[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.

[gregjor]

Millions of Americans without medical insurance cannot get routine care. That can happen for a variety of reasons, but one of those reasons comes down to hospitals and clinics refusing to give non-emergency care for free. I don’t need to provide anecdotes for an endemic problem that gets studied at the federal policy level.

Personally I have experienced wait times approaching infinity, the hospital not denying care, but not providing it either, because people with insurance or cash get to the front of the queue unless an indigent person bleeds out in the ER.

If you go to an ER and need diagnostic tests for a real but non-emergency condition you will likely get referred to a diagnostic clinic, a place that only does tests and does not provide medical care, and that’s where your journey will end if you don’t have insurance or cash up front.

Try to get prenatal care in the US without insurance or cash. Possible to find programs for low-income uninsured people in some cities, but not everywhere by any stretch, and getting worse every year.

Talk to homeless people and advocates about people who cannot get treatment or medications because they have no insurance or money. Hospitals won’t dispense things like insulin until you go into shock in the ER, assuming you can get to one.

[trimethylpurine]

In my state the wait is under 8 minutes for ER care. So, I can't relate.

Yes, you're required to fill out forms and participate in the system. And therein lies the rub. The people that don't have care are those who are not capable of filling out and keeping up with all the forms. Or are otherwise unwilling to do so. And that's exactly how it goes in Europe too. You don't just get to walk into any hospital with no ID and no registration (aka insurance) and get non emergency care. That's pretty comparable. And even with their "free" care they still have to pay for private treatment from the same doctor anyway so they won't have to wait a year for non emergency surgery.

At worst you can say our forms are longer, and more complicated. But you can't say it's not socialized. If you fill out all the forms you get the same care at the same price as Europe (if you count taxation) and at least in my state, there's no line for the hospital and I can see a doctor in a few days, usually, for specialty stuff.

And objectively, we have more broke people entering this country and still living long enough that our life expectancy is on par with countries that have a tenth of the immigration rate and a lesser poverty rate. So medically speaking, we're pretty miraculous, all things considered. So says the data.

[gregjor]

> In my state the wait is under 8 minutes for ER care. So, I can't relate.

That statement doesn't match actual data about ER wait times, for example [1], [2], [3]. It seems anecdotal (one lucky visit) at best, and just made up at worst. As the father of three with multiple ER visits of varying severity in my own set of anecdotes, 8 minutes seems extremely unlikely unless you required resuscitation, or the ER had no other patients.

While a hospital employee (health care professional) may talk to you within a few minutes to ascertain your condition and severity, and insurance/payment method, that doesn't equal time to get care, nor does it mean you will leave the ER with satisfactory treatment, referral to a clinic, or medications. Because American hospitals very often don't have diagnostic equipment, or only want to use it when absolutely necessary (and payment looks likely), you may get "treated" with pain killers and antibiotics and referred to a diagnostic clinic for further tests, scans, etc. Those clinics do not treat anyone who walks in, they require payment in advance of treatment, so they create a chokepoint on people receiving actual needed care.

One relative waiting over six months for a non-emergency MRI in Oregon. Another has waited for over three months for her insurer to "approve" diagnostic imaging for a foot surgery her (required by insurance) primary care provider already prescribed. That kind of thing happens in other countries too, but I have walked in to hospitals in Taiwan, Thailand, and Malaysia and received immediate care, including diagnostic imaging, at prices a fraction of what I've paid for the same thing in the USA.

Without getting into the possible reasons, health care in the US consistently (during most of my lifetime anyway) ranks very high for cost, very high for corruption and profiteering, and increasingly worse in terms of outcomes. And the US has a large and growing population of uninsured and underinsured citizens, even compared to other countries with similar demographics and immigration (Canada, Australia).

> our life expectancy is on par with countries that have a tenth of the immigration rate and a lesser poverty rate

Actually the US ranks rather poorly in terms of life expectancy, even compared to countries with similar immigration rates and poverty [4]. You can slice the numbers all kinds of ways, and interpret them according to your own biases, of course. But given that the USA stands as the richest country and the biggest spender on health care per capita, by wide margins, one has to wonder why it ranks below, for example, Thailand and Panama on at least some measures of medical outcomes and life expectancy.

As you seem to allude to, the truly indigent and uninsured may receive some minimal care faster, and for free, compared to the working class or middle class people who appear to have the means to pay. Hospitals and the US health care system at large factor treating the uninsured as a cost of business, passed on to those who can pay-- similar to how Americans who pay for car insurance subsidize those who don't. As a middle-class person with some form of insurance (often useless or inadequate, but that's a different topic) I know my first interaction at a hospital or emergency room will amount to establishing how I will pay, the wallet-dectomy.

America also leads the world in medical debt [5], the aftermath of inadequate insurance and inflated costs for treatment and medications. Medical debt usually ranks at the top of the list of reasons for personal bankruptcy in the US.

[1] https://worldpopulationreview.com/state-rankings/er-wait-tim...

[2] https://www.beckershospitalreview.com/rankings-and-ratings/e...

[3] https://www.statista.com/statistics/1475298/average-wait-tim...

[4] https://en.wikipedia.org/wiki/List_of_countries_by_life_expe...

[5] https://en.wikipedia.org/wiki/Medical_debt

[trimethylpurine]

I wouldn't trust those sources. Google funded sources (Wikipedia) and other major political lobby participants shouldn't guide a well formed stance on any topic. Statista's Wikipedia page itself demands for its own deletion due to being a poor and unverifiable source of data.

Outside my window is a line of billboards with digital displays that show the ER wait time at the hospitals beneath them (there are 7 within a 5 mile radius). I can see them without having to actually go to the ER. Maybe I could post a photograph for you somewhere. When I go (I've been over 47 times in my life, or at least that's what I have records for) in this state I've never waited more than 30 minutes, and there's rarely more than 4 or 5 people in the lobby. If you are really having a hard time getting care for your children that's a good reason to move to another state.

All that being said, I can agree with you in some cases. In Los Angeles I waited far longer and I don't blame people living there for believing it's bad everywhere. But in fact, it's common here to have no wait at all. The last time I took my elderly mother in for care (three times in the last week) the wait was for the front counter clerk to get back from the bathroom. The lobby was completely empty of patients. Her circulatory system was imaged. We were in and out within 2 hours.

Most of the hospitals here are owned by an insurance provider, and maybe that helps. I'm not sure, really.

>Actually the US ranks rather poorly in terms of life expectancy

Again, check that you are using reliable sources for your claims. Life expectancy is right around 80 in most civilized countries and the US is right there with Europe.

Keep in mind that large corporations don't like paying for their employees' health care and they don't want you to like the health care system that they are forced to pay for. They want you to get online and rally efforts to vote against it so that it will be as bad as it is in Europe.

I live in both places, and I can say with confidence, you will absolutely pay more (in taxes) for health care in Europe, and the wait for care is often so long that you'll pay for private care anyway. Same doctors, you just skip the long wait if you pay. I'm literally paying for it today for a family member.

I'm not saying the US is perfect, I'm just saying that it's partly socialized, and that if you fill out the forms you can get care, same as in Europe, and at least in some states, it's better.

The overarching reality is that even socialized care requires filling out forms and registering in some system. And the rich still get to go to the front of the line. It's no different in Europe.

[gregjor]

Possibly true, though too many separate studies and surveys show the inadequacies of American healthcare for me to dismiss them all.

When I last lived in the USA my ACA premium (self-employed, two adults) started at $1,150/mo with $12,000 combined annual deductible, plus a co-pay. I struggled to find doctors who would accept the insurance, and in the US you need a primary care physician to refer to specialists, get diagnostics, etc. After two years of that my premium got raised to $1,450/mo with $14k deductible — prohibitive for me and I will guess most middle-class people. Quality of care fairly poor — doctors and labs missed a critical cardiac condition twice.

I live in Thailand now, where I can walk in to a hospital without a referral, get the tests I need immediately, and pay out of pocket because prices come to 1/5th or less than US prices. Thai hospitals found two urgent conditions missed in the US. I have a catastrophic policy that costs $210/mo for me and my wife, with $500/yr deductible. In a poor developing country that, incidentally, has a lot of immigrants, legal and illegal.

Thailand has socialized health care for citizens. Very cheap but not the best quality of care. If you remove automobile and motorbike collisions (bad in Thailand) the medical outcomes and life expectancies match the US, on average.

Your mileage varies. In the US you can get treatment for some things in the ER. You cannot walk in and get a colonoscopy, or cardiac imaging, which may not seem urgent in the moment but can save your life nevertheless. I prefer not to wait for the heart attack or tumor I may survive if I can get to an ER in time. My father had the same largely genetic conditions and died without insurance, unable to get diagnostic care where he lived.