The only part of it I find hard to believe is Charity Doc's refusal to order the test. We just roll our eyes and do it, but C Doc knows what he did more than the rest of you.

And frankly the idea that people routinely go into hospitals for things they don't need is laughable.

That statement right there proves you have nothing to offer this discussion, because you have NO FRACKING IDEA what you're talking about.

Name one ambulance company in America, anywhere in America, that would transport her.

The one I work for, and every single one of our competitors. And any private ambulance company anywhere, actually.

And any municipal 911 service. All because the one time you refuse to transport a patient whom you think is full of it, THAT will be the one who actually has something legitimately wrong, and they'll die, and their family will take advantage of the completely out of control tort system to ruin you and your family and your service.

It's not that they don't exist, it's that they represent such a handful of cases that they are not worth mentioning. You might as well be talking about People surviving be struck by lightning as an argument to get rid of lightning rods.

Again, no clue what you're talking about.

Ever respond to a subsidized housing building at 3am for a "fall with back pain," only to find the same guy you picked up yesterday, who for the 8435956th time has "fallen" with his cellphone, medication list, and Medicaid card conveniently in hand? And oh by the way, he's allergic to every painkiller except Morphine and Dilauded?

No?

Then shut up.

first one: "The report also noted that between 10 and 50% of all emergency room visits are for non-urgent and avoidable conditions."

10-50%? First off that's a pretty big range, and at the lower end is probably pretty good really.

Good LORD this site is full of morons.

ROFLMAO. Keep it up Verndon. It's posts like these that really solidify that reputation as an economist.

If a parent brings three or more kids into the ER with "fever" and sniffles, it's guaranteed that they are covered under Medicaid, because they have zero copay and zero out-of-pocket costs. Heck, even their prescriptions are free. Usually, one of the kids has no complaints, but since Mom was bringing the other three in, she thought little Juan should get checked out too. Why not?

When a family of four comes in two days after a car accident with headaches and neck pains, you know they were rear-ended. None of them ever are from the car that caused the accident. Hmmmm. Of all the hundreds of x-rays and CT scans I have ordered on such people, how many of them ever showed a serious abnormality? None. But they are eager to have the tests, because someone else is paying. And I'm not eager to refuse them and punch their lottery ticket.

Charity's pregnant patient must not have learned the ropes yet. Most of the Medicaid pregnancy specials will complain of some sort of belly pain so they can get their free ultrasound.

Absolutely.

I figure if these people get hit with an $800 ambulance bill and a $400 ER bill, they will think twice about going to the ER for less than emergent care.

I think a move towards having urgent care type centers, and trying to steer people towards those is the route to go.

Nope, that was just one of literally hundreds. Another involved a college age woman literally crawling into the ER complaining about vomitting while pushing along her vomit bucket. Pretty much the same thing, stomach flu. And then there are the regular abdomominable-pain-to-get-a-pregnancy-test visits I noted earlier.

Of course, if the ER weren't subsidized, and she knew she would be paying $1000 for her trip, there is a good chance she wouldn't have gone in. But what if, on the other hand, she had been in an ER-appropriate situation?

Yes, that was Kent's point above. In the case of the woman from my mom's story she should have been forced to pay the full costs of the visit. If it turned out she did need surgery and it was an emergency she shouldn't have been required to pay beyond a deductible/co-pay. Today we have health insulation, not insurance.

As almost everybody agrees, this is a very complicated problem. There are two major things we want to avoid:
(1) People going into the ER when they shouldn't
(2) People not going into the ER when they should

We can't avoid (2) and even if we could we probably shouldn't, that efficiency thing that M1EK brought up rearing its rather ugly head. There will always be people who don't think they need to go to the ER when they should and suffer fatal consequences. And our current situation is un-sustainable. With the current growth rate in health care spending being higher than the growth in GDP we can't maintain the current situation.

Just like with setting speed limits at 55 or 65 MPH we are going to have to accept the fact that people are going to die. That is part of the efficiency point that M1EK raised, although he might not like it all that much now.

But oddly enough, your statements basically say it's wrong to subsidize the cheap stuff that can help save big costs down the road (your oft-abused oil change analogy).

Health insurance should cover those things that are rare and costly. Thus, these things should be paid out of pocket.

IE, you don't want to subsidize checkups; pregnancy tests; doc-in-a-box antibiotic dispensation; etc. But that's precisely the stuff you'd WANT to subsidize if you had any interest in efficiency.

You'd only want to subsidize it if there is some sort of public good/external benefit. If it is the case that people who get regular check-ups are healthier later in life when they tend to suck up the most health care resources and thereby actually suck up less; then yeah you might have a point. Frankly, I don't think this is the case. The old bormide of "an ounce of prevention is worth a pound of cure," isn't going to stop the ravages of aging on the human body. Or to use the "oil change analogy", even if I get regular oil changes, alignments, and other routine maintenance, my car's transmission will eventually give out. In other words, you've assumed your efficiency conclusion, you haven't demonstrated it.

And even if you are correct, then we want to subsidize these things intelligently. We subsidize the things like routine check-ups, mamograms, etc. We don't subsidize morons using ambulances as taxi cabs and people going to the ER to get an enema. These people should be hit with additional costs to disuade them from doing it. On top of that we want to be careful in how we subsidize even costly and rare events.

Well, I called my mother last night who worked for years as an ER nurse. Here is one memorable story from her.

This suggests to me that this type of story is fairly uncommon; otherwise, why would this particular one be memorable?

Also, I don't know if I would call this a case of abuse of the system, but rather it's a case of a person mistakenly thinking they truly were in an emergency. Who would demand surgery unless she seriously thought she was in very bad shape? Of course, if the ER weren't subsidized, and she knew she would be paying $1000 for her trip, there is a good chance she wouldn't have gone in. But what if, on the other hand, she had been in an ER-appropriate situation?

As almost everybody agrees, this is a very complicated problem. There are two major things we want to avoid:
(1) People going into the ER when they shouldn't
(2) People not going into the ER when they should

Subsidizing, of course, tips the balance in the favor of reducing (2) at the expense of increasing (1). Almost any system of charging or punishing (1) will also, inevitably, increase (2). Subsidizing less costly (non-ER) visits, like M1EK just suggested, is the only exception I can think of.