Hacker News Reader

Comment by dmcgee | Hacker News Reader

"There isn’t good evidence that people overuse the ER"

Have any of the people quoted been in an ER? Even accepting the premise that hospital prices are outrageous for ER visits, walk into any hospital and it should be clear that a lot of the patient population is not there for an "emergency". In the US, the ER acts as a catch all for what often should be handled by social services (some of which don't exist). Drug seeking patients, homeless patients, and patients with mental health issues very often end up in the ER.

View on HN

> Drug seeking patients, homeless patients, and patients with mental health issues very often end up in the ER.

A lot of these people end up in the ER because they don’t have any health insurance at all. But that’s well outside the scope of the “issue” the health insurance company describes in the article. I have had friends and family who had to be dragged to the ER because they didn’t think their situation was enough of an “emergency” but it absolutely was: chest pains were a heart attack in progress and a fever with a stiff neck was a pretty serious infection, for example.

How many legitimate emergencies vs “non-emergencies” will be discouraged from receiving ER treatment? I suspect legitimate emergency treatment foregone will be larger (and represent a significantly larger cost savings to the health plan) at the expense of our collective long-term health and well-being.

Indeed, I think the whole "ER overuse" thing is a smoke screen. Yes an ER has certain facilities that are needed for truly critical situations. Been there. But if someone walks in with a stubbed toe, that person is questioned at the front desk, and is directed to a waiting room and an experience that is pretty much just like regular urgent care.

Simple non-technical solution: Build a regular urgent care facility next to the ER and shunt the non-emergency people to it.

> Drug seeking patients, homeless patients, and patients with mental health issues very often end up in the ER.

Doesn't sound like those are the kind of patients this insurer is concerned about? Or is it?

United Healthcare administers many Medicaid insurance plans.

And many people with drug or mental health issues also have successful careers and private insurance plans.

So UHC does pay many of those bills.

Was doing dinner with the owner of the company I work for, some of his family stopped by to join us. They said we don’t need universal health care for everybody, because the homeless people can just use the ER

Technically the homeless have government health care: Medicaid

not true at all. this varies by state.

aside from the homeless, what about all the people making minimum wage who neither qualify for medicaid, nor work enough to get employer supplied insurance?

sometimes the head in the sand attitude here is fucking sickening

Not by much, and frankly they will get lifesaving treatment regardless whether or not they pay the bill. What is the negative for not paying? Destroying the credit of someone who has effectively no credit anyway? Empty threat.

People making a minimum wage or who are minimally employed can qualify for lower cost affordable healthcare insurance through the ACA. It’s available, whether people take advantage is up to them. I know someone who pays less for their ACA plan than they do for their mobile and Internet services.

Where the ACA fails is more at the middle class family level. That is where the income vs. family plan costs tend to be out of balance.

yes! I'd probably argue that a majority (or at least significant plurality) of acute care (hospital care) in the US is the direct result of the failure of social services. I include in this mental health issues directly resulting in poor health, inability to access primary care (so minor/treatable issues become severe), housing issues, drug issues, lack of elder care options, etc.

As, an ambulance chaser who reviews ER bills and records, I’d add that a large portion of the ER frequent flyers are hypochondriacs.

I can't help think that also ties up to some mental health issues. Anecdotal, but I know a hypochondriac, a bad one, and I think a lot of her issues stem from anxiety of leaving her daughter behind if she dies or of losing her daughter (she's raised her kid to be one too). It became really clear this past year when taking to her how she thought every little thing she had waa Covid, even when it never matched the symptoms, and was always worried about how it'd affect her daughter.

She's also very much an overprotective parent in a lot of other ways, and I can't help but think the hypochondriac part stems from that.

Or get fucking GERD/other minor issues that masquerade as heart attacks (tight chest, numb left arm, heart racing, lightheaded), wonder if you should go, really don't want to pay yet another $1000+ to find out it's nothing again, hear the "better be safe than sorry" voice in your head that doctors keep telling you, and then maybe go versus waiting it out.

I swear I won't really know when I've actually had a heart attack because I've been faked out too many times by GERD reactions.

I've gone about 6 times to ER for it over the past five years, and probably stayed home another ~20 times. Each time I decided to go it's been nothing.

I've driven myself to the ER each time, though, even if maybe I shouldn't, so that saved a little money. Helps that a hospital is only 5 minutes away.

I am finally getting an endoscopy soon, maybe it'll discover something treatable.

Could someone with more knowledge explain to me "urgent care" and if there could be a case made to expand it?

I got injured (not too bad) and went to urgent care - my wait time was about 10 minutes. It costs me nothing, seems like a good system that would catch a lot of these borderline ER cases we hear about.

In my case, my insurer runs the hospital so it seems like they have an incentive to keep costs reasonable. But maybe, if you're a hospital and you are running numbers on adding ER or Urgent Care you default more to ER since you know you can just bill the insurance 10% over cost (or whatever) no matter what.

SF general a lot of years ago. I went once and got right back out. I think people were basically living there?

Reply on news.ycombinator.com