US Public healt system

April 5, 2005 7:00 PM

I've had this argument with a friend of mine today on the United states public health services, we both disagree and i turn toward metafiler for an answer. my conception of the way it works it that if you don't have any coverage or work insurance or any way to cover for the bill you don't get treated...final ! his point was that people can allway acces "public" hospital and get treated for free, the truth must be in between our two vision, would anyone care to comment the way it works to our free health cared canadian ass ? regards, selfsck
posted by selfsck to health & fitness (57 comments total)

I'm poor, American, and I don't have health insurance, so I either have to go to the non-profit clinic for homeless youth or use a fake name and address at an emergency room when I get sick.

The ER legally has to treat someone when they show up. You won't get great care for non emergency things, and it certainly isn't preventative medicine, but yes, the truth is right between your opinions.
posted by cmonkey at 7:09 PM on April 5, 2005

They'll send bills, too, even if it's a public hospital emergency room. They're obligated to treat you, but also charge you (hence the fake name/address trick).
posted by amberglow at 7:11 PM on April 5, 2005

All you need to do is show up in the emergency room and you will be treated. The consequence: if you really need emergency care, you will be waiting as all of the uninsured are there for non-emergency, yet still somewhat urgent care. It's a broken system, but it somewhat works. They will send you a bill, which if you are destitute you will ignore. Of course with too many of these bills you will remain permanently destitute. Neat huh?
posted by caddis at 7:12 PM on April 5, 2005

I should also mention that the clinic option is really only open for me because I'm under the age of 25 and it's primarily staffed by students from a local naturopath college. People in more rural areas don't even have that opportunity and are left with ER visits as their only healthcare coverage.

And yeah, the ER will bill you for absolutely everything they possibly can.
posted by cmonkey at 7:12 PM on April 5, 2005

Your friend's right, basically. Hospital emergency rooms are required to treat all people regardless of ability to pay. But it means that many uninsured people put off primary care and use the ER as their only medical care. Problems which could have been solved/prevented with a simple office visit are allowed to exacerbate until they are a true emergency, which is a drain on the system.

We also have two social service programs: MEdicare and Medicaid. One is for senior citizens, one is for the poor. Each provides only very basic benefits which are not always adequate.

In addition, there are a range of clinics, practices, and service agencies providing a variable mix of services to specific populations. Clinics serve all kinds of different target groups (women and children, latinos, Vets, etc) and are funded in a variety of ways (federal, by grants, foundations, etc). The clinics are sort of ad-hoc. Some provide free treatment, some ask you to pay what you can on a sliding scale.

Others will flesh this out for me, but that's the overall picture. Obviously it's inadequate, but the US is not quite as brutal as to turn away the ill and unjured and let them die in the street. Yet.
posted by Miko at 7:13 PM on April 5, 2005

ERs have the right to turn away non-emergency patients, and some have started doing this (although only the non-insured need worry, natch).

They do have to treat genuine emergencies, but will bill you later at 3-10 times the rates insurance cos. pay for the same services.

I had no insurance last year when I needed an emergency gall-bladder-ectomy. Less than 24 hours in hospital = $26,000 bill. Insurance companies would have paid the hospital ~$5,000 maximum.

Most hospitals will go after you & sue if you own a house or car -- in Chicago they've taken to doing "body attachments" -- suing and then arresting non-payers.
posted by words1 at 7:22 PM on April 5, 2005

In various places I've lived in rural Vermont there are a few options. You can go to a clinic which is a place like Miko describes. I have been to them for non-emergency care and paid on a sliding scale. Many small towns here have little clinics that are in part funded by tax dollars. I think the one near where I work is actually just free, but it's open two days a week. Usually they are staffed either by permanent medical professionals or folks from the local hospitals doing pro bono work. You can also go to the emergency room where, out here, you generally will get treated without too much time wasted, you will also get billed, a lot. The biggest problem is that medical bills are high, ER prices are way higher than regular care, and poor or even un-rich non-insured people often can't get treated anywhere BUT the ER which saddles them often with unpayable medical bills.
posted by jessamyn at 7:34 PM on April 5, 2005

...and to make the system sound even more crazy and cruel...

When the hospital provides you treatment, they will then charge you between three and five times as much for the services as they would charge someone who had insurance !

I had a kidney stone last year (painful, but not serious), and spent about 4 hours in the emergency room. I got a first billing from the hospital as though I did not have insurance. The total--hang on to your hat--was $36,000 !

Once we cleared up the insurance matters, they created a new bill, using the "pre-negotiated" rates of the insurance company. The bill, for precisely the same services, was almost exactly $7,000. I ended up paying 20% of that.

Had I not had the insurance, I would have been obligated to pay the full $36 grand, and the hospital would have been free to attach my wages, car, computer, etc. to satisfy this bill.

Our health system is whacked.
posted by curtm at 7:41 PM on April 5, 2005

Do drop-in clinics, that is fee-for-service GPs with no appointment required, not exist in the US?
posted by bonehead at 7:42 PM on April 5, 2005

ERs have the right to turn away non-emergency patients, and some have started doing this

ERs in public hospitals? Say it isn't true, please. This whole situation contributes greatly to the bankruptcy rates--many people file because of overwhelming medical bills. And 40 million plus of us don't have insurance.

bonehead, we have things like that (DOCS in NYC is one), but you still need insurance, or pay way more than usual. I think they're allowed to charge whatever they want--there are no regulations for medical billing by private practices/concerns i don't think.
posted by amberglow at 7:48 PM on April 5, 2005

My parents don't have insurance and they've used their relationships/friendships with doctors to get things like surgery scheduled in a regular hospital. After which they enter into a payment plan with the hospital to pay the full bill over time.

The hospital is also holding off on billing my parents for care that is expected to be paid eventually by an insurance company (the other driver...).

My father also got some major dental work done in exchange for building the dentist a mantlepiece.
posted by xo at 7:49 PM on April 5, 2005

Hospitals that receive public monies are required to provide free "charity care" to the poor. However, hospitals can define "charity care" in a variety of stingy, evil ways, so fake name/address saves you from a long long argument about whether or not you are actually poor. This argument also applies to Medicaid (for the poor), as its cutoff income is so absurdly low, that you can be plenty poor and still not qualify. I was given to understand that this is a result of the povery limit being defined in large part by the cost of food, which has stayed low while other living costs have increased.

Many people I know who are uninsured have a doctor friend (often in another state or leftover from when one was insured) who will call in prescriptions for them. I am in this boat, as I have eczema & a friend's father who prescribes my ongoing meds.

As far as I know, bonehead, there are not public drop-in clinics as you describe. Many group practices that are part of an insurance program will have drop-in times. I do not know if you can go uninsured, as I have never tried. Another option is to get a good doctor and pay her ~$250 a year for a physical. If you get one with a small practice (usually a result of not taking insurance), you can usually get an appointment pretty fast/drop in. I know some people who do this. It's pricey, but not as expensive as paying insurance.

Also, the reason that ER bills for the uninsured are so high is *because* of the insurance companies. They negotiate rates so low that the hospitals have to recoup on the backs of those almost least-able to afford it: too rich for Medicaid, too poor to obtain insurance on their own.

Yeah, the US rocks.
posted by dame at 7:59 PM on April 5, 2005

So if I am uninsured, go to the ER for emergency care, and can't pay the bill, does it go to collection agencies & ruin my credit before I even have any?

Thank you for the question, selfsck, and to everyone for your answers. Very enlightening to this lucky Canadian. I've never paid a dollar for my medical care (other than perscriptions & dentistry after the age of 18) and I've had (minor) heart trouble and a baby.
posted by raedyn at 9:00 PM on April 5, 2005

We also have two social service programs: MEdicare and Medicaid. One is for senior citizens, one is for the poor. Each provides only very basic benefits which are not always adequate

Medicare at least provides far more than "very basic" benefits. Far, far more.

Do drop-in clinics, that is fee-for-service GPs with no appointment required, not exist in the US?

Sure. Lots of them. They usually end up being called "Urgent care centers" or "Minor emergency clinics." Maybe they're verboten in Brooklyn or there's some other reason dame hasn't seen any.
posted by ROU_Xenophobe at 9:13 PM on April 5, 2005

Those over age 65 are all covered by Federal Medicare.

Children in most states have 100% public coverage available.

The very poor who can get their act together to go through a 9 month approval process can get state Medicaid in 49 of the 50 states; different states cover different things this way. If you're very sick there are provisions for emergency Medicaid until the approval kicks in.

No E/R will ever turn a patient away. You may get billed by the hospital, but I've never heard of this going to collection or ruining a patient's credit. As a point of reference, when I was a student at the L.A. County Hospital, the hospital received payment for less than 10% of what it billed. (This came up every year when Clinton had to authorize FEMA to pay yet another $365 million bailout.)

The folks who get screwed are the non-indigent poor - too much assets or income to qualify for Medicaid (and that's not much), but no other way to obtain health coverage. Those who are well make do without preventative care, going to the E/R when they become very ill. Those who are chronically ill and really need to utilize healthcare eventually come in contact with a social worker who tells them they have to stop working and give away all their assets so they can qualify for Medicaid.

Approximately 15% of US annual GDP ends up getting spent on healthcare. 50% of Medicare dollars are spent on persons who are in their last 30 days of life. The system is really not in very good shape at all. But don't ask me how to fix it - I have no idea.
posted by ikkyu2 at 9:14 PM on April 5, 2005

Very enlightening to this lucky Canadian. I've never paid a dollar for my medical care

You've paid some indeterminate amount in general and specific taxes for it. The resources still have to come from somewhere.

I'd still prefer to be under something like that, or at least something substantially more commie than we have now, but for some reason the "I've never paid a dime!" meme seems like pernicious nonsense to me.
posted by ROU_Xenophobe at 9:22 PM on April 5, 2005

50% of Medicare dollars are spent on persons who are in their last 30 days of life.

Do you know whether that means

"50% is spent on hopeless treatment of people who are certain to die soon even if the treatment goes exactly as hoped."

Or

"50% is spent on drastic, expensive care for dying people such that if it works they can expect to live at least a couple years."

The two seem very different to me.
posted by ROU_Xenophobe at 9:28 PM on April 5, 2005

Last summer I broke my leg, in a very bad way, and required surgery and some hospital time. My bill was insane, like 20 grand. My insurance had a 5,000 dollar deductible, with 80% payment over that. The last bill I saw was for 9,000, after the insurance was subtracted. I'm really poor right now and don't own anything of value, so after a year of sending the hospital documentation that showed I could barely afford to eat with the amount of money I make, they wrote the whole thing off. I'm very happy, but I suspect they only did this because they were able to squeeze a little money out of my insurance. It's pretty awful to be poor in America.
posted by underer at 9:28 PM on April 5, 2005

Ikkyu2, they will indeed ruin your credit & sic a collection agency on you. (See Jonathan Cohn, "Uncharitable," New York Times Magazine, 19 December 2004. Now costs money.) Maybe it's changed since you were in LA, maybe LA doesn't bother, maybe you just don't know because you were a student doctor and not a billing agent. But it happens, and most uninsured kids I know are terrified of something really terrible happening to them for this exact reason.
posted by dame at 9:45 PM on April 5, 2005

raedyn: So if I am uninsured, go to the ER for emergency care, and can't pay the bill, does it go to collection agencies & ruin my credit before I even have any?

Absolutely -- they can be utter bastards. Mine (Mt. Carmel, Columbus, OH) said "You'd better file for bankruptcy right now, because we ARE going to sue you."

and ikkyu2: "You may get billed by the hospital, but I've never heard of this going to collection or ruining a patient's credit."

Happens all over the US, every day. Google "Scruggs" and "class-action suit." He's the atty. that fought the tobacco industry; now he's fighting "not-for-profit" hospitals that engage in predatory billing and collection practices.

Many docs I've spoken to have no idea that hospitals act like this, but they do. And many "not-for-profit" hospitals have for-profit subsidiaries and assets literally in the hundreds of millions.
posted by words1 at 9:50 PM on April 5, 2005

My. God. I'm simply stunned.
posted by five fresh fish at 10:33 PM on April 5, 2005

Can you really just give a fake name? They don't look at your ID or anything? I wouldn't have the balls to do it.
posted by palegirl at 10:35 PM on April 5, 2005

I'm seconding palegirl's question... does that really work, just like that?
posted by John Kenneth Fisher at 10:48 PM on April 5, 2005

I thought medical bills couldn't affect one's credit (though they could cause collection agencies to descend upon you like bats out of hell). Is this incorrect?

There are pay-as-you-go drop-in clinics that charge reasonable fees, but they're far from universal. The one here just opened about two years ago — there was nothing before that. It charges ~$60 for a visit for the uninsured, plus prescriptions, test fees, etc — which can hurt, if you're poor, but probably won't ruin you unless you're really poor, like homeless, in which case you can probably get Medicare (and if you can't, hey, medical bills are the least of your problems, right?) I'm uninsured and haven't been to the doctor in years.

Also: what sucks about Medicare is that the income cutoff gets higher as you age, so if you're you're 21 and making a pittance you won't qualify, but if you're 40 and making the same pittance you will, regardless of whether you are in a position to leech of of your parents. I can't think of any reasonable explanation from this aside from the fact that 40-year-olds vote in greater numbers than 21-year-olds.
posted by IshmaelGraves at 10:53 PM on April 5, 2005

There is no free healthcare, even from non-profit centers, but there are sometimes ways to defraud hospitals and centers.

But I'm under the impression that you're SOL if you need healthcare that is not provided by an ER and don't have money or insurance (such as if you split a tooth). I know a girl that had to have a (visible) tooth pulled out because she couldn't afford a filling and the toothache was unbearable.

When I moved to the US, I was stunned by how much more wretched and broken the bodies of homeless people here were. I suspect the lack of healthcare plays a major role in this.
posted by -harlequin- at 11:33 PM on April 5, 2005

ikkuyu: ERs turn patients away from hospitals all the time--it's called patient dumping. In Chicago, the private hospitals will send a patient in an ambulance over to Cook County (the public hospital) so they don't have to deal with the patient.

I'd also disagree with your statement that all children can get health insurance in all states. If you're referring to S-CHIP, it's a pretty broken funded mandate from the federal government, and many states do everything they can to keep kids off the insurance lists.
posted by gramcracker at 11:56 PM on April 5, 2005

Sometimes I wonder if what we really need to do is make it illegal for any member of congress or member of their staff to be covered by insurance for a period of five years.

Or at least no group coverage of any kind.

Yeah, it'd be mean, but boy, you'd see some serious and personal policy research.
posted by weston at 12:03 AM on April 6, 2005

"Absolutely -- they can be utter bastards."

Yes. From what I have seen, the medical collections people are perhaps the most bloodthirsty there are. And doctors tend to be completely isolated from this. The doctor will be compassionate and kind; the person at the front desk making sure he gets paid is often none of that. It's a weird sort of mix. And you definitely do get collection agencies sicced on you.

About the drop-in clinics -- as IshmaelGraves says, there aren't that many of them. There are some. In some areas there seem to be many, but in others they are scarce or non-existent.

I have never used a fake name/address at an ER, but I can totally see why people do. If it's that or a 5-digit medical bill that can be many times your yearly income -- I imagine it becomes an issue of survival. I don't think I could do it, but maybe I've just never been desperate enough.
posted by litlnemo at 12:08 AM on April 6, 2005

. . . suing and then arresting non-payers.

Wait a minute, I thought you COULDN'T be put in jail for non-payment of a debt; except in special cases like child support. Isn't this one of this Really Bad Things that as a civilized nation we decided to get rid of?
posted by [insert clever name here] at 12:30 AM on April 6, 2005

Add to the mix of grief and profiteering:
an internist once was charging me 18% interest on an unpaid bill, at a time when the prime lending rate was much lower. I filed a complaint with the state banking authority and wrote state reps. I think I paid the principle and simply told him to stuff his interest. This was a doctor who moonlighted as an evangelical preacher.
posted by Goofyy at 1:11 AM on April 6, 2005

My friend had a really bad infected toe once. We were sitting in his apartment and he started explaining how the pain was unbearable, which I then flashed my full coverage health insurance card and explained if he said he was me it would be free to go to the hospital.

Well, we drive up and he explains the situation. I mean, his toe was fucked up and he was stupid to let it get that far. He decides he wants to be honest about who pays the bill and was slapped with $1,000 bill for partial nail removal and medication. Goddamn. That is what you get for being honest in this country!
posted by Dean Keaton at 2:29 AM on April 6, 2005

How can you give a fake name and address without a matching ID card?
posted by AlexReynolds at 2:33 AM on April 6, 2005

You make sure not to bring any form of id!

(And by the way, I have family working for a major hospital which is why I can break an arm and pay about $35 for emergency room visits)
posted by Dean Keaton at 2:34 AM on April 6, 2005

No E/R will ever turn a patient away. You may get billed by the hospital, but I've never heard of this going to collection or ruining a patient's credit.

It happens everyday to a lot of people. I could show you the stack of collections notices from the ER for me, since I'm not insured.
posted by SuzySmith at 3:50 AM on April 6, 2005

Very enlightening to this lucky Canadian. I've never paid a dollar for my medical care - raedyn (me)

You've paid some indeterminate amount in general and specific taxes for it. The resources still have to come from somewhere. ... for some reason the "I've never paid a dime!" meme seems like pernicious nonsense to me. - ROU_Xenophobe

Well yes, of course the costs have come out of tax dollars I've paid. But I'm young and (until a few months ago anyways) low-income, therefore so far I've cost the system more than I've paid in taxes total in my lifetime. And my tax burden, unlike if I had to pay for private insurance, is directly tied to my ability to pay. So because I've made next to nothing up until now, I've paid next to nothing. And it's never, ever occurred to me to consider the cost before I go to the doctor to get that infection (or whatever) checked out. That was my point.
posted by raedyn at 6:24 AM on April 6, 2005

that's what we need. Civilized nations provide all their people with healthcare--at least some level of it.
posted by amberglow at 6:36 AM on April 6, 2005

We'd much rather spend our money on weapons than on universal health care. Besides, socialized medicine is communist.
posted by kirkaracha at 6:59 AM on April 6, 2005

Maybe if we called it "patriot medicine," instead...
posted by curtm at 7:22 AM on April 6, 2005

Some of us outsiders look at the health system in the States with confuzzled amazement. And that's not to say that other western world countries have it all perfect. The harsh realities in America are the historical, political and economic brick walls to 'proper' national health - no easy hurdles to overcome obviously.
In Oz, we've been drifting away from utopia during the life of the current political leadership. There are very very serioius taxation reasons to have private health insurance (say about $US1000/year per single) these days if you are employed. The aged and unemployed are covered free.
And there is a BOOMING private hospital industry (1/2 run by and/or inspired by US health groups). In one sense I grudgingly admit that with many people covered by insurance going to private facilities, it frees up (kind of) the public hospitals (our erstwhile centres of excellence) from so much intake of people.
But I worked in, remember well and long for the days when public hospitals treated EVERYBODY without any prejudice or 2nd thought and economics were very very very far down the list of anyone's priorities. But at least you can't really go bankrupt here from the bills - if you're insured, you go private and worse case wouldn't be more than 4 figures I think; if you're not insured, you go public and it's free. And fortunately there's still a fair few GP's around who bill the government and not the patient.
Oooops! /chattyhealth filter - this is tangentially related but in no way answers the question. Scuzee.
posted by peacay at 8:00 AM on April 6, 2005

I'd still prefer to be under something like that, or at least something substantially more commie than we have now, but for some reason the "I've never paid a dime!" meme seems like pernicious nonsense to me.

What he meant to say is that Canadians, like most of the socialized industrial world, pay no more than taxes for their health care. The difference is that when compared to the US govermnent, our goverments only pay a relatively tiny fraction of our taxes on things like defense (or should I say "offense"). This is the single most important reason why I think the quality of life is higher in most of Europe and places like Canada than in the United States.

on preview: etc. etc.
posted by sic at 8:07 AM on April 6, 2005

(posted this many times) Had a $70,000.00 medical bill paid Orange County, California. As I qualified under their indigent program. I was near DOA when I arrived at the hospital. The hospital was a private one.
posted by thomcatspike at 8:07 AM on April 6, 2005

Why do uninsured pay such high rates? It's complex. Medical billing is a complicated thing with all the private payers. Most insurance companies base how much they are willing to pay off of what Medicare will pay.

Medicare billing for inpatient services is based off entirely of DRGs. This is a system where medicare pays a set amount, regardless of costs incurred by the hospital during treatment, depending on the diagnosis and any complications or comorbidities. For example if Patient A is admitted for pneumonia and leaves after three days and Patient B is admitted for the same thing but leaves after ten days, the hospital gets the same amount of money for each. Now if Patient C is admitted for pneumonia, but falls and breaks their hip while admitted, the hospital has to eat the costs of the surgery to repair the hip because the patient was admitted for pneumonia. It doesn't even count as a complication (the pneumonia didn't break the hip) or a comorbidity (it didn't exist at the time of admission). They are moving to a system of APCs for the outpatient world (which include ER visits).

Medicaid pays less than ten percent of the medical bill and it is illegal for any healthcare organization to try to bill the patient to make up the difference.

Private Payers will often only pay a portion of what Medicare pays. Here in Michigan, there was a big hullabaloo a year or two ago because Blue Cross didn't want to pay as much as other private payers because they are an insurer of "last resort" (They accept patients with lower incomes than other insurance companies.) Spectrum Health (the organization that wanted Blue Cross to pay more) knew how much another major insurer (Priority Health) because they are a major stakeholder in Priority Health (Which payed 70% of what Medicare would pay).

So for inpatient services the only way a hospital can make up for money lost on treating the poor is by overbilling the uninsured and praying that medicare patients have horrible problems that can be discharged in a day or two.

Of course, I am not a medical biller, have never worked in medical billing. So I may be wrong.
posted by Apoch at 8:08 AM on April 6, 2005

Children in most states have 100% public coverage available.
No, ikkyu2, they don't. Not at all. In NC, there is a 2 year waiting list to get your children on the state health insurance and the income levels are quite stringent; 5 years ago, when I had 2 kids at home and was making $27,000 a year (single mother) I did not qualify. In MD it used to cut off at age 8; I guess 8 is an adult?

Simply echoing what everyone else has said. There are drop in "urgent care" centers here; if you are uninsured you can pay up front: it's $85 just to walk in the door, more for tests and, obviously, prescriptions. Oh, and emergency rooms WILL come after you for payment.

Health insurance is often useless anyway. I paid approximately $400 a month for insurance for my healthy self and my healthy son; when he needed some mental health/educational help and testing my insurance announced it wasn't covered: I'm looking at $4,000 worth of bills and it's part of the reason I'm going through bankruptcy proceedings. The doctors told me that unless I had Medicaid noone would pay for it but he desperately needed the help. With insurance, his broken arm cost me $300; with insurance, our teeth cost us $500 last year, just for routine cleanings and one filling, with insurance and a supposed prescription plan each medication cost us in the neighborhood of $50 and on and on. So yes, the system is so broken that it is unbelievable, but no one will do anything to fix it. And yes, I routinely write my congressperson and my senator and the newspaper and it has done NOTHING.
posted by mygothlaundry at 8:20 AM on April 6, 2005

In "body attachment" the hospital sues the patient, who often doesn't realize he/she has to appear at the hearing and doesn't show up (there have been complaints that the paperwork is also sometimes deliberately served to the wrong address or not served at all). The judge then is convinced to issue a bench warrant for contempt and the patient lands in the pokey for a few hours. It's a scare tactic.

The line between hospital collection efforts and the mafia tends to disappear in some cases.
posted by words1 at 8:28 AM on April 6, 2005

In Oz, we've been drifting away from utopia during the life of the current political leadership. There are very very serioius taxation reasons to have private health insurance (say about $US1000/year per single) these days if you are employed.

In the US, I don't believe there's any such thing as a private plan that's less than that, unless it's partially subsidized in some way.
posted by weston at 8:33 AM on April 6, 2005

weston.....I think it becomes vvv complicated comparing countries. Employers are not usually involved here - AFAIK it is usually individuals who take out insurance and it's not a job/pay perk or the like.
Our insurance often includes things like glasses, yoga, physical therapy, exercise classes as well as dental and hospital
And our Medicare (universal, govt. run) system pays at least part of the cost for most things - particularly when you go to emergency: they will treat you, bill the govt. then turf you over to the private hospital for followup - which are invariably right next door to the public ones.
posted by peacay at 8:44 AM on April 6, 2005

The folks who get screwed are the non-indigent poor - too much assets or income to qualify for Medicaid (and that's not much), but no other way to obtain health coverage.

Bingo. Here in Pennsylvania, Medicaid doesn't look solely at the applicant's income and financial position, they look at the household income (without any regard whatsoever to household expenses) so if you're unlucky enough to be unemployed and broke but fortunate enough to live with someone -- even if they're not related -- who is willing to feed and house you so that you're not dying of starvation on a sidewalk, you can both be struggling by on ramen and have turnoff notices from the utilities but the state will refuse to help you even to get (long term) follow-up care after a Medicaid-covered emergency surgery.
posted by Dreama at 8:58 AM on April 6, 2005

Dreama, do you mean they count even roommates? Because that's wack. I certainly don't get to claim head-of-household on my taxes & deduct them all.
posted by dame at 9:22 AM on April 6, 2005

How can you give a fake name and address without a matching ID card?

They don't ask for ID. I assume that's some legal thing, since every ER I've been too doesn't ask for ID.
posted by cmonkey at 9:25 AM on April 6, 2005

Every emergency room I've ever been to (MD, SC, NC) DOES ask for ID and in fact they act like they won't treat you without it. This may be because I've usually been there with a child, though. I was wondering about this fake name thing for that reason - I know I would cave in and give them ID.
posted by mygothlaundry at 9:43 AM on April 6, 2005

Just don't take your wallet, mygoth. It isn't so weird to run out without it if you are going to the emergency room, is it?
posted by dame at 10:01 AM on April 6, 2005

I woke up in an ambulance once. They got my ID out of my pocket while I was unconscious. I wasn't insured, they went after me for the bill. Ruined my credit for 7 years.

I still don't have insurance.
posted by redteam at 11:57 AM on April 6, 2005

Ah yes, the American health delivery system, responsible for more personal bankruptcies than any other single factor in the world.

I had injuries from an assault when I was in college and the campus medical clinic sent me to the hospital. I was semi conscious so they got my real name & address. Took me several years to pay off the several thousand dollars they charged me for tests, stitches, and various other treatments - this was the public, low-income county hospital.
posted by luriete at 1:38 PM on April 6, 2005

words1"suing and then arresting non-payers."

They will not be arrested for non-payment. If they are arrested it might be for contempt of court (failing to follow the court's orders) or because there was some sort of fraud involved in obtaining the services. To imply that people are arrested in the US simply for non-payment of a debt is ridiculous!
posted by Carbolic at 2:28 PM on April 6, 2005

In Chicago: The Hospital Accountability Project

It's a group whose mission is to end discriminatory pricing in health care (charging uninsured patients more than insurance companies), end predatory collections practices, make sure that "charity" hospitals who are getting tax breaks actually offer charity care, and end anti-union efforts by the hospitals themselves. There may be other similar organizations in other areas. Mygothlaundry, maybe Google for a group in your area -- there is strength in numbers.

As for the fake name thing, when I was in college and just after I had a lot of friends with no money and no health insurance. They relied on the ER for all their health care needs and always gave a fake name. Another common way around the lack of health care was to borrow the student ID of someone still in school with access to the university's health care clinic.

Now my friends without health insurance either declare bankruptcy after being treated for emergencies or live with chronic health conditions and no treatment. One friend died a few years ago from a heart condition that would have been caught and treated had she had access to preventative health care. She was 27.
posted by jennyb at 4:16 PM on April 6, 2005

Yes, arrested for contempt of court for not appearing at a hearing they apparently, in several cases, were not properly notified of. The term "body attachment" was invented by the hospitals' collections depts. They knew damn well what they were doing.

BTW -- those scumbags in DC just made it even harder on the uninsured by removing Chap. 7 bankruptcy protection in most cases. Catch 22 -- if you're not poor enough to get free care, you're too rich to declare Chap. 7.
posted by words1 at 6:52 PM on April 6, 2005

dame and others: I've done a little more looking into it, and I see that hospitals do indeed go after patients and ruin their credit. I don't approve of that at all. It does look like things have changed - for the worse - since I was a student, just like my professors warned me they were going to.

ROU: I don't mean either of your alternatives. When I say 50% of Medicare dollars are spent on people in their last 30 days of life, I mean: look back at people on Medicare who died last year, and see how much of the yearly Medicare expenditure was accounted for by expenditures on patients who died less than 30 days later. The figure is about 50%. Dying people are very expensive. Everyone agrees this is a problem, but no one knows what to do about it.

Gram: ER-to-ER transfer is against the law here in NY, and other places too. It's also unethical. Despite that, it happens - seems to me, though, that it always happens to people who don't seem likely to get a lawyer and sue.

Mygothlaundry: There's nearly unlimited Federal matching funds available, dollar for dollar, for states to provide 100% Medicaid health care for kids and pregnant women, which makes this fiscally feasible for a lot of states As you'd expect, it's the more backwards states that don't take advantage of it or have inefficient or dysfunctional programs. There are also issues with a few states - Tennessee and Wisconsin the most egregious offenders in the past few years - using some kinds of fancy legal loopholes to use these Federal dollars in their general funds. Guess who gets the shaft.
posted by ikkyu2 at 8:16 AM on April 19, 2005