<p>@dietz, the system you described supposedly existed many years ago. There was this little company that ran a fairly straightforward employer plan: you get $2400 or some such a year for routine care and prescriptions, preventive care was free, and after 2400 was over there was a deductible to be met ($500-600) and after that 80/20 or some such.</p>
<p>Their web site had tools that supposedly used pooled info to tell you costs of procedures, office visits, and prescriptions for members in your zip code. Then you could look up costs and decide where to go.</p>
<p>It did not work for a number of reasons, estimates varied too widely, were not accurate, and descriptions were too general. Prescription info was similarly useless. </p>
<p>I believe they were bought out by a super insurance company and that was it.</p>
<p>Well of course, polarscribe, that goes without say. Your post seemed to imply that the facilities would not ask for this insurance information, and that is not accurate.</p>
<p>Of course, the wealthy can self-pay. But many people of the people without insurance are not wealthy (since medical insurance is typically a benefit offered with better paying full time jobs).</p>
<p>Another option taken by many people in this situation is to ignore the medical problem until it gets bad enough to go to the ER for, so it is a worse problem by then (i.e. more expensive, even beyond the added expense of using the ER).</p>
<p>It is not just the uninsured that are causing our problems. No one likes it when people bring this up, but it is also the terribly unhealthy lifestyles that so many people choose to live that create a ton of unnecessary medical expenditures. We don’t hear much about what people <em>owe</em> society, if anything, for sharing the cost of their care. It is understandable to me, that those who make the effort feel some animosity towards those who do not appear to make even small, obvious changes in their lives, like not drinking sodas when they are obese, and then expect everyone to pick up the cost of their care.</p>
<p>I’m not talking about people who are the unlucky victims of medical conditions unrelated to their lifestyle choices. They are the ones for whom we all want to share the risk.</p>
<p>Probably most ordinary people would agree in principle with that, regardless of other political views on the subject. But the lobbyists of the providers and the drug companies would likely oppose it, since more transparent pricing would force them to compete on price. Also, the burden of maintaining it would likely be more costly for smaller medical offices, unless they were very specialized and have fewer procedures to keep track of.</p>
<p>However, one wrinkle is that sometimes the needed procedures are not known ahead of time. For example, a colonoscopy may find polyps that can be removed during the colonoscopy. Someone using a theoretical NPC would have to consider both the polyp removal and no polyps scenario.</p>
<p>“I would not go to an ER, unless I felt I had no alternative, because my insurance deductible is so much higher at an ER. If I go to a walk in clinic, the deductible is the same as a doctor visit.”</p>
<p>I’ve had to go to the ER for a few things which weren’t life threatening but could only be treated at a hospital, not a doc in the box. One was when my cornea got scratched while I was gardening. I initially didn’t think that much about it, but when the pain became searing I called my ophthalmologist. Since it was a Saturday she told me, in no uncertain terms, I needed to go to the ER straight away.</p>
<p>The other time was when I had a horrid headache that just wouldn’t quit. When I got to the ER I was surprised how quickly I was seen - literally only a few minutes. I was shocked, tbh. I immediately was taken to have a Cat scan (to rule out a tumor) and then given a spinal tap - which revealed I had meningitis. I was immediately quarantined in a private room until they could determine if it was viral or bacterial. Fortunately, for me it was viral. </p>
<p>I’m sure a lot of people would think it incredibly silly to go to the ER for “just a headache.”</p>
<p>Bay,
I was repeating something Polarscribe said.</p>
<p>All people are registered in the ER and give their insurance information at that time. We have to see them, insurance or not, emergency or not. Non emergencies go to “fast track” but they still get seen.</p>
<p>True, but the line between “not taking good care of yourself” and “being genetically unlucky” is a fuzzy one. For example, type 2 diabetes is typically associated with obesity and physical inactivity. However, genetics determines individual thresholds. One person may need to get extremely obese, not exercise, and eat extremely unhealthily before getting type 2 diabetes. Another person may need to maintain very low body fat percentage (e.g. <10% for men or <17% for women), exercise like an athlete, and eat extremely cleanly to avoid getting type 2 diabetes.</p>
<p>Then again, one would hope that the unpleasantness of medical problems already provides as much incentive as realistically possible to take care of oneself. But that may be far short of the incentive needed. Not sure if adding monetary incentive would help much – many people are already living at the very edge of their financial means, so future financial risks do not seem to be much incentive for them.</p>
<p>The CDC statistics say that the incentive isn’t strong enough for most people.</p>
<p>I have a friend that worked out a few days a week but was obese. He was diagnosed with diabetes 14 months ago. He dropped 20 pounds in a month after he found out. He works out strenuously 7 days a week and now looks great. I haven’t talked to him about whether he is off of his medications now but he could have lost the weight anytime in the last 20 years - he just didn’t have the motivation at the time to do so and was enjoying life too much.</p>
<p>Sometimes it takes a huge wakeup signal to wakeup. For a lot of people, even that’s not enough.</p>
<p>I have never quite understood where the notion evolved that an employer is expected to pay your health care. The more burdens you place on an employer, the less likely the employer is to hire new people.</p>
<p>In Europe, health care is a government responsibility. For many americans, who don’t work for big companies, it is a personal responsiblity. The employer doesn’t pay your car insurance, or any of your other expenses.</p>
<p>That being said, I would love to have employer health insurance. I pay $1000 a month, and so does my wife.</p>
<p>If I go to a walk in clinic, the deductible is the same as a doctor visit.</p>
<p>Because you have insurance which is accepted at the doc in the box. I’ve had to go twice out of town - once after flying and my ear was badly plugged and another time on vacation when I broke my ribs boggie boarding. Doc in the boxes won’t even see you without getting your credit card info or cash before being seen. And, they didn’t take my insurance straight off - I had to pay and submit my claim later. It wasn’t cheap either - both were several hundred dollars. Hard is this may be for you to believe but a large proportion of our population cannot afford even that, so they have to go to the ER where it’s required they be seen regardless of their ability to pay. </p>
<p>If I go to an an area doc in the box my insurance is accepted and I only have to pay the co-pay because my insurance is through NYS and living in Cap District practically every doctor is in network. Not so when I am away from home, though. Then it’s counted first for my deductible and then 80/20.</p>
<p>That’s the darned truth. Each of my kids has a rare bleeding disorder, inherited from my husband’s Ashkenazi Jewish ancestors. Even then, they’re unlucky. After the first kid was diagnosed, the doctor told me that the other two both had a 50% chance of having the disorder. Guess what, all three of them have it, along with my husband! When my husband needed to have part of his thyroid removed, to prevent bleeding they gave him two doses of recombinant Factor VIIa - the cost of the MEDS ALONE was $43,000! That’s not a typo. I think we hit our OOP maximum of $10,000 that year. Very unlucky.</p>
<p>Then there is also mental illness on my husband’s side, and two of my kids have inherited that. I guess young people should look at the family tree of prospective spouses! Sigh.</p>
<p>I have never quite understood where the notion evolved that an employer is expected to pay your health care. The more burdens you place on an employer, the less likely the employer is to hire new people.</p>
<p>One would think that big business would be pushing for single payer but for some odd reason they aren’t. Imo, if ACA doesn’t work well enough I think eventually they will come around to single payer and that will be that. The political party which is opposed to single payer will fold like a cheap suit.</p>
<p>Yes, that is how it is for me also. My office visit deductible is $100, so I pay that up front at the walk-in. I know what my coverage is. I know I will have to pay something every time I see a doctor. I factor this into my life and my budget. My health and my family’s health is the top priority for me. I have never expected to get health care for free, because it has never been free as long as I’ve lived. </p>
<p>
</p>
<p>So?</p>
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</p>
<p>Why would it be hard for me to believe that some people have no money? My point was that I don’t abuse the ER with routine visits. Why would I when it costs me more than going to a walk-in? </p>
<p>People who go to the ER get billed, too. If they have the money, they will have to pay. Its not like you just say, oh I don’t feel like paying my deductible so I’ll go to the ER. It will end up costing you more.</p>
<p>“Yes, that is how it is for me also. My office visit deductible is $100, so I pay that up front at the walk-in. I know what my coverage is. I know I will have to pay something every time I see a doctor. I factor this into my life and my budget.”</p>
<p>Someone making minimum wage cannot factor this into their budgets - they simply do not have the disposable income to do so. </p>
<p>“So?”</p>
<p>So, someone who does not have the money in the first place cannot go to a doc in the box for treatment. They have to go somewhere they can be treated even if they cannot pay. So they go to the ER for things most of us would go to our regular doctor for - colds, sore throats, bee stings, a bad cough, etc., etc, etc. </p>
<p>“Why would it be hard for me to believe that some people have no money? My point was that I don’t abuse the ER with routine visits. Why would I when it costs me more than going to a walk-in?”</p>
<p>You don’t have to “abuse” the ER because you have the money to pay the doc in the box. If you didn’t where do you think you would go to get medical care? </p>
<p>Yes, people without the money will get billed. The problem is that they cannot pay it and so the hospital never collects. So everyone who does have insurance pays more - to offset the cost the hospital incurs from non paying patients.</p>
<p>I would never go to my doctor for a bad cold, sore throat or cough (unless it lasted for weeks). And I have never gone to any doctor for a bee sting, I am not allergic. People need to be educated as to what is an emergency and what is not. Maybe some sort of triage in the ER to tell these people to go home and self treat.</p>
<p>“I would never go to my doctor for a bad cold, sore throat or cough (unless it lasted for weeks). And I have never gone to any doctor for a bee sting, I am not allergic. People need to be educated as to what is an emergency and what is not. Maybe some sort of triage in the ER to tell these people to go home and self treat.”</p>
<p>I’ve had colds turn into sinus infection and a sore throat be strep and a cough be bronchitis and for which I needed an antibiotic. All of which requires seeing a doctor. </p>
<p>I’m not allergic to bee stings but when I stepped on a bunch of ground bees my foot swelled like a balloon. My doctor will not prescribe certain drugs over the phone so going to the doctor is a necessity.</p>
<p>^ yes I do and I think it’s why so many are opposed to national health care. They think if they just prioritized better they don’t really need comprehensive insurance to get medical care.</p>