[trimethylpurine]

The US health care system is partly socialized. Health care is provided for the unemployed or low income and the employed are covered as employers are required to provide health coverage. The odd ones out are typically small business owners who don't insure themselves and choose to take on the risk of potentially large medical bills.

In all cases treatment is required by law, regardless of payment.

[shiroiushi]

>In all cases treatment is required by law, regardless of payment.

No, it's not. This is a myth. The only thing that's required is to stabilize the patient. If you need surgery to repair your shattered leg bone so you don't get an infection and need an amputation, you're not going to get that surgery without payment. But once you get a bad infection and need the leg amputated so you don't die, they'll do that for free.

[trimethylpurine]

I'm not sure where this is happening, and I'm not saying you're wrong, but where I live, doctors are paid salary and they care for patients, so from my perspective what you're referring to sounds like a myth. My friends, who are doctors, operate all the time on people who have no identification and they do their absolute best. And there is no monetary incentive to do otherwise and they would quit and find a different hospital if there were. Anecdotal? Maybe. I'm open to hear from a doctor that says otherwise.

As best I can tell, the medical community and education system would reject a doctor in the US from licensure for any other attitude towards health care.

[shiroiushi]

Doctors have absolutely nothing to do with who gets care and who doesn't: that's controlled by hospital administration and other hospital staff. The doctors are just employees. When was the last time you saw a doctor in the ER reception room talking to new arrivals and deciding if they need to see a doctor or not?

[trimethylpurine]

I'd love to go to a hospital where the administration determines if my health condition is emergency or not. That's a cash in hand settlement case.

[shiroiushi]

Please show me a hospital where actual doctors are manning the ER intake desks and triaging patients instead of actually working with patients in exam rooms.

[trimethylpurine]

I didn't say that. But at the very least a nurse or PA will take your vitals while you wait for the doctor. And the doctor will determine when you are low risk enough to be discharged. They aren't taking your vitals in the lobby anywhere I've seen, unless that's where you collapse.

[trimethylpurine]

Just wanted to post back to share that I researched such incidences and except for a few cases where the hospital was sued and lost and doctors fired, I didn't find any examples of this as an accepted or legally viable practice. If you have some examples to share, I'll be interested.

[daemonologist]

It's a patchwork, with a lot of holes for people to fall through:

* Hospitals must treat or stabilize regardless of payment, but only for emergencies - they just have to try to keep you from dying on the spot

* The ACA (or Medicaid) subsidizes insurance for the unemployed, if your household income for the calendar year is low enough

* Employers are required to offer coverage to their employees, provided they work more than 30 hours a week at that company and it has at least 50 full time employees (this extends to dependent children but not spouses or other dependents)

This is better than nothing, don't get me wrong, but it could be a lot better still. We have the technology.

[dragonwriter]

> In all cases treatment is required by law, regardless of payment.

Screening for and stabilization of emergency medical conditions is required at all emergency departments by law, regardless of ability to pay, but that's much more limited than "in all cases, treatment is required by law, regardless of payment", and even then, hospitals skirt the rules.

[trimethylpurine]

And how does this differ from care elsewhere?

To contrast, my sister lives in Europe and needs shoulder surgery and unless she pays for a private treatment (by the same doctor) she will not be treated for 12 months. Guess what I paid for. Is that any better?

[gregjor]

Not true except for immediate emergency care.

Many employers do not provide coverage. They skirt the law by employing people part-time (Walmart, Amazon) or as gig workers.

Even if the law reads as you claim that doesn’t mean you can get care in the US.

[trimethylpurine]

And that's different from other countries how? I can walk into a hospital in any country in Europe as a non-citizen and request non emergency care and receive it?

>Many employers do not provide coverage

For under 50 employees, making less than 50k, Healthcare.gov covers those cases. You can visit there now to confirm my claim.

And yes, it means you can get care in the US. I brought my Euro girlfriend here and she got care under a bullshit name. And they treated her, the same as any other patient. And she never paid anything. It was non emergency and we went to an emergency room anyway.

Do you have a counter example? If so please share.

[gregjor]

Counter examples that don’t involve fraud, as you describe? Yes, many, but I don’t see any reason to try to refute the nonsense you posted.

[trimethylpurine]

The point is that hospitals in the US indeed treat anyone with or without ID. Emergency or not.

I'm not sure what point you were making, or refuting, but I didn't catch it.

[gregjor]

You got lucky. US hospitals routinely turn people away for non-emergency conditions. That probably happens everywhere but I was only responding about US medical care.

https://journalofethics.ama-assn.org/article/obligation-prov...

[trimethylpurine]

What you linked to is a legal description and critique. While it represents the legal imperative, it's not representative, I don't think, of actual medical care.

It wouldn't make sense to risk your license or insurability. It's a bad business decision both for the doctor and for the hospital to send you home without care and discover later that a more serious condition was underlying the symptoms presented as non-emergent. It makes sense to at least check, and in so doing, treat. And if treating to provide the best care possible to avoid liability.

If you have examples of hospitals doing otherwise as a matter of practice I'll be interested to understand how that business model is possible.

As far as I've researched, I've only found cases where the hospital was sued and lost. Doctors fired or jailed. Etc.

The situation is that by requiring emergency care (which is subjective) the law creates enough risk that the de facto mode of operation is to treat all cases where risk is a factor, which is very nearly all cases.