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Public healthcare in US

Public healthcare in US

Old Sep 9th 2019, 10:37 am
  #1  
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Default Public healthcare in US

Listening to LBC this morning, and American caller was explaining that in fact the US has a system of public hospitals who will treat anyone regardless of ability to pay. He further explained that private hospitals will send patients who lack insurance/cash to such public hospitals. Not sure if it was limited to emergency treatment, perhaps. Is that the case, I had assumed it was wholly private in the US?
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Old Sep 9th 2019, 12:16 pm
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Default Re: Public healthcare in US

Originally Posted by Shard View Post
Listening to LBC this morning, and American caller was explaining that in fact the US has a system of public hospitals who will treat anyone regardless of ability to pay. He further explained that private hospitals will send patients who lack insurance/cash to such public hospitals. Not sure if it was limited to emergency treatment, perhaps. Is that the case, I had assumed it was wholly private in the US?
All US hospitals will treat in an Emergency room.
I assume all have an annual write off to cover people with no ability to pay.
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Old Sep 9th 2019, 12:28 pm
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Default Re: Public healthcare in US

Originally Posted by Shard View Post
Listening to LBC this morning, and American caller was explaining that in fact the US has a system of public hospitals who will treat anyone regardless of ability to pay. He further explained that private hospitals will send patients who lack insurance/cash to such public hospitals. Not sure if it was limited to emergency treatment, perhaps. Is that the case, I had assumed it was wholly private in the US?
The caller was 100% correct. Daughter who had an aggressive breast cancer diagnosed last August while they were uninsured (not going into this here) had her 16 weeks of chemo done at a public hospital. Some of the drugs were free and the charges for the rest were 1/3 of what the normal cost would be for a person with insurance. She was told by the hospital that she could not be denied the same care as anyone else who had insurance because they were a public hospital. MRI's, bone scans, etc. were at full cost (3 tests at public hospital would be $8,500). On advice she went to a private lab for testing and the same 3 tests came to under $1K. Needed to use a surgeon for breast removal who only practiced with a private hospital. Hospital would not allow surgery until it was pre-paid. What would have been over $100K was bill in full at just under $20K. The surgeon lowered his bill and charged only $1800.

As for what is still owed at the public hospital for the marked down services, she pays a small amount monthly and all is well. She will go for her last surgery for breast implant later this month. That needs to be paid in full.
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Old Sep 9th 2019, 12:38 pm
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Default Re: Public healthcare in US

All hospitals must assess and stabilize without regard for ability to pay (research EMTALA)

After that though, you're on your own. They can demand payment up front and refuse service until it is provided.

County hospitals (and there aren't many of them anymore) are what you are talking about when you say 'public' hospitals. Most of them have been bought out by healthcare groups as the counties can't afford to lose the money that they do.
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Old Sep 9th 2019, 12:58 pm
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Default Re: Public healthcare in US

Yes this is true.
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Old Sep 9th 2019, 1:00 pm
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Default Re: Public healthcare in US

Didn't know this, thanks.
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Old Sep 9th 2019, 2:30 pm
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Default Re: Public healthcare in US

One note, I have a friend who's an ER doctor for a large, prestigious private hospital here in Chicago. He estimates that about half of the work he does is pro bono (meaning they don't charge for it) and has told me that this is pretty typical for most ER rooms. The work they give away is far more than just "stabilizing" patients. Not sure how correct he is, just a relevant anecdote.
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Old Sep 9th 2019, 2:34 pm
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Default Re: Public healthcare in US

the work they give away is far more than just "stabilizing" patients.
As I said in my response, that is what they are legally required to do under EMTALA. In reality most often do more than that, agreed.

He estimates that about half of the work he does is pro bono (meaning they don't charge for it) and has told me that this is pretty typical for most ER rooms
Meaning that the rest of us, the paying part of the public, eat it in increased charges for the facility to remain profitable. In US healthcare, someone is always getting the bad end of the stick.
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Old Sep 9th 2019, 3:23 pm
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Default Re: Public healthcare in US

Originally Posted by excpomea View Post
I assume all have an annual write off to cover people with no ability to pay.
My other half works in healthcare and from what I understand, there are discount schemes and tax advantages for providers, especially when dealing with underserved and undocumented communities; there are things that providers can access for pennies per dose so long as the patient is suitably qualified.

They do what they can for patients in need, and what they can do is lot more significant than you might think although it's still not a position that you want to be in if you can avoid it.
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Old Sep 9th 2019, 4:05 pm
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Default Re: Public healthcare in US

VA is probably bigger than most Countries public systems.
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Old Sep 11th 2019, 1:28 am
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Default Re: Public healthcare in US

Here's an example of a non-profit, publicly supported hospital system that aggressively pursues medical debt.

"The hospital ranked No. 1 in Virginia by U.S. News & World Report is taxpayer supported and state-funded, not a company with profit motives and shareholder demands. Like other nonprofit hospitals, it pays no federal, state or local taxes on the presumption it offers charity care and other community benefits valued at least as much as those breaks."

But..

"Over six years ending in June 2018, the health system and its doctors sued former patients more than 36,000 times for over $106 million, seizing wages and bank accounts, putting liens on property and homes and forcing families into bankruptcy, a Kaiser Health News analysis has found."

https://beta.washingtonpost.com/heal...18c_story.html
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Old Sep 11th 2019, 2:41 am
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Default Re: Public healthcare in US

So I just went back to the UK. Parents' 50th wedding anniversary.
On the flight over, my little finger went weird. Not sure what the deal is - thought it was dislocated. Possible result of a dirtbike accident a few weeks prior. Went to the emergency room - they took X-rays. Couldn't relocate finger. Spent 20 minutes huffing nitrous oxide while the NP set up a meeting at "plastics". They told me I had a central slip injury. Went to Salisbury at ridiculously early time in the AM. They wanted to put a cast on but wouldn't because we were flying home in a couple of days and apparently casts are a no-no.
Went to the ortho place here, doctor says not a slip injury. Some weird deformity that white Western Europe males get. Recommends MRI. Self pay. Great.
It was nice to be seen by the NHS - self pay - but they sound like they dropped the ball. And an MRI? Seems like overkill. Meanwhile I have a "pinky" that looks like it could be the villain in a Vaudeville play.
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Old Sep 11th 2019, 4:54 pm
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Default Re: Public healthcare in US

MRI for a reliable diagnosis is surely a good idea? How else will they see what is going on? I wish my ortho had sent me straight for MRI with a shoulder injury a few years back - would've saved months of pain and useless steroids.
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Old Sep 11th 2019, 5:01 pm
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Default Re: Public healthcare in US

Originally Posted by Octang Frye View Post
So I just went back to the UK. Parents' 50th wedding anniversary.
On the flight over, my little finger went weird. Not sure what the deal is - thought it was dislocated. Possible result of a dirtbike accident a few weeks prior. Went to the emergency room - they took X-rays. Couldn't relocate finger. Spent 20 minutes huffing nitrous oxide while the NP set up a meeting at "plastics". They told me I had a central slip injury. Went to Salisbury at ridiculously early time in the AM. They wanted to put a cast on but wouldn't because we were flying home in a couple of days and apparently casts are a no-no.
Went to the ortho place here, doctor says not a slip injury. Some weird deformity that white Western Europe males get. Recommends MRI. Self pay. Great.
It was nice to be seen by the NHS - self pay - but they sound like they dropped the ball. And an MRI? Seems like overkill. Meanwhile I have a "pinky" that looks like it could be the villain in a Vaudeville play.
Normally they just chop it off as you have an extra one on the other hand.
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Old Sep 14th 2019, 1:27 pm
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Default Re: Public healthcare in US

Originally Posted by Rete View Post
The caller was 100% correct. Daughter who had an aggressive breast cancer diagnosed last August while they were uninsured (not going into this here) had her 16 weeks of chemo done at a public hospital. Some of the drugs were free and the charges for the rest were 1/3 of what the normal cost would be for a person with insurance. She was told by the hospital that she could not be denied the same care as anyone else who had insurance because they were a public hospital. MRI's, bone scans, etc. were at full cost (3 tests at public hospital would be $8,500). On advice she went to a private lab for testing and the same 3 tests came to under $1K. Needed to use a surgeon for breast removal who only practiced with a private hospital. Hospital would not allow surgery until it was pre-paid. What would have been over $100K was bill in full at just under $20K. The surgeon lowered his bill and charged only $1800.

As for what is still owed at the public hospital for the marked down services, she pays a small amount monthly and all is well. She will go for her last surgery for breast implant later this month. That needs to be paid in full.
I'm very sorry to hear of your daughter's illness and the financial problems she will experience as a result. I really don't understand why so many people in the USA seem implacably opposed to "socialised medicine".

I live in Spain, which has a publicly funded healthcare system much like the NHS, except that we have co-payments for prescriptions. On Sunday 1 September I experienced some alarming symptoms so went to see my doctor the next morning (no difficulty in getting same-day appointments here). She gave me an urgent referral to a gynaecologist at our local hospital. The next day I got a call from the hospital giving me an appointment with the specialist on Thursday 5 September. The gynaecologist did an ultrasound and took samples for a biopsy (said something was showing up on the ultrasound which could either be a polyp or a tumour). I was given another appointment for yesterday to get the results of the biopsy. At that appointment I was told I have a small tumour (Grade 1, thankfully) and will be having a radical hysterectomy. I was given an appointment to see an anaesthetist on 30 September and told to await a call from the hospital with an appointment for an MRI scan, and put on the surgical waiting llst as an urgent case. I will get a blood test done at our local health centre on 16 September. The call re the MRI scan came 2 hours after I got home, with an appointment on 17 September. As a patient, all this, plus the surgery itself and aftercare, costs me precisely nothing other than the small amount I pay in taxes.

We do have private health insurance, but for something like this the public system is actually better and faster. I once had a biopsy done in the private sector here and the results took 2 weeks to arrive, twice as long as this latest one. I will have to share a room and bathroom with one other patient in the hospital, but the newer public hospitals here are all built with individual private ensuite rooms.
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