No, that three million dollar bill, in Austin alone, is footed by the taxpayers. Proponents of a national health care plan would have you believe that the problem is one of access, that the 15% of uninsured in this country have nowhere to turn but the ER for their care.
He has some good ideas but the above is at least partially wrong. Heck, a friend of mine who had health insurance was once told by their doctor "I can't do anything for you because it's not covered but wait a day or two and you'll be sick enough for the ER."
1. Strengthen primary care by shifting reimbursement away from the current procedure-based model, and forgive medical school loans to any medical student entering a primary care field. In twenty years, maybe less, the problem of primary care access will be solved.
The forgive loans part is probably a bad idea, but moving away from reimbursement payment models is a very good one.
2. Repeal or drastically overhaul EMTALA. Put an end to the indentured servitude of ER doctors who are forced to provide a substantial portion of their services to people who don't need to be in an ER in the first place.
EMTALA is abused but it also serves a critical function. Before this was mandated, emergency rooms often turned away people who appeared to have expensive problems or where not carrying proof of insurance.
3. Institute a copay system for ER visits for Medicaid recipients. As long as the care is free, there will be no incentive to use it intelligently. And by taking the steps in #1, there will be far more primary care clinics willing to see Medicaid patients.
That is a good idea.
4. Institute a review system for ER visits by Medicaid recipients who also receive food stamps or other forms of public assistance. Anything determined not to be an emergency, take the copay out of their other benefits. If a citizen who pays for their insurance is forced to decide between other bills and their ER copay, why shouldn't we expect the same of people on Medicaid, who aren't required to pay premiums of any sort?
That would be a huge mess, hard to implement, hard to police and likely to punish the worst off. I would much rather see a system that gives ERs a good way to channel patients back to regular care if their problems do not require immediate treatment.
5. Come to some sort of compassionate, but reasonable, standard of how much futile care we are willing to subsidize. 27% of Medicare expenditures are spent on people in their last year of life. I'm not advocating feeding Grandma to the coyotes after she breaks her hip, but any nurse, doctor or EMT who has ever cared for a nursing home patient knows that, for a great many of them, we only prolong their suffering, not their life by any reasonable measure.
Huge can of worms, but probably a necessary one.
Jay