Do you think that free 'national' health care would lead to overuse of the health care system in the U.S.?

This story appeared today http://news.yahoo.com/s/ap/20090401/ap_on_re_us/frequent_er_patients
My experience working in a free clinic was that average Americans tended to come in frequently for even minor complaints and demand prescription medicines because it was all free. The 9 people who racked up 2700 ER visits over six years in Texas never paid - but the hospital had to charge others to cover their costs. These people all had mental disorders. But what of average Americans given access to free care and free medications as in Canada or Britain? Might some - or many - overtax the system? I suspect it might lead to overcrowding and longer waits for the very sick to be seen unless triage were handled very carefully. It looks like we are headed towards a national health care system in the U.S. I see good and bad consequences. Your thoughts?

2009-04-01T18:38:43Z

Excellent answer so far - especially Pangolin's. In the Michael Moore movie "Sicko" - a 32 year old man does not receive a bone marrow transplant for widespread kidney cancer because his insurance would not cover it. Moore cites this as a failing of the U.S system. But you can bet this patient would not have received a marrow transplant in Britain, France, Cuba, or Canada either. It is an expensive treatment that has not been proven to cure anyone with advanced renal carcinoma. In essence, this is rationing as Pangolin says. Not everyone will be able to have "everything possible" done. Today - there are many expensive things we can do for (or to) people to eek out a few extra months of life.

2009-04-01T20:27:17Z

I should add that the "free clinic" where I worked as a "moonlighter" during subspecialty internal medicine / oncology training was actually part of the health care plan for a major tobacco company. This was not for indigent people. These were working people who felt they were entitled to see doctors and get free prescription medications at any hour with any complaint. I worked night shifts and saw only one true emergency - an ectopic pregnancy - over two years. People at times insisted on medications, such as antibiotics, which were not medically indicated. I was required to give them what they wanted - though not including narcotics.

Anonymous2009-04-02T08:18:00Z

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Darn good question Spree. I watched "Sicko" recently too. I must say I was persuaded by some of his arguments. However, I reminded myself that Michael Moore never makes "objective" movies ... he makes movies to support a position he has.

I am lucky to have a great insurance plan that completely covered (other than about $5000 in copays over about 15 months) my cancer treatment.

There are a lot of people who are not so lucky, who are uninsured.

I do believe that a national healthcare system does cause some shortages in treatments. I also believe that it encourages more preventive care, just as most health insurance plans do. When you do not do preventive care because you have no insurance, this tends to lead to long-term chronic health issues that lead people to visit the ER over and over (diabetes, kidney failure, etc.).

When you check the numbers, every country where there is "socialized" medicine or a national health care plan, has a longer life expectancy than we do. So if you have to limp around for an extra year to get your knee replacement ... isn't that worth living 5 more years?

Pangolin2009-04-01T22:52:43Z

What you get with "national" health care is rationing. Certain procedures and medications just won't be available. Need a new hip? Your appointment with the orthopedic surgeon will be sometime next year.

Patients in the UK and Canada can "demand" all they want, but they don't get their surgery until it's their turn (unless they want to pay out of pocket). My father-in-law (British) had a bladder catheter for a year waiting for his prostate surgery. In the US, he would have had that done within days.

It's not completely a bad thing. Maybe some very expensive end of life care will become unnecessary when people die waiting for it.

I had a patient yesterday whose family refused to take any responsibility for her care. Their attitude: do everything, but don't send us the bill. Her physicians did her surgery for free, because she needed it. A financial safety net would be helpful, but all care at the taxpayers' expense? No thank you.

John de Witt2009-04-01T23:55:05Z

There's a persistent myth that people with government-supplied health insurance like Medicaid overuse the system. While there are glaring examples that it happens, that isn't the overall situation. As your own experience points out, payment really doesn't seem to correlate at all with use/overuse, and those who will overuse the system seem perfectly happy to do so no matter what their insurance status, or whether they're insured at all. The great majority of people simply have better things to do with their time than go to the doctor.
If anything, I'd expect people in a universal insurance situation not to have to have such fragmented care, and they might actually wind up needing fewer visits to accomplish the same purposes they now get by going many times to free clinics and emergency departments.

Anonymous2009-04-01T21:38:15Z

I think the people who do that sort of thing have an illness in and of itself. I don't think that the average person that benefits from a National Health Care program would overuse or abuse it. After all, how many people actually enjoy going to the doctor? It's also been my experience that overcrowding and long waits are already an issue, but people with very serious problems are treated first. And of course, people caught abusing the system should have to face fines and possibly psychiatric treatment.

tom4bucs2009-04-01T21:42:31Z

If people think health care is expensive now -

Wait till it's FREE

Years ago, our state goofed and provided a health insurance policy
with $25 copay for your primary and $10 copay for ER visits

One enterprising father took the plan - and now all Doctor's visits
are at the ER - they pay $10 and get seen - no appointment necessary
all other fees paid - including meds -

no wonder that plan was never offered again

but those that have it - can keep it till they retire

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