Free Markets, Free People

emergency rooms


Wait … didn’t they say if we didn’t pass ObamaCare this would get worse?!

Why yes, yes they did.  And they also told us it was because of the expense of this sort of medical care that the benevolent and non-intrusive federal government saw a reason to attempt to manage this through its new and wonderful law.

Surprise!

Nationally, nearly half of ER doctors responding to a recent poll by the American College of Emergency Physicians said they’ve seen more visits since Jan. 1, and nearly nine in 10 expect those visits to rise in the next three years. Mike Rust, president of the Kentucky Hospital Association, said members statewide describe the same trend.

Experts cite many reasons: A long-standing shortage of primary-care doctors leaves too few to handle all the newly insured patients. Some doctors won’t accept Medicaid. And poor people often can’t take time from work when most primary care offices are open, while ERs operate round-the-clock and by law must at least stabilize patients.

Plus, some patients who have been uninsured for years don’t have regular doctors and are accustomed to using ERs, even though it is much more expensive.

“It’s a perfect storm here,” said Dr. Ryan Stanton of Lexington, president of the Kentucky chapter of the ER physician group.”We’ve given people an ATM card in a town with no ATMs.”

I love the doc’s line about ATMs.  He’s nailed it on the head.

Now I won’t bore you with the fact that we foresaw this and wrote about it.  I mean we talked about doctor shortages, that an increase in those having insurance didn’t mean they’d be able to see a doctor and how doctors were dumping Medicare because of all the hassles and low payments.

But our ever faithful zealots on the left kept telling us that a) we didn’t know what we were talking about, b) human nature isn’t really human nature and c) now that everyone would have insurance all would be sunshine and roses and costs would magically come down (because, you know, the Democrats said they would).

Instead it is all mostly compost.  ERs are seeing a surge in patient visits and expect it to get worse.   Of course, that sort of care is much more costly than regular doctor office visits (according to the article, about $580 per visit more) but what they hey, they have subsidized insurance now … so you get to continue paying for it.

Another in a long line (and getting even longer) of predictions about the effect of a program that this administration has gotten completely bass ackwards.

Competence?

It just doesn’t exist in Washington DC and especially with this administration.

~McQ


Emergency rooms aren’t closing because the market doesn’t work, but because it does

Emergency rooms in “urban and suburban” areas (not rural – the study is limited to urban and suburban) are closing rather rapidly it seems:

Hospital emergency rooms, particularly those serving the urban poor, are closing at an alarming rate even as emergency visits are rising, according to a report published on Tuesday.

Urban and suburban areas have lost a quarter of their hospital emergency departments over the last 20 years, according to the study, in The Journal of the American Medical Association. In 1990, there were 2,446 hospitals with emergency departments in nonrural areas. That number dropped to 1,779 in 2009, even as the total number of emergency room visits nationwide increased by roughly 35 percent.

Emergency departments were most likely to have closed if they served large numbers of the poor, were at commercially operated hospitals, were in hospitals with skimpy profit margins or operated in highly competitive markets, the researchers found.

Sit there for a moment and let that all sink in.  Got it?  All ready to go?  Now, let this sink in:

“This suggests market forces play a larger role in the distribution and availability of care” in the United States, Dr. Hsia said, especially emergency care. “We can’t expect the market to allocate critical resources like these in an equitable way.”

Really? That’s precisely what the market is doing here – Dr. Hsia just doesn’t like it’s method of allocation or the outcome, that’s all.  So the hidden premise here is we (the collective) should allocate “critical resources” (emergency rooms and health care providers) differently than the market does (subsidize) and we’ll say a “market failure” made us do it, mkay?

That’s exactly the case Dr. Hsia is trying to build although it isn’t said outright.  Market failure requires we (collective) pick up the slack (through government) and pay what is necessary (no matter how much it puts us in debt) to ensure “critical resources” (ERs and docs)  are allocated “fairly” (as we think they should).  This is also known as a form “central planning” which has always worked so well.

So that would mean unprofitable requiring emergency rooms stay open and we (collective) subsidizing them.  BTW, anyone else find it ironic that there’s competition among hospitals keeping prices down to the point that some ERs are unprofitable,  yet we’re consistently told that health care costs are spiraling out of control?

Anyway, as you recall the vaunted ObamaCare is supposed to take care of all this, right, because then even the poor will have insurance.  And once they have insurance, they’ll never darken an ER again – except when they have a real live emergency.    Well here’s a clue junior, the poor already have insurance – its called Medicaid.  The problem isn’t lack of insurance, it is a lack of doctors.  And it isn’t going to get better soon.  Massachusetts has already demonstrated the problem:

When the Massachusetts Legislature made health insurance mandatory five years ago, supporters of the first-in-the-nation law hoped it would keep patients out of hospital emergency rooms.

Patients with insurance, the theory went, would have better access to internists, family practitioners, and pediatricians, lessening their reliance on emergency rooms for routine care.

There is more evidence today that it did not turn out that way.

Three-quarters of Massachusetts emergency room physicians who responded to a survey last month said the number of patients in their ERs climbed in the last year.

They cited ‘’physician shortages’’ along with a growing elderly population as the top two reasons why more patients come to ERs.

The law ‘’didn’t create an infrastructure,’’ said Dr. David John, chief of emergency care at Caritas Carney Hospital in Boston. “Doctors offices are full to capacity.’’

That’s right … MA’s single payer system is swamped.  You can waive your magic wand and behold everyone has insurance, but you can’t waive your wand and make health care providers appear.  And most doctors know that Medicaid is probably the worst paying insurance out there, not to mention the bureaucratic hassle that goes with it, so they limit their number of Medicaid patient – a prudent small business decision.  Because after all, doctors are small businessmen and women.  They employ staff, make payrolls, etc.  So, just like hospitals that do the same thing, they’re concerned with – what’s that nasty word?  Oh yeah, profit.

Nope, the market isn’t the problem here.  It is doing precisely what markets should do.  The outcome just isn’t the preferred one.

Oh, and under the category “never let reality stand in the way of your reality” or perhaps “facts, who needs facts, I have an agenda”, we find this.

~McQ

Twitter: @McQandO


Meanwhile back to the more mundane but important stuff

Like uncovering more nonsense to be found in the promises made for ObamaCare.

Such as, “when everyone has insurance, Emergency Rooms will no longer be overcrowded.”

Uh, wrong:

Hospital emergency rooms, the theory goes, get overcrowded because people without health insurance have no place else to go.

But that’s not the view of the doctors who staff those emergency departments.
The real problem, according to a new survey from the American College of Emergency Physicians, isn’t caused by people who don’t have insurance — it’s caused by people who do, but still can’t find a doctor to treat them.

A full 97 percent of ER doctors who responded to the ACEP survey said they treated patients "daily" who have Medicaid (the federal-state health plan for the low-income), but who can’t find a doctors who will accept their insurance…."The results are significant," said ACEP President Sandra Schneider in prepared comments. "They confirm what we are witnessing in Massachusetts — that visits to emergency rooms are going to increase across the country, despite the advent of health care reform, and that health insurance coverage does not guarantee access to medical care."

Yes, that little 1/50th scale ObamaCare model that’s been functioning – well sort of – in Massachusetts (aka RomneyCare) has proved to be the debacle it was predicted to be.

And the ObamaCare promise hasn’t tested out there at all. 

The Massachusetts story Schneider refers to is important because it shows exactly what we can expect under the new health care law. In the wake of the Bay State’s 2006 health care overhaul, which provided the model for ObamaCare, emergency room visits soared. Backers of that overhaul made arguments similar to President Obama’s, saying that they hoped that by expanding insurance coverage, they’d get people set up with primary care physicians and thus reduce the number of emergency room visits. Didn’t happen. Lines to see doctors got longer. And as they did, emergency room visits rose 9 percent between 2004 and 2008, at which point the commissioner of the state’s Health Care Finance and Policy division kind of shrugged his shoulders and admitted that the uninsured aren’t really the cause of emergency room crowding. Too bad, I guess, and too late: Massachusetts passed the law anyway. And now the rest of us are stuck with it too.

Yup.  And the cost?

But John Goodman, the head of the National Center for Policy Analysis, did some rough calculations for the health policy journal Health Affairs last year, and he estimated that thanks to the law’s coverage expansion, we can expect somewhere in the range of 848,000 to 901,000 additional emergency room visits each and every year. ObamaCare’s backers are right that, as passed, the law will result in significantly greater health insurance coverage across the country. But all that coverage will come with a hefty price tag attached: about a trillion dollars over the next decade, and more like $1.8 trillion in the first full decade of operation. In return we’ll get longer wait times at the doctor, and even more crowded emergency rooms—but nothing like a guarantee of actual access to care.

Reality.

Sucks, doesn’t it?

~McQ

Twitter: @McQandO

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