health has ALWAYS been open to scrutiny by the companies that write the checks for coverage! When has there ever been a blank check without any input into what and why healthcare spending occurs?

#35 | Posted by tonyroma at 2014-02-26 03:59 PM | Reply | Flag:

Look up compulsory.

#37 | Posted by Huguenot at 2014-02-26 04:03 PM | Reply | Flag:

Granted, the length of those studies is relatively short; over time those stats could change I suppose...

It's usually not a good idea to declare the game over in the first period.

Of course there's going to be increases in visits by those newly brought into the healthcare system. Hasn't anyone heard of "pent-up demand"? Many people put off care until it became absolutely acute, but now they may seek treatment sooner while still not having a PCP or clinic that they can visit instead of the ER. Culture doesn't change overnight, but logic hopefully points in improvements in efficiency over time, but we have to give it time before reaching conclusions.

#38 | Posted by tonyroma at 2014-02-26 04:04 PM | Reply | Flag:

#37

With what insurance company is not predetermination of benefits not "compulsory"?

Do you have any idea what you're talking about?

#39 | Posted by tonyroma at 2014-02-26 04:06 PM | Reply | Flag:

Rome wasn't built in a day and no one said that every single positive change from ACA would manifest itself overnight after it was passed regardless of what detractors like you continue to insist.
No program attempting to shift such a tremendous part of our GDP can be accurately judged before it has been fully implemented, but I'm sure you'll keep trying.
#24 | POSTED BY TONYROMA

I agree Tony, but its certainly doesn't look good......

Will this be like the GW debates, it can never be proven not work, until after its engrained in our economy, and no way to get rid of it?

You see I don't think Medicare, and SS are bad things, in moderation. But today we are going more and more in debt, and its not good long term. Long term we can't afford what we are doing.

Do you believe ObamaCare will really save us money? A better question, has any government program ever saved us money? IMO, the larger the program the more the cost overrun and far exceeding their original purpose, yet not even ameliorating that purpose (insurance for the uninsured).

ER services for undocumented immigrants. That is where the moral rubber hits the road. Do you care more about saving lives or saving money?
#26 | POSTED BY MODER8

This is a good question, and not a good answer, if the use of ER facilities by undocumented immigrants was small, I would venture to say saving lives is more important.

But... we don't have good immigration control and its costs are a burden on the system...

The Center for Immigration Studies estimates that the current cost of treating uninsured immigrants who entered this country illegally at all levels of government to be $4.3 billion a year, primarily at emergency rooms and free clinics. This doesn't take into account the billions being absorbed by in-patient care delivered by hospitals.
www.moneynews.com

To you Moder8, should US citizens take priority over illegal immigrants in the waiting room of the ER? Given the same ailment of course....

#40 | Posted by AndreaMackris at 2014-02-26 04:07 PM | Reply | Flag:

"But... we don't have good immigration control and its costs are a burden on the system..."

"The inspector general's report said ICE submitted notices totaling fines of more than $52.7 million from 2009 through 2012, but ended up charging only $31.2 million -- for a 40 percent break for businesses.
It still marks a huge increase over the Bush administration, which imposed just $1.5 million in fines from 2003-2008"

www.washingtontimes.com

#41 | Posted by danni at 2014-02-26 04:11 PM | Reply | Flag:

#37

With what insurance company is not predetermination of benefits not "compulsory"?

Do you have any idea what you're talking about?

#39 | Posted by tonyroma at 2014-02-26 04:06 PM | Reply | Flag:

Here's how it goes:
When we had a quasi free market offering health insurance you were free to choose the plan that most suited your needs. It was a contract btwn you and your insurance company. You entered into that contract voluntarily. If you didn't like what the insurance company was selling you could look elsewhere.

Now, Obamacare is compulsory. There are over 2000 pages of Obamacare regulations now and as you say we need much, much more.

So, why shouldn't they regulate emergency use???

#42 | Posted by Huguenot at 2014-02-26 04:16 PM | Reply | Flag:

Why shouldn't they regulate emergency room use Tony?
(for the third time)

#43 | Posted by Huguenot at 2014-02-26 04:25 PM | Reply | Flag:

Now, Obamacare is compulsory. There are over 2000 pages of Obamacare regulations now and as you say we need much, much more.

Putting words in my mouth? Where have I advocated for more regulations as it regards ACA? The EMTLA is LAW, and it was signed into law by Ronald Reagan, and since that day the costs for uninsured people seeking medical care in American ERs has been paid for by taxpayers, insurance companies and healthcare providers alike. Which part of this do you find more efficient than providing a mechanism for millions to be insured and having these costs paid for instead of being cost-shifted onto insureds paying higher premiums for those who freeload off the current system?

#44 | Posted by tonyroma at 2014-02-26 04:30 PM | Reply | Flag:

Why shouldn't they regulate emergency room use Tony?

Who is "they"? Insurers? Hospitals? State governments? The federal government?

And how do you propose this "regulation" occurs? Let the free market decide who deserves care? Do you realize that is the reason for the law in the first place because business is in business for profit, not to save the random dying poor person who doesn't have insurance?

The answer is to provide insurance to the uninsured, not carve out regulations for EMTLA, but I'm glad we have you on the record as an anti-life supporter.

Only the selfish (or myopic) fail to see where the denial of healthcare doesn't lead to savings, it leads to greater expenditures when inexpensive problems become catastrophic, massively expensive ones because access to healthcare is denied as a "cost saving" measure.

#45 | Posted by tonyroma at 2014-02-26 04:36 PM | Reply | Flag:

Putting words in my mouth? Where have I advocated for more regulations as it regards ACA? The EMTLA is LAW, and it was signed into law by Ronald Reagan, and since that day the costs for uninsured people seeking medical care in American ERs has been paid for by taxpayers, insurance companies and healthcare providers alike. Which part of this do you find more efficient than providing a mechanism for millions to be insured and having these costs paid for instead of being cost-shifted onto insureds paying higher premiums for those who freeload off the current system?

#44 | Posted by tonyroma at 2014-02-26 04:30 PM | Reply | Flag:

You said it here:

Rome wasn't built in a day

#24 | Posted by tonyroma at 2014-02-26 03:42 PM | Reply | Flag:

Now, for the 4th time. WHY SHOULDN'T THEY REGULATE EMERGENCY ROOM USE?

#46 | Posted by Huguenot at 2014-02-26 04:39 PM | Reply | Flag:

#46

Answer 45. And the quote has NOTHING to do with MORE regulation. It addresses that it's too soon to draw conclusions.

Why do you insist on being so intentionally obtuse?

#47 | Posted by tonyroma at 2014-02-26 04:48 PM | Reply | Flag:

"Eb, the problem is that the hospitals in GA AREN'T being paid for the care they provide and the hospitals in Medicaid-expanded states ARE because they're treating INSURED patients, not uninsured"

Gee, I understand that, Professor ACA.

My point is that it's not going to be enough to make a difference.

IOW, those rural GA hospitals would be in the same situation regardless. Yes, they would see some insured patients vs uninsured under Medicaid expansion.....perhaps.

your claim that "a majority of them....." is something you pulled from your nether region and you can't substantiate it at all.

And you know it.....

#48 | Posted by eberly at 2014-02-26 04:48 PM | Reply | Flag:

"Yes, because everyone knows waiting 5 hours for a preventative doctor visit is more fun than spending an hour going to a PCP that accepts Medicaid"

I don't know exactly why poor insured people go to the ER at a greater rate than non-poor insured people.

But they do. But some folks still don't understand that even with proof in front of their eyes.

#49 | Posted by eberly at 2014-02-26 04:50 PM | Reply | Flag:

"Only the selfish (or myopic) fail to see where the denial of healthcare doesn't lead to savings"

depends on the healthcare.

the healthcare you're being paid for or the healthcare you're NOT being paid for?

#50 | Posted by eberly at 2014-02-26 04:52 PM | Reply | Flag:

#46

Answer 45. And the quote has NOTHING to do with MORE regulation. It addresses that it's too soon to draw conclusions.

Why do you insist on being so intentionally obtuse?

#47 | Posted by tonyroma at 2014-02-26 04:48 PM | Reply | Flag:

45 doesn't say anything about why emergency room use shouldn't be regulated. In fact you seem to be saying that primary care needs to be better regulated in order to reduce emergency room use. Is that correct?
So you seem to be advocating emergency room use regulation in a more indirect way.

#51 | Posted by Huguenot at 2014-02-26 04:55 PM | Reply | Flag:

#51

For the last time, WHO the eff do you want to regulate it?!!!!

You're against government interference, so do you want government to set the standards for ER care?

Or do you want to return to pre-EMTLA days and let each provider make the decisions?

And on what planet is this not letting others decide about the health of the person seeking care which you claim is a fault of the ACA?

Explain it to me Hugunot!

#52 | Posted by tonyroma at 2014-02-26 05:00 PM | Reply | Flag:

I never was in favor of Obamacare.
Before Obamacare, when you contracted for medical insurance you had a contract saying what the insurance provider would cover and what they would not. You voluntarily signed the contract agreeing to the terms. Others did not make the medical decisions for you, you agreed to the predetermined medical decisions in the contract. You were the one determining what level of care you were willing to accept. You made that decision not "others".

Just simply answer the question. It's so easy, just finish the sentence.
Emergency room use should not be regulated because....

#53 | Posted by Huguenot at 2014-02-26 05:12 PM | Reply | Flag:

I cannot answer the question until you inform me of who you want to regulate ER care.

The answers are different depending upon which group is in charge of deciding which uninsured persons will or won't receive care in the ER.

What is it about this simple request that evades your ability to comprehend it's importance in providing you the requisite answer?

Define your terms of "regulation" and tell me "who" is in charge of determining just "what care" is being regulated as it regards the uninsured.

#54 | Posted by tonyroma at 2014-02-26 05:48 PM | Reply | Flag:

You were the one determining what level of care you were willing to accept. You made that decision not "others".

Are you really this dense or do you only do this on the internet?

In what universe is choosing a plan offered by insurance companies - IF they accept you - a REAL CHOICE? What choice did anyone have if the insurance companies denied coverage due to pre-existing conditions or refused en-mass to pay for life-saving drugs or to authorize payment for specified treatments?

You have no idea what "choice" really means. The only thing that ACA has done is to regulate the minimal coverage that is allowed to be sold because the different groups involved reached consensus on a baseline that best served the goals of health insurance in the first place.

#55 | Posted by tonyroma at 2014-02-26 06:37 PM | Reply | Flag:

Before Obamacare, when you contracted for medical insurance you had a contract saying what the insurance provider would cover and what they would not. You voluntarily signed the contract agreeing to the terms. Others did not make the medical decisions for you, you agreed to the predetermined medical decisions in the contract.

That's the same after Obamacare, silly.

#56 | Posted by snoofy at 2014-02-26 10:38 PM | Reply | Flag:

Rome wasn't built in a day and no one said that every single positive change from ACA would manifest itself overnight after it was passed regardless of what detractors like you continue to insist.

No program attempting to shift such a tremendous part of our GDP can be accurately judged before it has been fully implemented, but I'm sure you'll keep trying.

#24 | Posted by tonyroma at 2014-02-26 03:42 PM | Reply

That's the fall back position for every idiot that supported this disastrous piece of legislation and are still attempting to rationalize it. The same people that mother nature is kicking in the face that believed in man generated "global warming". I'm just fascinated about how the brains of these kind of folks operate.

#57 | Posted by matsop at 2014-02-26 11:04 PM | Reply | Flag:

I don't know exactly why poor insured people go to the ER at a greater rate than non-poor insured people.

But they do. But some folks still don't understand that even with proof in front of their eyes.

#49 | Posted by eberly at 2014-02-26 04:50 PM | Reply

Probably because they aren't very smart and aren't very responsible---and that's probably why they're poor. Also, it's easier for them to wander into the ER (when it's convenient for them)instead of making an appointment at a PCP when it might inconvenience them.

#58 | Posted by matsop at 2014-02-26 11:11 PM | Reply | Flag:

Also, it's easier for them to wander into the ER (when it's convenient for them)instead of making an appointment at a PCP when it might inconvenience them.
#58 | Posted by matsop

You're close with that one.
The ambulance will take you to the ER but not to a doctor's office.

#59 | Posted by snoofy at 2014-02-27 02:38 AM | Reply | Flag:

Probably because they aren't very smart and aren't very responsible---and that's probably why they're poor.
#58 | Posted by matsop

Don't be afraid to mention how much you hate those stupid, irresponsible poor people.

#60 | Posted by snoofy at 2014-02-27 02:45 AM | Reply | Flag:

Probably because they aren't very smart and aren't very responsible---and that's probably why they're poor.
#58 | Posted by matsop

Matsop pretty much speaks for the RW.

#61 | Posted by BruceBanner at 2014-02-27 02:50 AM | Reply | Flag:

As with so many other things, this is a people problem. You could give a non-income earner the best healthcare plan out there, but it's going to be useless if they don't know how or care how to use it. Emergency rooms are the most rational response to those people who wouldn't otherwise know how to find a doctor or make an appointment, even if it was free. And let's be honest, I'm in and out of a traditional doctors appointment in a fraction of the time it takes to see a doctor at the ER.

#62 | Posted by madbomber at 2014-02-27 08:46 AM | Reply | Flag:

"The ambulance will take you to the ER but not to a doctor's office."

I assume its still the case. but when I was in college in the early 2000s, Medicaid not only paid for your healthcare, but also covered the cab fare to and from the clinic.

#63 | Posted by madbomber at 2014-02-27 08:47 AM | Reply | Flag:

"The ambulance will take you to the ER but not to a doctor's office."

Snoofy, the crux of this issue is NON-EMERGENCIES and the expectation and cost of treating them in an emergency room.

Not actual emergencies.

maybe some people can get past the words of the title and actually read what's being discussed in the article.

#64 | Posted by eberly at 2014-02-27 08:50 AM | Reply | Flag:

Wasn't ACA going to fix that? They went to the ER because they couldn't be turned away even though they had no insurance?

#65 | Posted by wisgod at 2014-02-27 08:58 AM | Reply | Flag:

Deal's solution isn't to extend coverage to struggling families, thereby creating paying health care consumers for the hospitals; Deal's solution is to make it easier for the hospitals to deny care to the struggling families.

It seems obvious that the hospitals are beginning to pressure the governor to do something about indigent care. Either the federal gov't pays, the state gov't pays or the hospitals will go broke caring for the indigent.

Deal will cave and accept federal money to expand Medicaid as will the other republican governor holdouts.

#66 | Posted by FedUpWithPols at 2014-02-27 09:18 AM | Reply | Flag:

Why do the GOP hate the poor and the sick and the non-white?

#67 | Posted by e1g1 at 2014-02-27 09:46 AM | Reply | Flag:

#64 | Posted by eberly

So, who gets to decide what is or isn't an emergency? A broken finger is hardly an emergency, but what about a broken wrist, or a concussion, or an ear infection? Many things that do not appear to be an emergency can develop into an emergency in a short period of time without treatment. Should people be told to come back when it gets worse?

.

#68 | Posted by Dave at 2014-02-27 09:46 AM | Reply | Flag:

Whole argument is so needless. Whole issue could be solved with single payer.

#69 | Posted by zeropointnrg at 2014-02-27 10:18 AM | Reply | Flag:

"Whole argument is so needless. Whole issue could be solved with single payer."

Actually, it wouldn't. There are still human factors at play. Unless you can demonstrate that those folks who go to emergency rooms now wouldn't under a single payer system.

#70 | Posted by madbomber at 2014-02-27 10:33 AM | Reply | Flag:

Hospitals would be getting paid either way when they went though, if everyone was universally covered. And were those hospitals smart, they would then start admitting people to the section of hospital they belong in, instead of ER if they came over sniffles. Which might mean designating their own 24 hour non-emergency urgent care section. I don't know why that's not SOP as it is. But our entire current for-profit model is so screwed up it's unreal anyway.

#71 | Posted by zeropointnrg at 2014-02-27 11:07 AM | Reply | Flag:

But our entire current for-profit model is so screwed up it's unreal anyway.

#71 | POSTED BY ZEROPOINTNRG AT 2014-02-27 11:07 AM | FLAG: Even non-profit hospitals could not afford to do that which you state.

#72 | Posted by MSgt at 2014-02-27 12:40 PM | Reply | Flag:

EMTALA should only apply to emergent cases. And yes, the determination of emergent does and should fall under the perview of the attending MD. Mothers waiting all week so they can take little Johnny to the ED after 5pm on Friday for treatment so they don't have to pay for the doctor's visit has got to stop. Frequent flyers drug seeking has got to stop. Homeless walking into the ED with "mysterious ailments" to get out of the cold for a day or two has got to stop. Reimbursing hospitals for "theoretical" instead of actual costs of treatment has got to stop. And for those who think that expanding medicaid will solve the problem, the paitients we're talking about won't pay that either. Even when they have plenty of money to do so.

#73 | Posted by bogey1355 at 2014-02-27 12:59 PM | Reply | Flag:

"So, who gets to decide what is or isn't an emergency?"

medical professionals who have to make decisions daily on who to see first in ERs.

#74 | Posted by eberly at 2014-02-27 01:31 PM | Reply | Flag:

"Should people be told to come back when it gets worse?"

Doctors and nurses do that all the time. At the very least, you can tell someone without an emergency to go to the clinic the next day.

#75 | Posted by eberly at 2014-02-27 01:32 PM | Reply | Flag:

"And were those hospitals smart, they would then start admitting people to the section of hospital they belong in, instead of ER if they came over sniffles"

you mean have hospitals provide care usually provided in a doctor's clinic?

that would be the equivalent of an urgent care or immediate care clinic.

which these small, rural towns can't justify having....which is why this is being discussed.

It's not all hospitals...it's just the small, rural hospitals that this is a problem with.

You don't know a thing about how to run a hospital or a clinic especially in a small, rural town.

Jesus Christ, people.

#76 | Posted by eberly at 2014-02-27 01:35 PM | Reply | Flag:

"Why do the GOP hate the poor and the sick and the non-white?"

they smell and they have no money.

who doesn't hate them?

#77 | Posted by eberly at 2014-02-27 01:36 PM | Reply | Flag:

Maybe the problem is small rural towns.

#78 | Posted by snoofy at 2014-02-27 02:06 PM | Reply | Flag:

Snoofy,

The other issue small rural communities face is the lack of an urgent care facility which will lead many folks, insured or not, to seek attention at the local ER as the clinics are closed and there isn't anything else.

That's not a right vs left nor a Medicaid expanded state issue.

It's just an issue of economics in small, rural communities.

#13 | Posted by eberly

#79 | Posted by eberly at 2014-02-27 02:10 PM | Reply | Flag:

If you want to cut costs, you cut reimbursement (which in turn cuts quality and quantity of care). If you want everyone to have the best healthcare money can buy, it costs money. While a single payer system funded by taxing the producers more and more sounds good, it will likely just lead to a secondary private pay system for those who can afford it. For those who can't, they will just have to wait a long time for sub-standard service. And don't forget that with less money to go around, there will be less and less regulators such as JCAHO because at $1,000,000, administrators are already putting them on the chopping block. And rightfully so. Like unions, they have outlived thier usefulness and corrupted the healthcare system.

#80 | Posted by bogey1355 at 2014-02-27 04:38 PM | Reply | Flag:

Personally, just to piss off the cheerleaders, I'm going to SUPPORT this notion (it's really just a notion....a speech and nothing more).

#7 | Posted by eberly

oh gee thanks. Now I don't have to read the article to know that I will be against it.

I appreciate you saving me all that time.

Now I can go harass those idiots over on that thread where they think that the vote to unionize that VW plant in Tennessee was a fair election.

#81 | Posted by donnerboy at 2014-02-27 04:38 PM | Reply | Flag:

they think that the vote to unionize that VW plant in Tennessee was a fair election.

What was unfair about it? *serious question*

#82 | Posted by JeffJ at 2014-02-27 04:43 PM | Reply | Flag:

What was unfair about it? *serious question*

#82 | Posted by JeffJ

there is a thread on it.

www.drudge.com

#83 | Posted by donnerboy at 2014-02-27 07:07 PM | Reply | Flag:

#83

Thank you.

I'll check it out.....

I don't see anything in the linked thread you provided that substantiates your claim.

I am not trying to be difficult, I just don't see what your point of contention is.

#84 | Posted by JeffJ at 2014-02-27 07:39 PM | Reply | Flag:

"While a single payer system funded by taxing the producers more and more sounds good, it will likely just lead to a secondary private pay system for those who can afford it. For those who can't, they will just have to wait a long time for sub-standard service."

Which is why most state provided healthcare has very specific rules regarding treatment. In Canada, if you accept the state plan, you can't treat private patients. Because it violates the egalitarian principles of the program. Even if people are dying because of those principles. Check this out:

"The system, providing Canadians with free doctor's services that are paid for by taxes, has generally been supported by the public, and is broadly identified with the Canadian national character.

But in recent years, patients have been forced to wait longer for diagnostic tests and elective surgery, while the wealthy and well connected either seek care in the United States or use influence to jump ahead on waiting lists.

The court ruled that the waiting lists had become so long that they violated patients' "liberty, safety and security" under the Quebec charter, which covers about one-quarter of Canada's population.

"The evidence in this case shows that delays in the public health care system are widespread and that in some serious cases, patients die as a result of waiting lists for public health care," the Supreme Court ruled. "In sum, the prohibition on obtaining private health insurance is not constitutional where the public system fails to deliver reasonable services.

...

Dr. Chaoulli, who was born in France, has long called for Canada to adopt a two-tier, public-private health care system similar to those of France, Germany and Switzerland. Supporters of the current system, however, have argued that a two-tier plan will draw physicians away from the public system, which is already short of doctors, thus further lengthening waiting lists."

You can imagine how that would go over in the US. If doctors were allowed to favor paying patients over those who expected free treatment.

#85 | Posted by madbomber at 2014-02-27 11:29 PM | Reply | Flag:

But wait! There's more:

"Accepting money from patients for operations they would otherwise receive free of charge in a public hospital is technically prohibited in this country, even in cases where patients would wait months or even years in discomfort before receiving treatment.

But no one is about to arrest Dr. Brian Day, who is president and medical director of the center, or any of the 120 doctors who work there. Public hospitals are sending him growing numbers of patients they are too busy to treat, and his center is advertising that patients do not have to wait to replace their aching knees.

The country's publicly financed health insurance system -- frequently described as the third rail of its political system and a core value of its national identity -- is gradually breaking down. Private clinics are opening around the country by an estimated one a week, and private insurance companies are about to find a gold mine.

Dr. Day, for instance, is planning to open more private hospitals, first in Toronto and Ottawa, then in Montreal, Calgary and Edmonton. Ontario provincial officials are already threatening stiff fines. Dr. Day says he is eager to see them in court.

"We've taken the position that the law is illegal," Dr. Day, 59, says. "This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years."

"www.nytimes.com"

#86 | Posted by madbomber at 2014-02-27 11:32 PM | Reply | Flag:

"Well, someone has finally done it. They called for slamming the ER doors to those who don't have the money to pay for healthcare services even after the federal government has made these same taxpayer's dollars available to pay for care for millions of people currently bankrupting our broken system."

And Obamacare solves that problem? Look at the result when people start seeing their tax refunds stolen if they do not have Obamacare. They will revolt at the voting booth and this governor's suggestion might well become the norm.
The more things change, the more they stay the same.

#87 | Posted by Diablo at 2014-02-28 04:26 AM | Reply | Flag:

Triage is an important part of the ER and if it is decided, by an ER doctor that his time is more valuable to other patients that actually need services then so be it. I can see pros and cons in regulating ER visits.

The main issue is education. If people understand they have coverage, since it is now required, and what that coverage entails, ER usage should drop. If it doesn't then definitely there needs to be some type of regulation on what can and can't be considered an emergency.

Also, responding to a post above, just because a hospital calls itself non-profit does not mean they don't make money. They just increase payouts to upper management and buy more and more property to take off the tax roles so there is nothing left to claim at the end of the year. Non-profit only means that a small portion of operating expenses can be held over at year end. It doesn't mean they are not making money.

Many of the people I know who work in non-profit organizations have substantial salaries.

#88 | Posted by TheRef65 at 2014-02-28 11:43 AM | Reply | Flag:

"Many of the people I know who work in non-profit organizations have substantial salaries."

Personally, I don't want to go to a hospital that doesn't provide substantial salaries to it's managers and medical staff.

#89 | Posted by bogey1355 at 2014-02-28 02:14 PM | Reply | Flag:

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