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A major portion of the money that is spent in the United States healthcare system is for end of life care. No one wants their elderly mother, father, grandmother, grandfather, etc. to die and wants "everything to be done" despite our recommendations that these interventions will not prolong their life. See http://khn.org/morning-breakou.... The emergency department is most likely the most efficient part of our health care system. See http://newsroom.acep.org/fact_...

And hospitals are already on the hook for uninsured patients due to the EMTALA laws.

No, the article said:

The Emergency Medical Treatment and Labor Act (EMTALA) of 1986 was enacted to prevent hospitals from refusing care to anyone needing urgent care and presenting at a hospital’s emergency room, regardless of insurance status. Unfortunately, EMTALA has sometimes been viewed as a mandate not funded by the federal government, and violations occur without reprisals or corrective actions.

It's even worse in Texas. They refused to implement Obamacare, fought it, and kicked people out of Medicaid. I think MedPage Today's KevinMD had a blog entry by a doctor at one of the charity clinics who said that the hospitals were referring uninsured people to them (after the hospitals kicked them out) even though the clinic didn't even have an x-ray machine.

Texas is a good example of the Republican health care plan -- you get sick, you die. http://online.wsj.com/articles... Legal Loophole Ensnares Breast-Cancer Patients; Shirley Loewe Chooses The Wrong Clinic And Starts Long Ordeal

You're insane. The insurance companies are at the end of the line here. Things are going to happen way too fast for insurance companies to change their policies, treatments are going to be medically necessary, the only question is whether the extra costs entailed by the infection precautions are going can be charged back to the patient's insurance (likely with a subsequent hissy fit about actually paying it).

No one is going to call Aetna and say 'can we treat Ms. Doe for potential Ebola exposure?' - that's not the way the system works. This sort of thing is something insurance companies hate - fast moving problems that can't rationally be refused. And hospitals are already on the hook for uninsured patients due to the EMTALA laws.

I thought there's a shortage of qualified doctors? Given the crazy hours many doctors are working, there seems to be a shortage in many areas.

We should weed out those unfit to become doctors, but from what I see exceedingly few doctors (from GPs to surgeons, to neurosurgeons) need to know organic chemistry to the level the courses are requiring. All they need to know is enough to look stuff up if they ever need to - which might happen say once in a few decades?

Heck between organic chemistry and hygiene practices I think I'd prefer doctors and nurses who were better at washing their hands and had high hygiene awareness (e.g. they know when they've contaminated themselves or something): http://www.acep.org/Clinical---Practice-Management/Hand-Hygiene-Program-Halves-Spread-of-MRSA-in-Hospitals/

Wash hands, use hand directly to turn tap off or open door = hand re-contaminated = you've just wasted your time washing your hands.

Another thing the knowledge of many doctors (or anyone) on "eating healthily" based on actual sound scientific research is very poor. Prevention is better than cure, and diet does a fair bit in prevention, and yet the advice many doctors give and have given is not based on scientific evidence. Many are just as in the dark as the man on the street.

Very few even give advice close to this:
http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/
http://www.health.harvard.edu/newsweek/Eat_Drink_and_Be_Healthy.htm

For example, many doctors tell you to avoid eggs and other high cholesterol foods (e.g. squid) when there's not that much evidence that it's that bad for people who aren't diabetic:
http://www.hsph.harvard.edu/nutritionsource/eggs/

There's plenty that doctors should know, but I'd like to see some evidence that knowing organic chemistry to the level required is really going to help patients or doctors that much. Otherwise weeding them out based on that seems almost as stupid as weeding them out based on their lack of knowledge in nuclear physics.

How do you propose to kickstart a healthcare market?

Like I said, that's the exact question the government should be spending money + brainpower solving. I know it's not impossible, but I acknowledge that's it's not trivial either. What I'm saying is that no one is even trying to address this problem, seemingly more content to let insurance companies run the show.

Keep in mind, if you're in an accident, you will be taken (often unconscious) top the nearest facility. There is no shopping around and they don't even know what your preferred hospital might be.

Emergency care is a very small portion of our total healthcare bill (around 2%): http://newsroom.acep.org/download/ACEP+2%25+booklet.pdf

If we could turn 98% of the healthcare system into a true competitive market, that would be plenty sufficient for me. The 2% we could deal with through other means.

The free market works for elective surgery because you *can* shop around and take advantage of competition. That isn't where the problems lie. The problems occur in situations where you *cannot* shop around and for which there is no competition, sometimes not even consent (you can't make a deal when you're unconscious).

Except you're wrong and stop spouting this lie. "Emergency care", namely care that is so imminent that you don't have time to react or wait, is a very small portion of our total healthcare bill: http://newsroom.acep.org/download/ACEP+2%25+booklet.pdf

Wake the fuck up.

Why is the care in the US 2.5x as expensive as the "too expensive" NHS (per person per PPP normalized GDP/capita) if the free market system works so well?

Because we don't have a free market!!!! I evaluate insurance plans, not medical costs.

You're nuts if you think that eye surgeries are anything but an outlier.

It isn't just eye surgery. Most elective surgery has seen cost declines, such as plastic surgery. Namely, most everything that isn't handled through insurance has seen cost declines. Notice the correlation?

Christ, man, how can you know they're illegal? Or even aliens?

Well, the American College of Emergency Physicians seems to think so:

In some hospitals, as much as two-thirds of total operating costs are for uncompensated care for illegal aliens. As a result, hundreds of emergency departments have closed. In Los Angeles, for example, 10 hospitals have closed in the past five years because of uncompensated care.

http://www.acep.org/content.aspx?id=25206

they do it for the good of mankind, so long as mankind has his Health Insuranse Plan card

Why are health care practitioners derided when they want to make a decent living just like the rest of us? The harsh reality is, the only reason your child got such excellent care was because you PAID for it (ok, the insurance paid, and you pay the premiums, but that's splitting hairs). Without the motivation to earn good money, the medical field would not attract the best and brightest minds, nor would we have the fantastic advances in medical advances that we enjoy now. Sure, there are altruistic folks out there who do wonderful work, but there's no way we could care for everyone without the support of a well-financed medical industry like we have now.

Besides, by law, no one is supposed to be denied emergency medical care in the US. Hospitals simply absorb the cost (well, in reality, they pass the cost onto paying customers) of uninsured patients who can't afford treatment. Incidentally, it's reported now that 55% of emergency care is uncompensated.

I am hopeful like you about the democrats, but you are wrong about the Hippocratic Oath. The original doesn't include anything about seeing anyone without regard for ability to pay. It does proscribe having sex with your patient's male and female slaves when you go for a house call (look it up, shit you not.) But it says jack squat about treating without regard for compensation.

Though many modern oaths do.... the one I took when I graduated from medical school included: "that in the treatment of the sick, I will consider their well-being to be of a greater importance than their ability to compensate my services." You might also be thinking about the code of ethics for emergency physicians, which does say something similar. http://www.acep.org/practres.aspx?id=29144

But there aren't a whole lot of specialties that are as explicit about it as Emergency Medicine... but then we don't have a choice anyway courtesy of EMTALA. If you have the be the safety net for providing care (and accepting the cost for it) to all of the uninsured in America because the rest of society won't accept that responsibility, you may as well get some ethical yayas out of it.

You'd have to snort a shell in order to inhale enough depleted uranium to cause significant kidney damage. 96% of DU is passed through the body within 24 hours. In order to cause any significant health risks you'd have to inhale literally grams of the substance, and there are plenty of other heavy metals on the battlefield that would kill you before the DU would.

As The American College of Emergency Physicians says this about DU exposure:

There is no evidence of permanent kidney or lung damage to individuals exposed to aerosolized DU, including those with retained shrapnel.

For instance, Soviet tanks have significant amount of radium, asbestos, and dioxins in their construction. In fact, I'd wager that most of the toxicity and radioactivity comes from the Soviet-era military hardware that was blown up rather than the weapons used in their destruction.

There is absolutely no credible epidemological evidence which supports the contention of significant health risks from DU exposure. Even if one accepts that there have been increases in birth defects near sites where DU has been used correlation does not equal causation. Until someone can show that the symptoms being reported are A:) not skewed and B:) directly related to DU rather than other environmental factors, there is no credible scientific evidence that indicates such a connection.

How much does medical liability insurance cost? A. Insurance premiums for emergency physicians grew on average by more than 50 percent from 2002 to 2003 to $53,500 (AMA 2003), with some paying more than $100,000 annually. Other medical specialists, such as neurosurgeons and OB-GYNs pay $200,000 to $300,000 annually.

I think this is a very good example of someone pulling a story out of his a**. There are 6 insures listed for emergency room malpractice insurance in Nevada. That's one less than the number listed for Texas with a set of "written by the insurance industry itself" limits on lawsuits.
And California, with one of the better insurance company oversight systems also has 6. Many states only have two or so providers. So what have the "reforms" got to do with anything. See Malpractice Insurance Providers by State. The company named (American Physicians Insurance) is listed there as only doing business in Texas. So Dr. Gondy is going to have to work in Texas, or so it seems.... And of course Texas has the highest homeowner and automobile insurance rates in the country, so she had better not plan on living in the state or buying a car there....

Another view is presented in Malpractice Rates Whitepaper. It appears that malpractice caps in California did not prevent them from having the highest insurance rates in the country (a 450% increase in the 13 years following their tort "reform"). That lead directly to Proposition 103, controlling the insurance companies directly and imposing a 20% rate reduction. Notice those insurance companies keep doing business in California because they MAKE MONEY doing so.

By the way, this directly contradicts your assertion that "the rate of growth in protected states is lower than that of unprotected states." But it does not keep the ACEP web site from asserting that MICRA has "lowered" rates 6% since 1988, forgetting to mention that from the passage of MICRA in 1975 to California's forced rollback of insurance rates in 1988, rates went up 450%. See the Q & A titled Was MICRA effective?.

And note that in Connecticut a "physician owned" insurance provider is jacking rates up 30% after a 20% increase in the same period that California rates dropped 6%: American Academy of Family Physicians "challenges".

Finally, I can't find any information anywhere about what rates really are other than urban legends about $300,000/year premiums. Doesn't that strike you as interesting, too?

I think this is a very good example of someone pulling a story out of his a**. There are 6 insures listed for emergency room malpractice insurance in Nevada. That's one less than the number listed for Texas with a set of "written by the insurance industry itself" limits on lawsuits.
And California, with one of the better insurance company oversight systems also has 6. Many states only have two or so providers. So what have the "reforms" got to do with anything. See Malpractice Insurance Providers by State. The company named (American Physicians Insurance) is listed there as only doing business in Texas. So Dr. Gondy is going to have to work in Texas, or so it seems.... And of course Texas has the highest homeowner and automobile insurance rates in the country, so she had better not plan on living in the state or buying a car there....

Another view is presented in Malpractice Rates Whitepaper. It appears that malpractice caps in California did not prevent them from having the highest insurance rates in the country (a 450% increase in the 13 years following their tort "reform"). That lead directly to Proposition 103, controlling the insurance companies directly and imposing a 20% rate reduction. Notice those insurance companies keep doing business in California because they MAKE MONEY doing so.

By the way, this directly contradicts your assertion that "the rate of growth in protected states is lower than that of unprotected states." But it does not keep the ACEP web site from asserting that MICRA has "lowered" rates 6% since 1988, forgetting to mention that from the passage of MICRA in 1975 to California's forced rollback of insurance rates in 1988, rates went up 450%. See the Q & A titled Was MICRA effective?.

And note that in Connecticut a "physician owned" insurance provider is jacking rates up 30% after a 20% increase in the same period that California rates dropped 6%: American Academy of Family Physicians "challenges".

Finally, I can't find any information anywhere about what rates really are other than urban legends about $300,000/year premiums. Doesn't that strike you as interesting, too?