<p>“Medicaid envy? That’s just so sad.”</p>
<p>Why? </p>
<p>^^ Because she doesn’t have an actual argument with actual facts.</p>
<p>And, More people on Medicaid is not imho an appropriate measure of compassion.
Sometimes it sounds like people either want “perfect world” or are willing to turn a shoulder to others, with little in-between. Sounds like.</p>
<p>It sure does, LF. The choice, let’s remember, was between more people on Medicaid and more people without insurance. Of those, more people on Medicaid was the more “compassionate” choice. IMO. But obviously Flossy disagrees. </p>
<p>For me, the Medicare data points up some issues in Medicare reimbursement. As I understand it, when a doctor administers a drug, they get a percentage of the cost of the drug. So administering a more expensive drug is more lucrative than a cheaper generic, even if the administration procedure for the two drugs is identical. That’s why the opthamologists and oncologists are making the big bucks: they administer expensive drugs.</p>
<p>If it was suddenly more lucrative to adminster Avastin ($50 a dose) for macular degeneration than Lucentis ($2000 a dose) suddenly doctors would see the virtue of Avastin. Turns out Avastin and Lucentis are basically the same drug.</p>
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<p>I agree. It’s sad that some poor, sick people in non-expansion states see their peers in neighboring states getting treatment, while they have to suffer without health care because they live in the wrong place. Sad indeed.</p>
<p>I just want to not have to use the ER because I’ve put off treatment. I’m going to need care either way. Much cheaper for everyone if I’m on Medicaid or highly subsidized insurance ;)</p>
<p>I wonder if we will start to see some people leaving non-expansion states so that they can get insurance. </p>
<p>R- and that was my doc’s point, when I asked him how he felt about ACA (in the midst of some posters’ certainty docs are against it.) He said they had a slew of patients they treated free, post 2008 (or with some other employments shifts here.) That, at least with some new plan, those would be able to pay something. Not everyone is out to climb to the top of the heap, on others’ backs.</p>
<p>LM- I feel a bit stuck in my state, sure not as eager to move back to CA.</p>
<p>LM, not sure about established families but when my friends were looking to leave the state post-graduation, that was a definite factor. (It’s part of the reason why I now have a large group of friends living and working in Colorado…)</p>
<p>It wouldn’t be a flood. Moving is expensive, and this is a population which doesn’t have money lying around. But I bet there will be some. Unless governors start to succumb to the already-growing pressure. </p>
<p>Romani points out something real. Suppose it costs exactly the same for her to be treated, finally, at the ED than to get ongoing treatment when she needs it. Or suppose it even costs a little less for her to go the ED. Is that a better system?</p>
<p>Not to me it isn’t. I don’t want to save a little money by having Rom suffer for a few months when she could be getting prompt treatment, until finally her condition gets so bad that she has to go to the ED. That’s not a good result, to me. </p>
<p>Oh I can point to a very concrete example, CF. My put-off gallbladder surgery ending up costing upwards of 30k because they ended up having to slice me open. Had I had the surgery a year earlier when I was told to (but couldn’t because no insurance), it would’ve been an outpatient procedure with minimal cost. Instead, I had to be in the hospital for 3 days. </p>
<p>BCBS paid it (I was not on Medicaid) but that increased costs for everyone else- completely unnecessarily. We won’t even talk about productive time lost and all that due to me being in the hospital and not working. </p>
<p>More expensive, usually, to hold off then go to ED in a crisis state. Way back, maybe the first thread, we were talking about how ongoing care can prevent many issues from getting to the ED proportions. </p>
<p>What I’m going through now, statistically and based on common medical knowledge, CAN be put off. But at a greater need for services later, more complex and higher costs. There may be a second, exacerbating issue I need to take care of. Now is (or could be) far better than later, when more damage could have occurred. (No need to worry, btw. Just one of those “somethings.”)</p>
<p>I really feel for folks who have to play Russian Roulette. Anyone remember when another young poster we like couldn’t afford her large ED co-payment? </p>
<p>In the aggregate, nobody has been able to prove that giving people better access to health care lowers health care costs. We may wish it did, but so far we haven’t been able to demonstrate that it does. Just because we want to believe something doesn’t make it true.</p>
<p>Well, an anecdote, but had DH gone to the specialist when he had a kidney stone, as I told him to, it would have cost the system $150 plus any imaging. His ER charges came through at 3k. (Minus whatever adjustments.) That was when we had the cadillac plan. </p>
<p>The anecdotes you are giving are anecdotes where something got worse. But a lot of times, people have conditions for which they see doctors, but the conditions don’t get worse.</p>
<p>I had excruiating chest pains one night. I was pretty sure I wasn’t having a heart attack, but I definitely had heart attack symptoms. I went to the ER, where the doctor diagnosed some benign condition I’d never heard of that mimics heart attack symptoms. But the doctor was clear and definite that I was right to go to the ER: I am not a doctor, and I can’t diagnose heart attacks. People with heart attack symptoms should go to the ER.</p>
<p>Suppose I hadn’t had insurance. I wouldn’t have gone to the ER. 99 times out of 100 (or whatever, I don’t know the exact numbers), I would have been OK, and the 100th time (or whatever) I would have been dead. That’s not a bet people should be making-- even though it saves money, and a lot of it.</p>
<p>If you have chest pains or signs of stroke or several other things, everyone recommends ED. If you think you have the flu, ED is a more expensive option for the system. People who couldn’t previously afford a doctor visit but have, say, a gall bladder condition, may be very well served with ongoing medical attention, at lower cost. Yes, they may still need an operation and may still have a need for ED. But this is not the same as doing nothing, waiting for the night it gets so bad that there is no alternative. I think it does show an example where “better access to health care lowers health care costs.” There will still be true emergencies. Also, our earlier examples were many things where a stitch in time saves nine. Different from a possible heart attack. (CF, am I misunderstanding your 238 post?)</p>
<p>Show me the science here. If providing more access to health care lowers health care costs, show me the studies. I’m afraid you won’t be able to find any of them. </p>
<p>Here we have an example of increasing Medicaid coverage ending up increasing ED use:
<a href=“http://www.sciencemag.org/content/343/6168/263.abstract”>http://www.sciencemag.org/content/343/6168/263.abstract</a></p>
<p>CF, we agree about this issue. Patients who are covered by Medicaid do not use the ER less or take advantage of preventative services anymore than uninsured poor people. One reason for this is that few internists or other specialists take Medicaid. It is not easy to find a doctor who will see you if you are medicaid eligible.</p>
<p>I would never advise anyone, such as a student who has other alternatives, to enroll in medicaid. It is highly doubtful you are going to get good care if you get very sick.</p>