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Sarah Kliff, health policy reporter for The Washington Post and Wonkblog, gives us the latest updates from the ACA roll out, and what we can expect in 2014.
re: getting more physicians to accept Medicaid patients. Medicaid payments are so low that most independent primary care physicians and specialists cannot afford to accept the ridiculously low payments and still pay the rent, auxiliary staff and malpractice insurance. It is not that they don't want to, they just can't afford it. Come visit our surgery practice in NYC and get an idea of how low all insurance payments already are (pennies on the dollar) , how high the expenses are and how we struggle to pay our bills and still provide quality care and time with our patients.
So the logical question is has the Massachusetts' Emergency Room "use rate" gone down from its pre-RomneyCare level or from its Medicaid-inflated level?
If you or your guest (or, most likely, your staff) would put up the links for study or studies you're relying on I'd like to look at them.(Or is this another instance, like from the last segment, that you hope someone has crunched the numbers for?)
Call me naive - and simplistic - but If we got our priorities straight and had a National Health plan that eliminated private insurance companies, we wouldn't be having this conversation.
Unless I'm mistaken, I recall reading about studies a few years ago that determined that there was no difference in mortality -- life spans -- between folks who visited physicians on a regular basis vs those who avoided doctors. The study may have been only for men, but I don't recall that detail.
That would align with what the guest is saying about the lack of showing of any noticeable health gains in -- where was it? Oregon?
Emergency Room is today a misnomer. There is no "emergency" in emergency care rooms you're brought in by an often uncaring EMS "couple" and you get in line and wait your turn when you arrive. That to me is not emergency care it's developing world care where you line up and wait your turn. Some even hand out numbers. My last experience was truly a horror where I was bleeding profusely, called EMS who wouldn't enter my apartment unless I got dressed then roughly got me down to the ambulance slowly then got in line at the ER entrance bleeding profusely and then answer questions. Ugh, I'm getting sick rethinking it. Just trust me, next time a taxi would be faster and better.
PS: The critical emergency conditions that the poor suffer from don't disappear overnight--out-of-control diabetes (people need to learn how to manage it), erratic blood pressure (managing varied Rx), mental health problems that there are varied mechanisms of treatment ... It takes time to relearn these complicated problems, especially at the same time as people are trying to manage reduced food stamps, a cut off in unemployment, low wages, changes in children's care and schools.
Is there any way we can develop the compassion to put such changes in context?
I'm one of the social workers in a large NYC hospital ER, and a big part of the problem is that so many people who use the ER for primary care for so long because they lack insurance, etc., have come to respect and expect the high-quality care they've received over the years, and the staff eventually is considered their "primary" care providers.
What I want to see happen is more Medicaid providers to serve these people; absent that, then ER's should get a separate, negotiated rate from Medicaid (and even Medicare for the many many 80, 90, and even 100 years olds we see regularly).
And the primary care doctors who immediately send their patients to the ED on the phone, should provide the follow-up appointment at that same moment.
This is a critically important moment to observe the detrimental effect of our frenetically rushed so-called information society. How long did it take for the poverty reduction of Social Security and Medicare to show up in stats on the elderly? Seems to me that would be the best point of comparison, not recent studies.
Emergency rooms should present all users with a list of primary care providers who take Medicaid in their regions. New health insurance recipients need to be steered to smaller clinics for mundane health issues.
It's not all that complicated, new coverage increases usage across the spectrum of care. ER visits are a part of that spectrum.
This should have been alternatively called the Unaffordable Care Act for low income and those living below so-called poverty level income. I call it so-called because it should actually be quite a bit higher than it is, it's way too low for livable means. If you all rejoice in an $8/hr pay rate, you must be making at lest a 6 digit annual figure and are that distanced from the reality of how much is required to live these days in rising food and shelter costs. I don't expect TV and radio hosts to get it at the levels of their salaries.
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