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Debating "Gratis" Services


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I overheard a Nursing supervisor suggest to a PHD Psychologist (who doesn't see patients unelss insurance auth is obtained first) that he should do more gratis work since "we all have to care for these indigent patients".......I get a kick out of Administrators and nurses "suggesting" anyone do more freebee work. Do nurses work for free on self-pay patients? Do administrators take a cut in their salary each week?

 

The PA' MD's have to take it, and somehow I'm made to feel guilty for not showing sympathy.

VENTING

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Over the years, I have become less sympathetic (meaning, less likely to offer reduced prices) to patients without insurance and MORE likely to reduce my fees to patients with insurance that carry a high deductable. So often THESE patients are paying huge costs out of pocket just to have insurance, then turn around and have to pay again when they receive medical services. On the other hand, patients with out insurance at all have no initial out of pocket costs. I realize not every one can get insurance (maybe turned down due to pre-existing condition) but I see just as many driving a nice car, carrying an expensive cell phone, wearing designer clothes, etc... We have to be honest and admit that many of these patients simply choose not to spend their money on insurance, while others sacrifice to carry a high deductible policy. THAT is the patient I want to help. I guess I can relate since my own insurance costs me about $750 a month (family plan) and has a $10K deductible. That's a lot of money!

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The issue is not, nor has it ever been, insurance. Insurance is simply a way of cost-sharing--in a perfect world, the average person would be unaffected financially by whether or not they had insurance: on average, the cost of insurance would equal the average of their healthcare costs. Tack in a bit for profit and lawyers, and throw in the hugely free-market affecting impact of having employer-paid premiums be non-taxable, and you have the ba-roken system we experience today.

 

Insurance is not "something for nothing", insurance is risk reduction through up-front expenditures.

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-in a perfect world, the average person would be unaffected financially by whether or not they had insurance: on average, the cost of insurance would equal the average of their healthcare costs. .

I would argue that in a perfect world anyone who worked full time would have a health insurance policy provided for them by their employers with minimal copays for visits and prescriptions.

the elderly/disabled would have govt provided health care as would children of parents without the means of acquiring it for them.

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Another reason I'm going into the Navy.

I recently discovered a big problem with va medical services for retired vets.

I had a pt at my rural job who was in his early 60's with unstable angina. needed to be cathed.

the va would pay for care at our facility or the nearest va facility 3 hrs away but not for the transfer between facilities. if he was 65 medicare would pay but he wasn't. they wanted me to d/c his heparin so he could drive unmonitored for 3 hrs to their facility. I basically had to threaten to send him by lifeflight(which is always covered) before they would agree on a 1 time basis to cover a long distance critical care transfer.

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I would argue that in a perfect world anyone who worked full time would have a health insurance policy provided for them by their employers with minimal copays for visits and prescriptions.

the elderly/disabled would have govt provided health care as would children of parents without the means of acquiring it for them.

Why should anyone ever have insurance of any kind? Seriously, why is the discussion of health care always tied up with insurance?

 

Insurance is a cost and risk averaging solution, nothing more. Insurance doesn't create free money to pay for healthcare, it just takes the premiums of the healthy people and allocates them to support the care of the non-healthy.

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ok, that was in a perfect american political world....

I'm ok with govt sponsored single payor universal healthcare. it works in every other developed country in the world.

yes, your taxes pay for it but everyone draws off what they need from it. no one gets shorted. eventually everyone will need something from the system and the system will provide it.

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I pretty much stopped discounting my services for most social situations - people choose high ded plans, and a lot of the people that don't have ins in MASS have made the choice and conscious decision to take the risk to run with out insurance (and I end up talking to them about this in the OV)

 

If someone is truly caught with out knowing with out insurance I have all teh sympathy in the world for them and will adjust - but just the whinning person that c/o charges gets nothing out of me - I don't go to their workplace and gripe about prices.... and beg for discounts

 

 

Also on the larger scale by giving it away it patches along a broke system and we just need a whole new system

 

Single Payer is the answer and it is silly we do not have it. Still private delivery of care but just take the 28% that we loose to the health ins costs out of it!

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