Where is this happening in the U.S. ? Where are the people who are not getting health care?

Question

Hospitals are required by law to treat any health emergency regardless of the patients ability to pay. Poor people have Medicaid, their local county hospital and free clinics to go to. Illegal aliens are not questioned about their immigration status at the local ER, they are taken care of and the hospital. Anyone can call 911 and get a ride to the local ER at any time no questions asked.

Do those without health insurance have to wait longer to see a DR. Yes. Do they have to go to public facilities without all the amenities of a private hospital. Yes. But they still get healthcare.

If you want better health insurance do like I do and PAY for it YOURSELF. Can't afford it, then work more hours, go to school and get a better job, or cut back in your spending in other areas.

Why do Universal Health Care advocates want to make it miserable for everyone to go to the DR?

Answer 1

I do not support universal health care--it does not work and in the US it would be unconstitutional.

Our current system stinks, however. A lot of your premises are wrong. First, the "poor" do NOT have Medicaid--you need to actually look at what you can earn to qualify. You have to either NOT declare your income, have a LOT of kids, or be a bum.

"Medicaid does not provide medical assistance for all people with limited incomes and resources. Even under the broadest provisions of the Federal statute (except for emergency services for certain persons), the Medicaid program does not provide health care services for everyone. You must qualify for Medicaid. Low-income is only one test for Medicaid eligibility; assets and resources are also tested against established thresholds. As noted earlier, categorically needy persons who are eligible for Medicaid may or may not also receive cash assistance from the Temporary Assistance for Needy Families (TANF) program or from the Supplemental Security Income (SSI) program. Medically needy persons who would be categorically eligible except for income or assets may become eligible for Medicaid solely because of excessive medical expenses."
http://www.cms.hhs.gov/MedicaidEligibility/

Their 2005 posting shows 33 states and DC have coverage for "medically needy" people. Sorry, but 2005 is the year that's on the site that is by the government, so that's what I have to work with to be factual.

A single person who earns $9,570 is at 100% of the poverty level. The site states that is $797.50 per month. That means basically if you made about $5 an hour and worked 40 hours a week you made TOO MUCH MONEY for Medicaid.

Apparently the government believes that two can live as cheaply as one, because for two people, the poverty level is $12,830 a year or $1,069.17 a month. If that were two adults who were working, $3.36 an hour makes you too wealthy if you both get that and work 40 hours a week. Assets are also held against you--so if you have a home, vehicle, or anything in savings--you very well may not qualify. How we get as many on Medicaid is there are special "groups" who can earn more than 100% of the poverty level and be on it--but typically this requires children (and remember, this is NOT the SCHIP program, this is for adult members).

For the working poor, THIS is what they are getting now:
http://www.businessweek.com/bwdaily/dnflash/content/nov2007/db20071120_397008.htm

That's because the uninsured don't get the massive discount prices that insurers command. I mean the price charged to the insurance is about half of what is charged to the uninsured, so the insurance pays a portion, the patient is supposed to pay his co-pay, and if they both do that, they're still paying less than half of what the uninsured are billed.

The CAGW (Citizens Against Government Waste) in 1998 took a look at if we were getting our money's worth out of the taxbreaks we provide the majority of hospitals. They concluded usually no. In 2006, they went back and updated (Wright, “Nonprofit Hospitals Still Abusing Tax-Exempt Status,” 26 July 2006). One example of what you can find is the uninsured poor woman billed for $20,296 for a procedure that Medicare would pay $3,994 to perform. I wouldn't be surprised if the Medicare reimbursement were too low (Medicare tries not to pay profit--to doctors for sure--or hospitals), but let's face it, with regular insurance, there's a good chance that would have been billed at under $10K. Some of it is a profit issue, but not $6K. Why bankrupt the poor woman (more than half of all bankruptcies are for medical bills and most of those folks are insured), throw her on a government program (Medicaid), but cut the handful of HUGE profitable health insurers such a massive break? I am all for profit and capitalism, BUT for capitalism to be what is operating, then the company needs to pay its bills. If it's only paying a portion of costs, then the "profit" is NOT earned. The trick is to pay your way AND turn a profit. THAT is business ability. Scamming the taxpayer is not.) And that is another problem with too many hospitals, even when they call themselves non-profits.

"In Who Killed Health Care?, Regina Herzlinger gives another frightening example of what too many hospitals are about: profit. She recalls being at a meeting for congressional legislative assistants about the creation of small, specialty hospitals to treat a particular health area, such as heart disease. The hospital was to be “partially owned and managed by doctors.” She notes that hospitals account for the bulk of costs and increases in costs of health care, but the established general hospitals saw the creation of specialty hospitals as an economic threat, so they went to Congress to disallow such hospitals from existing. The hospitals were represented primarily by the CEO of a “chain of 24 non-profit hospitals” who stated that such a specialty hospital would interfere with the billion-dollar non-profit’s ability to provide free and subsidized care to the poor and sick in that region. Supposedly the best-paying patients were being lured away from his chain to the 55-bed specialty hospital. Congress listened and instituted a “moratorium on the expansion of specialty hospitals.”

Herzlinger then looks at the facts. In 2003, while battling the small hospital, the non-profit earned $26 million in profits and had $50 million in liquid assets—after all expenses and charity care were deducted. In 2004, after Congress acted, the hospital had their profits and liquid assets increase 15 percent and saw fit to do things such as donate $200,000 to the local high school football league. However, the hospital’s charity care fell by 40 percent and profits increased. By 2005, the charity care was down to $3 million. By being considered as a non-profit, they had avoided “tens of millions of dollars in taxes.” The way they determined their charity care was also questionable. They listed the prices they’d charge the uninsured as what they were providing for free as well as declaring that the difference between the uninsured prices and what they did receive for Medicare and Medicaid were charity care as well. Herzlinger also notes that part of what the Congress was willing to fight, and the hospitals wanted them to fight, was that price transparency where patients would be told the truth before any procedures about costs so they could comparison shop (4-6)." --Save America, Save the World by Cassandra Nathan, pp. 143-144.

So yes, a person may get care, but then he may get a bankrupting bill, far in excess of what an insurer would have to pay. Is that right? How?

Also ERs are required to treat life-threatening cases to the point of stability, NOT see all patients, though I suspect esp. if you're an illegal they'll do anything for you for fear of a lawsuit about "discrimination." County hospitals also charge--they're not free. Here's an example from Maricopa County, AZ "Affordable Health Care

At Maricopa Integrated Health System, we know seeking medical care can be overwhelming. That's why we have developed a program to help you deal with the financial stress of paying for the health care you deserve.

MIHS' Financial Assistance Program is designed give you realistic payment options. Applicants must apply for, and be denied, AHCCCS to qualify for our Financial Assistance Program.

Key facts about MIHS' Financial Assistance Program

Maricopa Integrated Health System has professionals ready to walk you through the AHCCCS application process. Call the clinic nearest you to begin the application process.
Based on federal guidelines, you may be eligible to receive medical care from Maricopa Medical Center. (Based on AHCCCS denial)
A sliding fee scale will be used to determine the percentage of your bill you will pay. To find out more about the sliding scale, call the MIHS Business Office at 602.344.8181." http://www.mihs.org/servicesprograms/fap.html

"Free clinic" is misleading. "HRSA-supported health centers care for you, even if you have no health insurance. You pay what you can afford, based on your income." http://ask.hrsa.gov/pc/
There may be some genuinely free clinics, but they're not so common and it's not so easy. Let's look at LA as they love to try to be a total nanny state in CA.

"The Los Angeles Free Clinic provides high-quality and compassionate
medical and dental care, social services and education and outreach
to men, women and children in need.

When you come to The Los Angeles Free Clinic please bring your Medi-Cal BIC (Benefits Information Card) with you. If you do not bring your BIC you will not be able to receive services. If you do not have a Medi-Cal BIC, we can help you to get one." http://www.lafreeclinic.org/what.htm
Their mission says AFFORDABLE, their name says free:
"The Los Angeles Free Clinic, in collaboration with strategic partners, provides dependable and affordable quality health care and human services in a caring environment for the underserved and those who are most vulnerable." http://www.lafreeclinic.org/

There seems to be an underlying assumption that 911 will haul anyone for free to an ER for more potentially free treatment. Let's move to another state, MD and check that out:
"1. Does everyone get charged for an ambulance transport?
It depends! If you are insured, our Billing Agent will work directly with your health insurance provider and process all necessary claims. However, if you are uninsured, you will receive a bill.
2. Who sets the rates that are charged and how much does an ambulance transport cost?
The rates are set and approved by the Board of County Commissioners for Frederick County. The cost for an ambulance transport can range from $240 to $525 depending on the severity of the call. In addition, mileage is charged at $7.50 per mile.
3. What will happen if I do not have insurance?
No patient will be denied or refused medical assistance or transport due to a lack of insurance. Any patient who has difficulty paying the bill for ambulance transport services, or has a question, should contact the EMS Billing Coordinator at 301-600-1308 to set up a payment plan."
http://www.co.frederick.md.us/FAQ.ASP?QID=207

BTW:
"Does Medicare pay for ambulance transportation?
Medicare Part B pays 80% of the charge for a medically necessary ambulance transport. The remaining 20% will be due from you. If you have secondary insurance coverage, they will be billed for the remaining balance."
"What happens if I call 911 and don't need to be transported? Will I be billed?
No! We bill ONLY if we transport you. You will, however, be required to sign a refusal of care form, releasing all Emergency Medical providers from any liability arising from your refusal to go to the hospital."
" Isn't this double taxation? Am I already paying a fire/rescue tax for ambulance transport services through my property tax payment?
NO! Your fire/rescue tax helps fund career personnel stationed at local fire/rescue companies throughout the County. Revenues obtained from Ambulance Transport Insurance billing help offset all other costs associated with the management, maintenance, and operation of ambulance and emergency medical equipment. Additionally, revenues help provide funding for new fire/rescue operations, capital improvements, and training, etc. Making insurance claims to offset ambulance transport costs is an opportunity to help maintain taxes. Without it your taxes would be higher!
10. Why am I being billed for ambulance transport services? Isn't the service free?
No! Ambulance Transport services are not free. Each year the emergency call volume increases, placing an enormous strain on an already overburdened resource. In order to recoup costs and help ease the burden on taxpayers and property owners, we bill your Health Insurance for this cost. You are already paying a premium to the Health Care provider, that, in many cases, covers a portion of the Ambulance Transport services."

Do you have to wait longer to see a doc because you have no insurance? Not necessarily--you have to pay more, but they don't make you wait just because you don't have insurance.

You say the uninsured can go to a public facility which is not so nice as the private and get health care--yes and they'll get a huge bill far out of line with what an insurance COMPANY will pay.

FYI, there are many people who are UNINSURABLE. Not uninsured--they can't get insurance AT ANY PRICE. They're not drug addicts, AIDS patients, or bums either. Furthermore, there a lot of folks with pre-existing conditions that pay more and have less coverage and are financially at risk because of it. NOT ALL STATES offer high-risk insurance pools either.

SOME people can only get "guarantor" class coverage--their premium can be far in excess of $1K a month, their deductibles, co-pays, etc. can be very high. They could be looking at $18K a year JUST for the health insurance coverage you assume is so easily available.

Don't even get me started on Medicare for disability--virtually no one can get on without an attorney. You will have NO coverage until at least 29 months after they recognize you as disabled as well.

So, why am I not a Socialist? Because I see where the problems lie: governmental interference and domination of the market by insurers given special breaks left and right.

When the insurers are out of it (or largely so) and the government is not micro-mis-managing health care, it IS affordable:

LASIK--down dramatically in a decade (Medicare, Moore's "solution" has premiums that more than doubled. In 1998, $43.80, in 2008 $96.40. Let's not forget the 20% co-pay or the premium for the medigap insurance. Or the prescription donut hole. Or the fact doctors are leaving the system because of low pay. Or...)

Plastic surgery--purely elective--extremely affordable. Compare a tummy tuck to a basic appendectomy WITHOUT peritonitis or complications.

http://www.simplecare.com/

Diagnostic tests (from blood work to mammos) at grocery stores monthly from a private lab--very affordable.

Walk-in clinics, again popular with some grocery stores, Wal-Mart, CVS, etc.--can be seen for a REAL problem like an upper respiratory infection--for probably $80 or less (not necessarily including the medication).

Here's a doctor OWNED and RUN hospital:
http://www.azcentral.com/community/gilbert/articles/0217er17.html

So health care does NOT have to be outrageously priced. It is because we've allowed government and a handful of insurers to squeeze us.

Here's a sensible plan at this site. Read the PDF:
http://www.booklocker.com/books/3068.html

Answer 2

The Postal Service is failing because it can't maintain pace with today's correspondence. In the early 1970's Congress made it illegal for the USPS to do anything other than deliver mail. They cannot expand their services. To make things more difficult, we now have many more options for sending mail. Email, text, IM, etc have all taken their toll. Private businesses, which are able to do more than simply deliver mail, have also managed to take hold. Of course the USPS managed to screw some things up as well, such as paying millions of dollars for homes. For the record, postal employees get paid a a decent, living wage.

Answer 3

If you are middle class American, you can expect two things. One, expect to shell out $600-$1100 for health insurance per month for your perfectly healthy family. That bites the big one right there. Secondly, if you do need to call 911 for a trip to the ER because you have suffered a stroke, expect to stand in line behind the illegal from El Salvador who sprained his ankle.
The only thing that can possibly worsen this health care fiasco is for the government to get involved. No doubt it would use Canada and the UK as role models. God help us all.

Answer 4

The government has never been capable of running any program, without huge deficits or running it into the ground
or have so much fraud that the people it was meant to help get nothing. When will we figure this out?
I don't want the government getting involved in anything other than protecting the nation, and infrastructure.


Mike...

Answer 5

Number one:Hospitals are required to provide ONLY what treatment is necessary to stabilize a patient IF that hospital has received Federal Funds.
Number Two:Try standing beside the bedside of your 80-year old WWII Veteran father when he is kicked out of the hospital after he has reached the limits of his coverage following a heart attack and it is his PHYSICIAN who tells him he has to go.
Then tell me how you feel.

Answer 6

You need to get out more.

Do you realize the number of patients that are turned away from emergency rooms because they are filled up with those people you just listed? They are forced to go to an available one farther away. That ties up emergency resources everywhere.

Do you know that most doctors will not give you the time of day without having insurance or be able to pay out-of-pocket? What happens to those that cannot pay? They wait until they are in dire need of care and go to the emergency room. The cycle starts again.

You have to look at the big picture. Not just your tiny corner.

Read it and weep (if you can muster the tears.)

Answer 7

You're right. The working poor has medicaid and the elderly have medicare. This are people who are living below povert line therefore qualify for these programs. The people who supposedly don't have health care earn more than medicaid recipients because they don't qualify. Even for adults who are below poverty line there is a program called Charity Care where they can go to the doctor for free. As you said illegal immigrants can go to the hospital anytime, I'm curious to see what people are the ones without healthcare.

Answer 8

They are probably the working poor who are not qualified under student insurances--most estimates claim they are adult age through middle age. Forgotten in re to the legislation that was implemented in the 90's.

Now the current proposed legislation is targetting children; the legislation should consider that kids need healthy parents as well.

Some kind of tax break, or way to reduce insurance premiums for families.

The American Medical Association has alot of great info in re to this topic, as well as recommendations for insurance plans :)

Answer 9

I think its the $28,000 bill and harassing phone calls from collectors when you get emergency treatment without Healthcare!

A person can afford themselves to pay for insurance
That is only $45.00 per month (Employee only)

But as soon as you add your family (Spouse & Children)
It goes up to $948.00 per month

What the holy heck!

Why does it go up $900.00 to add your family?

Seems like they are forcing both spouses to work!

This Nations healthcare system sucks!

Just like the consumer Corporation scam.

You know

How every business is now a franchise so the parent company can't be touched by complaints or lawsuits.

It is everywhere and in every business!

We are ruled by Corporation - Automated systems, Redirect - it is rediculous!

There is no protection for the consumer! It is all about nickle and diming us to death and forcing us to do things their way!

All meant to steal from you and force you into a corner

Answer 10

Wow you put exactly how most people feel about this into perfect perspective, God forbid the media does the same...