Without Medicaid Expansion, Poor Forego Health Care

Jul 2015
2,691
1,605
Maryland USA
#31
Sure in an ideal world single payer is best. But again how do you get the person who lives two hours away from a doctor to agree to pay taxes for healthcare he cant get to or has no access to? We have a lot of things to change first before we can address single payer. We found that out the hard way from the ACA. Getting way more doctors and healthcare professionals out there and offering clinics in rural areas. Hospital consolidation also has gone nuts and now there are fewer hospitals. Its another issue thats going to be urban v rural.
The most important statement that you made is "We have a lot of things to change first before we can address single payer." We operated what are known as "Rural Critical Access Hospitals". As such, there were certain reimbursement considerations and the ability to operate "Swing Beds". A Swing Bed gave us the ability to discharge a patient that no longer required acute care, but admit them into a skilled or intermediate care service for a limited time without moving them from the bed. Regarding access to primary care services, we were able to establish "Certified Rural Health Clinics'. Such clinics were staffed by a physician extender (in our cases, a nurse practitioner) under the supervision of a licensed physician. Such supervision required the routine review of the medical records and the availability to be contacted for consultation and scripting narcotics if necessary.

You are totally on point regarding hospital consolidations. In Maryland, now most facilities are part of the Johns Hopkins, the University of Maryland, or MedStar systems.
 
Likes: bajisima
Mar 2012
52,896
35,011
New Hampshire
#32
It relates to the typical level of Medicaid payment. Typically, the Medicaid payment does not cover the actual cost of providing care, most times it does not even cover the facilities fixed cost for the care provided and hospitals tend to have an extremely high fixed cost percentage. Accordingly, the hospital must eat some fixed costs and all variable costs. Medicaid recipients creates ER volume, volume that must be accommodated through staffing and other high cost items. Therefore, hospital's cannot not respond sufficiently through cost reductions. Currently, the payment shortfalls are being subsidized by commercial payers.

In the typical ER, its not just Medicaid, ER services must subsidized by the payment for other hospital services. One make ask, why was the payment for that service so high, it's because it is subsidizing the ER among other factors.
Yup that $100 Tylenol pays for uninsured and those on Medicaid which pays much less for services.
 
Mar 2012
52,896
35,011
New Hampshire
#33
The most important statement that you made is "We have a lot of things to change first before we can address single payer." We operated what are known as "Rural Critical Access Hospitals". As such, there were certain reimbursement considerations and the ability to operate "Swing Beds". A Swing Bed gave us the ability to discharge a patient that no longer required acute care, but admit them into a skilled or intermediate care service for a limited time without moving them from the bed. Regarding access to primary care services, we were able to establish "Certified Rural Health Clinics'. Such clinics were staffed by a physician extender (in our cases, a nurse practitioner) under the supervision of a licensed physician. Such supervision required the routine review of the medical records and the availability to be contacted for consultation and scripting narcotics if necessary.

You are totally on point regarding hospital consolidations. In Maryland, now most facilities are part of the Johns Hopkins, the University of Maryland, or MedStar systems.
We had a similar situation a few years ago where we had two insurers in the entire state and in the rural areas no doctors. So they had to undercharge to keep some of the hospitals opened. Some ended up merging with others and some had to close. Doctors make far less in rural areas and dont always want to stay here. One of our friends son is now a surgeon and and a simple appendectomy up here costs $10K. In Boston it can cost over 30K. Massive difference. No healthcare professionals want to take that cut in pay.
 
Likes: TheWahoo
May 2016
3,559
883
california
#34
The homeless around here get free, and frequent (usually redundant), medical tests costing thousands of dollars, though the hospitals usually pass the buck to Uncle Sam. The key for free medical care here seems to be to have little to no money at all.
 
Jul 2013
37,007
23,435
On a happy trail
#35
The homeless around here get free, and frequent (usually redundant), medical tests costing thousands of dollars, though the hospitals usually pass the buck to Uncle Sam. The key for free medical care here seems to be to have little to no money at all.
So you prefer to have those who might have contagious diseases running around spreading them?
 
May 2016
3,559
883
california
#36
So you prefer to have those who might have contagious diseases running around spreading them?
Not at all, in fact that's a good reason for health care for all, buuut, they come in mainly for "pain medication". The hospital just gives them a lot of tests that cost a lot ( and 99 out of hundred times find nothing wrong) and pass the cost on, unless they want to go out of business. They usually get some pain medication but grudgingly. It's the costs that are passed on that seems unfair to me especially since they are usually unnecessary.