What happens when health care is "free"

in Uncategorized | 14 responses

You use more of it, naturally.

Comments

Evan
Wow, that’s about the most disingenuous use of statistics I’ve ever seen. Given that the primary determinant of health care use is probably overall illness burden, which tracks closely with overall socioeconomic status, the data presented are exactly what you would expect. Especially since “NO INSURANCE” used more ER visits than the insured, even though the cost to “NO INSURANCE” for an ER visit is astronomical.
If the chart purported to show what you say it does, Kevin, the “NO INSURANCE” number should be the lowest.
Anonymous
“No Insurance” almost always, in the context of an ER visit, means “indigent, uncollectible, and therefore, free”.
Anonymous
Some of the “no insurance” group may pay an ER bill or have assets or hope to have assets that they don’t want a judgement against, but most are uncollectible and judgement proof and therefore free.
When I went into practice, I soon found that charging for hospital services for those charts marked “self-pay” didn’t pay often enough to be worth the expense and stopped trying.
Morris Berg
Alrighty then . . . let’s roll up our sleeves here a bit.
Assuming this measure is actually an appropriate one to support your rather sweeping macroeconomic conclusion (confounds be damned), please explain this:
Increase in visit rate (number of visits per 100 persons) – 2004-2005:
Private insurance
2004: 20.3
2005: 23.8
Increase: 17.24%
Medicaid/SCHIP
2004: 80.3
2005: 89.4
Increase: 11.33%
http://www.cdc.gov/nchs/data/ad/ad372.pdf
So what happens when you have health insurance to pay for your health care?
You use more of it, naturally.
OR
Maybe . . . just maybe . . . using these overly simplistic stats to support such a conclusion is either intellectually dishonest or dis-intellectually honest (sincere stupidity). And if you really wanted to draw any conclusion about the effects of payment method not muddied by the underlying differences between the populations and you were limited to just this one in-apt measure, you would compare utilization within these distinct groups over time rather than comparing utilization across groups in one year . . .
Unless of course you just want a pretty graph to throw out in support of your pre-conceived and idiotically simplistic conclusion about a very complex and serious issue.
One more reason why I wish they taught stats in medschool . . . anyone making this argument based on this report should be embarassed . . . just embarassed.
Evan
/bow Morris Berg
By the way Morris, I did take stats in medical school which allowed me to be skeptical of the conclusion.
Kevin’s plenty skeptical about woo but he loses his skepticism when it comes to insurance, health policy etc.
Morris Berg
Evan:
No offense. Didn’t mean to paint the profession with a broad brush. I could tell as much from your comment. I was actually giving the him the benefit of the doubt.
scalpel
Let’s say that 60 inch plasma screen TVs were free to certain members of the population, specifically those who earned less than the federal poverty level and therefore qualified for government assistance in purchasing TVs. They might just come in every other week to get a new one. Why not? It’s free, right?
Everyone else could buy plasma TV insurance, so that when their current plasma screen TV broke, they could get their next one at a discount (but they still had to pay a rather large copay). These people, who worked for a living, might just do without a plasma TV for a while, settling perhaps for watching their old (but adequate) tube TV. Even if they did go buy a new one, they probably would be satisfied with just one or two, because they have to pay a substantial amount each visit.
Now let’s say that a federal law required that Circuit City had to give away plasma screen TVs free of charge to anyone who showed up in the store requesting one, regardless of their ability or inclination to pay for it or without regard to their plasma TV insurance status. Some of these folks would try to pay for it anyway, because they are honorable people, but many more would just ignore the bills and stock up on TVs at the expense of the company.
I suggest that if we were to create a plasma screen TV utilization chart, it would look strikingly similar to the CDC one.
Imagine that. Human nature is what it is.
Morris Berg
Scalpel: Free is easier than not free. We get it. Sure. No disagreement.
It is also human nature to try and fit very complex multi-variabled phenomena (particularly human behavior) into simplistic cause-and-effect explanations.
Is some of that going on? Sure. How much? Here is the limit of the power of your model.
What about the no insurance group, which is less insulated than the insurance group? How would they fit?
Please explain how this “model” accounts for underlying differences between the groups?
Why is the insurance group increasing is visits to CC at a higher rate than the free group?
scalpel
Because thanks to EMTALA, the no-insurance group doesn’t have to pay anything either. It isn’t a true free market.
Evan
Scalpel,
First, the no-insurance group most certainly pays something. If you doubt me, please go to an ER and tell them you don’t have insurance; don’t pay, and see how that works out for you.
Second, there can NEVER be a true free market for emergency care. You must be aware of that. If you are driving and you crash your car and are laying by the side of the road bleeding and unconscious, you will be taken to an ER. You will not negotiate the price, you won’t even know if the ER is any good, and your life will be completely in the hands of strangers who you have zero active knowledge of. That is not a market, can never be a market, and if you think it can be, it shows just how little thought you have put into this issue.
It is certainly true that some emergency care is not actually an emergency, but for the cases that meet the criteria for an emergency, there can never be a market, ergo your argument is prima facie wrong.
scalpel
Some pay something, some pay the whole bill, and some pay nothing. The ones who pay nothing come back over and over again, because they don’t care about their credit rating anyway and we have no other recourse if they don’t pay.
They can come right back the next day and twice next week, laughing at us on their way out while asking for a cab voucher.
The uninsured patients who pay their full bill don’t come back as often, because the negative reinforcement of the huge bill discourages them from seeking care in the absence of a true emergency.
As more and more patients learn that they don’t really HAVE to pay, they are coming more often. No money? We’ll send you a bill. No drivers license? No problem. Just make up an address. We have to see and treat you anyway.
Don’t believe me? Come work with me one night.
Evan
Scalpel, I’m not sure where you work, but I’m willing to bet it’s around a lot of poor people if what you say is correct. Poor people, as you know from going to med school get sick more. This fact seems to easily explain why they would go to the ER more. If your argument were true, then the extremely wealthy would consume health care at the highest rates, since their marginal percentage of income devoted to health care would be the smallest.
Yet as I’m sure you’re aware, the extremely wealthy consume health care at rates that are substantially lower than that of the poor.
Medical care, and most especially emergency care is just not a market in the Adam Smith classical economics sense. If you can’t grasp that, you probably have never been poor and sick.
Anonymous
First, the no-insurance group most certainly pays something. If you doubt me, please go to an ER and tell them you don’t have insurance; don’t pay, and see how that works out for you.
Evan
Never heard of emergency medicaid? Get admitted, can’t pay your bill, qualify for EM and voila the state pays you bill.
Works out pretty well for you actually. You say you went to medical school Evan. Do you actually practice medicine?
Scalpel:
“Morris Berg” has never spent one minute in the Er as a doc. He has no clue as to what you are talking about.
Evan
As usual, the people who make the most sweeping claims are anon.
Anon 10:23,
Yes, I went to medical, I practice medicine, and I see patients in ERs.
I also see them after they went to an ER and have a gigantic bill because they don’t qualify for medicaid (they work and make money) and didn’t have insurance when they went.
They are lower middle class to middle middle class people who are punished by the system for having assets but no insurance.
Again, I suppose if all of your patients are poor enough to qualify for medicaid then you are arguing about a different population than the one I see, but the population I see is just as real as the one you are talking about. And I do assume that the people being admitted to the hospital have to reach some sort of threshhold for admission. They’re not being admitted at their own request, they must have some sort of actual medical reason for it, which again would mean that market reforms aren’t quite the thing to fix people going to the ER and getting admitted because they are too sick to go home.