7 ms·

People make "frivolous" visits because they are legally required to stabilize patients. This is what passes for a social safety net in the US, and we have faile

People make "frivolous" visits because they are legally required to stabilize patients. This is what passes for a social safety net in the US, and we have failed in developing anything better for those not covered by Medicaid. People often make frivolous ambulance calls if they have trouble getting to the hospital or PCP. There are often reasons, and we would have a more reliable, more humane system if we focused on cheaper care over penalizing the poor. Providing only guaranteed emergency care is absurdly expensive.

wilg 3y ago
IIRC this gap exists in states (guess which!) that opted out of Medicaid expansion. So a solution is available if states take it.
- LapsangGuzzler 3y ago
  This is a nationwide problem, it's not restricted to states that opted out of expansion. Federal Law requires that ERs treat anyone who comes in, regardless of ability to pay. Until the poor are able to access other resources like urgent care clinics, this is going to continue to be a problem.
  - wilg 3y ago
    Well the poor have access to Medicaid, and if they make more than the Medicaid maximum, subsidized ACA plans. In neither of those cases should you have to go to the ER for non-emergency care. I believe the biggest problem is the coverage gap I mentioned, where 10 states for political reasons have not opted into the higher Medicaid maximums which creates a gap between Medicaid and ACA. This is dumb as hell. I am having trouble figuring out where exactly the other coverage gaps are or how big they are. I'm sure there are some. I would definitely support a switch to single payer to smooth out this mess.
- init2null 3y ago
  To be fair, someone making $25,000 a year will have almost as much trouble paying out of pocket for an MRI as someone making $15,000. But the former won't qualify for Medicaid and the heavily-discounted health insurance won't do much to help with their first $10,000 of medical debt. Good but worthless advice to the majority living without any savings: don't get sick and don't get injured. Can anyone blame them if they avoid expensive testing? Medicaid is a great bandage, but the US needs a better system.
Auracle 3y ago
That’s not the only reason. A (well known, national) turkey company considered building an on-site clinic just because so many of their Somali immigrant employees were going to the ER over frivolous things. They have insurance. Of course, that’s certainly not limited to immigrants. I think anyone who has spent any time in an ER waiting room has thought “you’re in here for that?” I’ve heard plenty of anecdotes from doctors about people with insurance or no going to the ER for colds. As an aside, even though the Somali population is just a small fraction of the total population in the area they seem to be about half of the people in the (non-ER) clinic. I’ve always wondered what was up with that.

wilg 3y ago

IIRC this gap exists in states (guess which!) that opted out of Medicaid expansion. So a solution is available if states take it.

LapsangGuzzler 3y ago
This is a nationwide problem, it's not restricted to states that opted out of expansion. Federal Law requires that ERs treat anyone who comes in, regardless of ability to pay. Until the poor are able to access other resources like urgent care clinics, this is going to continue to be a problem.
- wilg 3y ago
  Well the poor have access to Medicaid, and if they make more than the Medicaid maximum, subsidized ACA plans. In neither of those cases should you have to go to the ER for non-emergency care. I believe the biggest problem is the coverage gap I mentioned, where 10 states for political reasons have not opted into the higher Medicaid maximums which creates a gap between Medicaid and ACA. This is dumb as hell. I am having trouble figuring out where exactly the other coverage gaps are or how big they are. I'm sure there are some. I would definitely support a switch to single payer to smooth out this mess.
init2null 3y ago
To be fair, someone making $25,000 a year will have almost as much trouble paying out of pocket for an MRI as someone making $15,000. But the former won't qualify for Medicaid and the heavily-discounted health insurance won't do much to help with their first $10,000 of medical debt. Good but worthless advice to the majority living without any savings: don't get sick and don't get injured. Can anyone blame them if they avoid expensive testing? Medicaid is a great bandage, but the US needs a better system.

Auracle 3y ago

That’s not the only reason. A (well known, national) turkey company considered building an on-site clinic just because so many of their Somali immigrant employees were going to the ER over frivolous things. They have insurance. Of course, that’s certainly not limited to immigrants. I think anyone who has spent any time in an ER waiting room has thought “you’re in here for that?” I’ve heard plenty of anecdotes from doctors about people with insurance or no going to the ER for colds. As an aside, even though the Somali population is just a small fraction of the total population in the area they seem to be about half of the people in the (non-ER) clinic. I’ve always wondered what was up with that.