ACA in Kentucky

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morriswalters
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Re: ACA in Kentucky

Postby morriswalters » Thu Jan 09, 2014 3:39 am UTC

First you have to become eligible. Not so easy in the past. Low reimbursements make access hard. First you have to find a doctor who accepts it. Then you have to get an appointment. And then you have to get there. The papers were written before the ACA. A lot of care happens in ER's or in walk in clinics. In ER's the primary mission is to get you out quickly. If your doctor friends are telling you they are seeing a lot of Medicaid patients they are both scholars and gentlemen.

Arariel
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Re: ACA in Kentucky

Postby Arariel » Thu Jan 09, 2014 3:51 am UTC

CorruptUser wrote:The people not on medicaid are by definition wealthier than those that are. As wealth correlates very heavily with health, it's hard to form a baseline to compare medicaid to. Of the uninsured, many are voluntarily uninsured; young healthy males that don't want to pay far more than their insurance is worth to subsidize everyone else.

First, all of that is irrelevant. The comparison is between people already undergoing treatment; they're already not healthy. Second, these are all studies done by people who actually know how to do studies, not random statistics; what kind of idiot doesn't correct for age and gender? Third, if you would actually read:
USA Today wrote:... And these findings hold up even when you correct for age and socioeconomic status.

Manhattan Institute wrote:... Medicaid was a statistically significant predictor of death three years after transplantation, even after controlling for other clinical factors. ...

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EMTP
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Re: ACA in Kentucky

Postby EMTP » Thu Jan 09, 2014 9:19 pm UTC

morriswalters wrote:First you have to become eligible. Not so easy in the past. Low reimbursements make access hard. First you have to find a doctor who accepts it. Then you have to get an appointment. And then you have to get there. The papers were written before the ACA. A lot of care happens in ER's or in walk in clinics. In ER's the primary mission is to get you out quickly. If your doctor friends are telling you they are seeing a lot of Medicaid patients they are both scholars and gentlemen.


I work in an ER, and this is mostly correct. (I'd say our priority is keeping you safe, focusing on emergency medical conditions that will kill you right now, rather than to "get you out quickly" but where possible, a quick "treat and street 'em" is a goal.) Having medicaid, or even medicare or private insurance, does not ensure that you will get the care you need in any kind of a timely fashion. People with Medicaid are better off than people with nothing, but that's not saying a lot.

We do our best in the ED. We know that we are the care provider of last resort. But there are several problems with loading more and more routine care on EDs:

1. It's expensive.
2. We aren't primary care doctors. I'm going to repeat that: We aren't primary care doctors. I can set a broken bone, recognize a heart attack, or cut a hole in your trachea to bypass an airway obstruction. But I know very little about the management of treatment-resistant hypertension, or designing an insulin regimen, or talking to people about smoking cessation or weight loss. I do it, but I'm a rank amateur. Primary care is its own thing. We aren't like the doctors on ER, who instantly recognize the most obscure medical syndromes and have flawless recall of the entirety of the medical literature. We are specialists. We specialize in emergencies. We aren't as good at the other stuff.
3. It's frequently a terrible experience for the patient. You have no appointment, you may wait for hours just to be seen, and the environment is typically noisy, crowded, and full of people who are exhausted and in pain.

Everybody needs access to primary care and as far as practicable, primary care should happen at the doctor's office, not in the ED. As the baby boomers' health declines, we're going to have our hands full with actual emergencies.
"Reasonable – that is, human – men will always be capable of compromise, but men who have dehumanized themselves by becoming the blind worshipers of an idea or an ideal are fanatics whose devotion to abstractions makes them the enemies of life."
-- Alan Watts, "The Way of Zen"


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