Comments on: Is rationing health care impossible in the United States?

By: kevin not md

kevin not md — Wed, 03 Jun 2009 23:18:40 +0000

it’s possible that hospitals receive more in charity than they spend on emergency care for the poor

http://www.boston.com/news/health/articles/2009/05/31/much_is_given_by_hospitals_more_is_asked?mode=PF

By: k

Wed, 03 Jun 2009 02:01:46 +0000

Good points, Dr Green and Anonymous 11:21.

@Bad Medicine, Good Solutions – IIRC, Shadowfax and/or WhiteCoat discussed this topic during the UCMC ED dumping furor a month or two ago. The point was made that, if UCMC declined to accept Medicare/Medicaid pts, they would also have to give up federal funding for research grants, trials, and the like – meaning UCMC would essentially go out of business as a teaching hospital. It is my understanding that hospitals can open urgent care facilities that provide almost the same level of service as hospital EDs, but do not fall under EMTALA.

By: Bad Medicine, Good Solutions

Bad Medicine, Good Solutions — Wed, 03 Jun 2009 00:07:25 +0000

The smarter hospitals won’t close down. They will simply opt out of medicare and other federal funds which will free them from needing to follow EMTALA. EMTALA is only a requirement for facilities that accept federal funds.

Large scale rationing will not work in America. The whole system is going to crash and burn. We are all going to end right back where we started before medicare. Except, in addition to your wallet rationing medicine, there will also be a high deductible insurance that functions as just insurance (not a guise to pay for everything).

By: Anonymous

Anonymous — Tue, 02 Jun 2009 15:21:50 +0000

Two things most people ignore or fail to realize: 1. The emergency room is what provides universal medical care in the US, albeit very inefficiently. 2. Medical care is already rationed. If you are among the minority who pays your own way, you self-ration. If you use medical insurance, your medical care is rationed by the (private or government) insurance company. If you are uninsured with no money and use the emergency room as described in the blog entry, you won’t have access to non-emergency followup or preventive care.

By: Donald Green MD

Donald Green MD — Tue, 02 Jun 2009 14:47:02 +0000

Care is already rationed in this country by ability to pay. No matter what reform comes, however, the cost of care will always be an issue as it is even in countries that pay far less for care. This is not the problem. The problem is how we pay for this to get the most bang for the buck. As we add more services and professionals to the health care system, its price will go up. The decision making will continue to be a political football. If there are reduced barriers between patient and doctor perhaps treatment will not have to reach the confrontational stage. I notice that the private insurers are not mentioned in the above entry and frankly they are worse in ensuring services for people.

By: SmartDoc

SmartDoc — Tue, 02 Jun 2009 13:45:05 +0000

Maybe I am just trying to make lemonade out of lemons, but the much maligned malpractice system offers far, far more protection against government mandated rationing in my humble opinion.

By: Dr. Grumpy

Dr. Grumpy — Tue, 02 Jun 2009 13:24:18 +0000

Agree with you on this, particularly the unfunded headache that is EMTALA, but dont’ know what the answer is.

Americans want 1907 prices on a 1997 salary. They want free healthcare, amazing tests, and revolutionary medications and treatments- all for free.