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Pawlenty: Let ER's turn away patients to cut costs

My hospital has after hours clinics. They stay open until about 1am or 2am.

I don't see the market addressing it either.

However it's handled, an after hours program is needed. EMTALA is an unfunded mandate and an unfair burden that's being forced upon on our healthcare system.

True. But there would be serious objection to paying for it. And the situation prior wasn't acceptable. We're really not willing to turn people away and let them die. So, something had to be written into law. True, it led to others using the ER, as the market had not addressed this, but the core problem was the turning away of people in need who couldn't pay.
 
These are all very perplexing questions, and I would like to hear some thought out answers from everybody on this issue. So, in regard to what I have posted, the discussion in this thread should be as follows:

Our health care system - Where do we go from here?

Back when I was seriously considering med school in college, to prep for it and beef up my application, I volunteered in a hospital. Did a day a week on the telemetry ward and two days a week in the ER. What I noticed about the ER is that many, many people use it as a doctor's office and that's not what it's for. I would see elderly people who would use it as an escape from their day, drug addicts who used it as a place to crash out, homeless who would fake illness to get in out of the elements, and a whole host of other abuses of the ER.

I have no problem with triage nurses turning people away from the ER for these kinds of abuses. I also think there should be a specific list of guidelines indicating what symptoms cannot be turned away.

Another thing I noticed is that the ER also jacks prices up on everything. The same sutures that you pay $20.00 for in the medical offices upstairs will cost $60.00 from the ER. That's just not acceptable to gouge the price in a time of actual emergency. Costs could be kept down for everyone if the hospital paid premium for the staffs' time in the ER but didn't jack up materials costs on top of it.
 
Everything gets paid for one way or another. If we have no system of controls that includes how to pay for it, then we will have some ad hock measures that will do it for us.
 
Lets expand the federal program for low income people. to include emrgency services. the program now has medical facilities that support low income people , you pay a precentage of your income for medical tests and office visits. medicines you buy yourself, but the program exists. if it was expanded we could have the private system eased somewhat.If we wanted to we c ould have Health care professionals work in it to pay back government loans. etc. school loans.
 
Lets expand the federal program for low income people. to include emrgency services. the program now has medical facilities that support low income people , you pay a precentage of your income for medical tests and office visits. medicines you buy yourself, but the program exists. if it was expanded we could have the private system eased somewhat.If we wanted to we c ould have Health care professionals work in it to pay back government loans. etc. school loans.

I certainly see possibilities there, but you would again be faced with tax dollars paying for health care. Am I wrong to expect some objection to this?
 
you dont directly pay its subsidized thru insurance. start payin directly costs will drop. also lets compete for hospitals i say lets put a hospital and dr. on every corner and do away with health insurance. you direct pay for your animals care why not your own?
 
Pawlenty just provided proof he is a big business sellout.

Turning away the injured or the sick is unacceptable. If there is an issue with the condition, the ER staff can do the responsible thing; send those patients to an urgent care facility.

To refuse treatment is unacceptable. Pawlenty should be asked to resign. We cannot afford to have business-sellout nazis in the Senate or the House.
 
you dont directly pay its subsidized thru insurance. start payin directly costs will drop. also lets compete for hospitals i say lets put a hospital and dr. on every corner and do away with health insurance. you direct pay for your animals care why not your own?

Because animal care doesn't cost $50,000.

Direct pay for hospital care is not a viable option. Insurance is a must. I say remove big insurance's ability to decide what they will pay for and have done with it.

I also favor making it illegal for medical doctors to work for insurance companies. This will make it harder for insurance goons to deny necessary treatments.

Doctors should lose their licenses if they take employment with an insurance company.
 
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I certainly see possibilities there, but you would again be faced with tax dollars paying for health care. Am I wrong to expect some objection to this?

I think there would ultimately be less objection to having these types of low-cost clinics than there would be to completely revamping the insurance system. My parents are absolutely freaked about the possibility of losing my mom's doctor. She has a rare terminal illness that she's really struggled with until she found a good doctor who has really helped her. I have hypothyroidism and I have the same feelings about my doctor, who makes evening phone calls to his patients when needed.
 
interesting...

Walk-in clinics are springing up across the country. Currently, there are about 1,200, up from 850 in 2008 and 250 in 2007, according to the Convenient Care Association, a trade association for retail-based convenient care clinics.

They're run by hospitals, retailers like CVS and Walgreen, community health centers, or nursing schools who diagnose simple maladies, like strep throat or flu, and provide prescriptions, medical advice, or referrals if the problem is beyond their scope. These clinics have caught on in part because they don't require an appointment and tend to be less expensive than visiting the doctor or an emergency room visit. Some take insurance.

When visiting one, says Dr. Lori Helm, president of the American Academy of Family Physicians (AAFP), ask to have your records forwarded to your doctor, and be sure to tell him about any medication prescribed at the clinic. She says the organization doesn't recommend walk-in clinics for treatment of chronic medical problems.

10-things-primary-care-physicians-won't-say: Personal Finance News from Yahoo! Finance
 
True. But there would be serious objection to paying for it. And the situation prior wasn't acceptable. We're really not willing to turn people away and let them die. So, something had to be written into law. True, it led to others using the ER, as the market had not addressed this, but the core problem was the turning away of people in need who couldn't pay.

It's cheaper than the current system.
 
Another thing I noticed is that the ER also jacks prices up on everything. The same sutures that you pay $20.00 for in the medical offices upstairs will cost $60.00 from the ER. That's just not acceptable to gouge the price in a time of actual emergency. Costs could be kept down for everyone if the hospital paid premium for the staffs' time in the ER but didn't jack up materials costs on top of it.

They have to recover costs somehow. Remember, EMTALA is an unfunded mandate and someone has to pay for it.
 
Before anybody starts making statements about Pawlenty being a heartless Conservative, let's set the ground rules for this discussion, and get it straight on what Pawlenty proposes. He is talking about minor medical conditions, which are not emergencies.

1) In that context, I don't see Pawlenty's proposal as heartless, but as a realistic idea. Emergency room care for minor conditions is one of the things that his bankrupting our medical care system.

2) But is Pawlenty's "realistic" idea actually realistic? I don't think so. Minor medical conditions frequently lead to major hospitalizations. So what is the better way to cut costs in the medical system? Turn away minor conditions, to have people admitted to hospitals for long and very expensive stays? Or to keep things as they are, and treat those minor conditions before they flare up and cost orders of magnitude more money? I believe that the second one is best, and ultimately more cost effective.

In the end, I don't see Pawlenty's proposal to be heartless at all. But I do see it to be poorly thought out, from an economic standpoint. Is there a third solution somewhere out there that we haven't looked at? Some would say that a public option would be that third option, but I disagree. Whatever solution we come up with must not take money from peoples' pockets without their consent. Or should it? If it does, then do we slide down the slippery slope to Socialism? If we do, then is this still America, or do we begin to say goodbye to a system of government that has has worked for more than 2 centuries?

These are all very perplexing questions, and I would like to hear some thought out answers from everybody on this issue. So, in regard to what I have posted, the discussion in this thread should be as follows:

Our health care system - Where do we go from here?

PLEASE - NO TROLLING. If you only come here to bash Bush, Obama, or anybody else, while not offering constructive ideas and / or constructive criticism, then please leave this thread, and do not post. I will be asking moderators to thread ban those who do not stick to the topic at hand, and the discussion on it, along with those who display disruptive behavior.

Article is here.

This would take away part of the hospital's need to cross level medical costs to insured patients.

oh, and if we don't do it, it's Obama's fault.
 
If people can set aside their visceral "oh noes!" reaction, they might see the argument from the other perspective. Because hospitals are losing such a huge amount of money on their ER's, they're closing the ERs and sometimes the hospitals.

Which one is worse for the community: A solvent hospital with an ER that turns away a small subset of injuries, or an insolvent hospital that closes altogether?
 
If people can set aside their visceral "oh noes!" reaction, they might see the argument from the other perspective. Because hospitals are losing such a huge amount of money on their ER's, they're closing the ERs and sometimes the hospitals.

Which one is worse for the community: A solvent hospital with an ER that turns away a small subset of injuries, or an insolvent hospital that closes altogether?

EMTALA is a good example of why unfunded mandates are wrong. Many hospitals are struggling because of it.
 
We not talking about emergency or critical cases here. It's the cases that should be in the clincs that are the issue.

I think all of them are the issue. What I've seen was that in all cases, when the hospitals turn them away, they take the person home to deal with as best they can. "Capitalism stepping into the void and filling it" would be in the form of charlatan giving out traditional medicine that do harm as often as they do good. Real doctors have to feed their family too, so they have to take only cases where the patient could actually afford their rates. So I'm curious how else capitalism can come in and fill the void? Because capitalism as I know it is amoral, that means, if people have to die because they don't have the money to cure themselves, they die. There's no right or wrong about it. Just profit or no profit.

But let's concentrate on the "cases that should be in the clinics". How do we classify them?
 
Lives are generally considered to be more important than money. But for non emergency cases, people should be encouraged to use less expensive treatment methods, such as the county health department or some other public clinic if they are unable to pay a private practitioner.

But all those requires public money. Someone else has to pay for them. And were those people asked that their money be paid to treat these people who can't be bothered to buy their own insurance? Would all of them have agreed if they were asked?
 
you dont directly pay its subsidized thru insurance. start payin directly costs will drop. also lets compete for hospitals i say lets put a hospital and dr. on every corner and do away with health insurance. you direct pay for your animals care why not your own?

I'll let my pet go if the treatment is too expensive. Bye, bye puddy cat. ;)
 
I think there would ultimately be less objection to having these types of low-cost clinics than there would be to completely revamping the insurance system. My parents are absolutely freaked about the possibility of losing my mom's doctor. She has a rare terminal illness that she's really struggled with until she found a good doctor who has really helped her. I have hypothyroidism and I have the same feelings about my doctor, who makes evening phone calls to his patients when needed.

I've seen nothing that would cause her to worry about losing her doctor. Perhaps the fear campaign has done its job on her.
 
But all those requires public money. Someone else has to pay for them. And were those people asked that their money be paid to treat these people who can't be bothered to buy their own insurance? Would all of them have agreed if they were asked?

It doesn't matter if they agree. We live in a society with representative government and they got their vote too.

The government does stuff all the time and never gave me veto rights over anything other than my vote. Why should people who disagree have special rights?
 
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you dont directly pay its subsidized thru insurance. start payin directly costs will drop. also lets compete for hospitals i say lets put a hospital and dr. on every corner and do away with health insurance. you direct pay for your animals care why not your own?

Because there is a world of difference in letting a cat die vs letting your sister die. That emotional bond is easier to extort.
 
It doesn't matter if they agree. We live in a society with representative government and they got their vote too.

The government does stuff all the time and never gave me veto rights over anything other than my vote. Why should people who disagree have special rights?

Because:

danarhea said:
Whatever solution we come up with must not take money from peoples' pockets without their consent. Or should it? If it does, then do we slide down the slippery slope to Socialism? If we do, then is this still America, or do we begin to say goodbye to a system of government that has has worked for more than 2 centuries?
..
 
I don't see how that applies. Nobody is totally happy with the government because it has to serve all people, not just one person (not that it does a great job at it, but that is another thread). People have been fighting over the proper role for the government since before the constitution and people will continue to fight long after we are dead. If a certain segment of the population doesn't like something, than they need to muster up the votes to have their way.

And to say people don't have consent is also silly, we can all vote. Its an imperfect system, i admit, but we all have a say.

However, to say that socialism will change our government is nonsense. It still has congressmen, senators, the president, the supreme court, the various agencies, state government, local government, etc. Its all still there and still basically doing the same thing.
 
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If people can set aside their visceral "oh noes!" reaction, they might see the argument from the other perspective. Because hospitals are losing such a huge amount of money on their ER's, they're closing the ERs and sometimes the hospitals.

Which one is worse for the community: A solvent hospital with an ER that turns away a small subset of injuries, or an insolvent hospital that closes altogether?

People first! Republican greedmongering second!
 
Before anybody starts making statements about Pawlenty being a heartless Conservative, let's set the ground rules for this discussion, and get it straight on what Pawlenty proposes. He is talking about minor medical conditions, which are not emergencies.
Wouldn't it be helpful to post the actual EMTALA laws for everyone to see?

Here are excerpts from EMTALA:

TITLE 42, CHAPTER 7, SUBCHAPTER XVIII, Part E, § 1395dd

(a) Medical screening requirement

In the case of a hospital that has a hospital emergency department, if any individual (whether or not eligible for benefits under this subchapter) comes to the emergency department and a request is made on the individual’s behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition (within the meaning of subsection (e)(1) of this section) exists.

(b) Necessary stabilizing treatment for emergency medical conditions and labor

(1) In general​
If any individual (whether or not eligible for benefits under this subchapter) comes to a hospital and the hospital determines that the individual has an emergency medical condition, the hospital must provide either—​
(A) within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition, or​
(B) for transfer of the individual to another medical facility in accordance with subsection (c) of this section.​

[Sections c and d skipped for the sake of brevity.]


e) Definitions
In this section:
(1) The term “emergency medical condition” means—​
(A) a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in—​
(i) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy,​
(ii) serious impairment to bodily functions, or​
(iii) serious dysfunction of any bodily organ or part; or​

(B) with respect to a pregnant woman who is having contractions—​
(i) that there is inadequate time to effect a safe transfer to another hospital before delivery, or​
(ii) that transfer may pose a threat to the health or safety of the woman or the unborn child.​


If I am not mistaken, nothing in EMTALA requires an emergency room staff to treat a patient for a non-emergency problem once the emergency room staff has determined that the patient has a non-emergency problem.

If I am correct, then Pawlenty is mistaken about EMTALA needing changed.
 
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