Health insurer plans to deny ER claims if it doesn't think you had emergency

Fezman92

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Do you think that we shouldn’t have universal healthcare?
 

EpiEMS

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Cannot access the article. Yes, I did the "register for free" and then it said site down. Tried a second time, and it went to locked page.

If you have the article in its entirety and can share it, please do so. I am not going to buy it.

The headline is interesting, but without all the other data points and breakdown by category, I cannot debate or comment.

Authors’ manuscript is free here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3955206/#!po=0.943396

The long and short of it is that there are only two true insurance RCTs done in the US. The Oregon Medicaid one and the RAND health insurance experiment - both are gold standard but the RAND one (which had similar findings) is much older. One reference here: https://www.rand.org/content/dam/rand/pubs/reports/2006/R3469.pdf
 

EpiEMS

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Do you think that we shouldn’t have universal healthcare?

As a stand-alone term, universal healthcare is basically meaningless. What is health care (e.g., do you include dental? Prescriptions?)? Are there copays?

There are so many variants on the theme - the NHS, Canada’s provincial Medicare, our Medicaid, etc. all of which are hugely different.

I do not believe that universal zero fee at point of service care makes sense. I am in favor of at most a catastrophic coverage mandate and subsidies for catastrophic conditions, public health measures, and basic research.
 

Fezman92

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What do you define as catastrophic conditions?
 

FiremanMike

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Do you think that we shouldn’t have universal healthcare?
I have a VA clinic in my running district and we are there daily to transport people out.

I think universal healthcare is theoretically a fantastic idea. With that said, you can view what universal healthcare looks like in America by viewing our VA system…it ain’t pretty..
 

DrParasite

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EpiEMS

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What do you define as catastrophic conditions?

Catastrophic coverage is probably best defined by the financial and/or employment burden - the proverbial “hit by a bus” or a cancer diagnosis, something like a $5,000 deductible. Obviously that is a handwave-y estimate but roughly in line with what you see out in the marketplace.
 

E tank

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Catastrophic coverage is probably best defined by the financial and/or employment burden - the proverbial “hit by a bus” or a cancer diagnosis, something like a $5,000 deductible. Obviously that is a handwave-y estimate but roughly in line with what you see out in the marketplace.
I have one. It works in combination with an health savings account. You contribute pre-tax dollars and the earnings are not taxed as long as it's used for qualifying medical expenses which are pretty broad. Balances roll over year to year and when you're 65 you can use it for non-medical expenses and not be penalized. Getting into one in your 20's or 30's generally assures you 10's of 1000's of dollars cash for when you begin to access substantial medical care. They keep premiums low and even if you're deductible is 7500 to 10000, you don't feel a thing. Great way to go especially if you're young...'cause you won't always be and when kids come along and have problems with tonsils, ear infections and broken bones, you'll be covered then too. And because you have cash in hand (it accumulates surprisingly quickly) you can come to terms with providers for a discount.
 

Fezman92

NJ and PA EMT
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I have a VA clinic in my running district and we are there daily to transport people out.

I think universal healthcare is theoretically a fantastic idea. With that said, you can view what universal healthcare looks like in America by viewing our VA system…it ain’t pretty..
that’s not quite universal healthcare since it’s contained to one company so to speak. Universal healthcare wouldn’t replace hospitals or anything like that, just replacing the private insurance with publicly funded insurance.
 

FiremanMike

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that’s not quite universal healthcare since it’s contained to one company so to speak. Universal healthcare wouldn’t replace hospitals or anything like that, just replacing the private insurance with publicly funded insurance.
For that cohort of patients (veterans), it is universal healthcare. They have publicly funded insurance and a variety of hospitals, clinics, and practitioners that provide all levels of care based on the individual needs of the patient. It is the US example of what we hear of universal healthcare in other countries, such as “this isn’t an emergency, we will refer you to the next available ortho surgeon” and then you wait for a call.
 

EpiEMS

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that’s not quite universal healthcare since it’s contained to one company so to speak. Universal healthcare wouldn’t replace hospitals or anything like that, just replacing the private insurance with publicly funded insurance.
Not necessarily true. Universal "healthcare" takes many different forms in many different countries.

Medicaid is an example of single-payer, which is a form of universal health care (in this case, for a large subset of the population) - Medicaid pays private or not for profit providers for providing care to the population at designated rates.

The NHS, in the UK, is another example of universal healthcare, a classic Beveridge model in which care is provided by public (yes, government employed & owned) providers and facilities at zero cost to patients at point of service.

The Germans have a universal system too, but it's multi-payer - you must either be part of a "sickness fund" (basically, an insurance plan) and these funds pay providers based on contractual arrangements. In theory, this isn't so crazily different from the US, except for the scope of coverage, the mandatory nature of coverage, and that the sickness funds are all not-for-profits. (There is also about ~10% coverage of what we understand as private insurance, which you can get only if you are above a certain income level.)

Singapore has a universal system too, everybody has to have (public) catastrophic coverage & mandatory tax exempt HSA-style accounts (plus a Medicaid-style plan for the poor).

However -- universality is subjective because no system covers all types of care. The NHS, for example, excludes dental & vision care. Medicaid may or may not cover dental (depending on the state).

Point is, universal healthcare is not one concept & may vastly differ across the globe, or even within a country! (The VA vs. Medicare vs. Medicaid, etc.) You can have universal healthcare with public providers, with private providers, or with a combination. You can have universal coverage with or without public insurance options. You can even have universal healthcare without insurance -- think the Soviet Union's model.
 

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