The government did an awful lot to cause this, and they could take steps that could make a huge difference:
-increase reimbursement rates to encourage physicians to go back into primary care. Since the 1990s, paltry reimbursements drove physicians out of primary care and to higher-paying specialties. Medicare/medicaid killed the family doctor.
-modify EMTALA. Before, Emergency rooms could make referrals to low-cost clinics for patients who showed up for non-urgent reasons. I worked ER when EMTALA passed, and almost immediately, our ER was overrun with women coming in seeking routine pregnancy tests, people with acne wanting zit cream, and every kind of nonemergent bullshit. Now we HAVE to see these people, and they know it. The ER used to be for emergencies. Now it has replaced primary care, but at a much greater cost.
-Do something about illegal immigration! The cost of keeping someone alive indefinitely is astronomical, and once a hospital accepts a patient and stabilizes him, they are not allowed to discharge him until a suitable facility or arrangments are found for long-term care. These subacute longterm care patients then take up hospital beds indefinately and at a huge cost. I've seen families refuse to accept supplies of medical equipment at their homes after discharge has been arrange and refuse to take the patient because they know they will become financially responsible for the care of the patient. I worked at one unit that blew through it's entire yearly operating budget taking care of one vegatative-state illegal alien. Our doors were within weeks of closing when benefactors stepped forward. Futile care is expensive, and it's absurd to pay for futile care of people who haven't contributed. Acute care for anchor babies with no prenatal care also falls into this gategory.
-Hold people accountable for their own health. You may not be able to help that you have a disease, but you hold some responsibility for maintaining your health. I've seen this scenario over and over again...diabetic with emphysema and seizure disorder is found in a diabetic coma. We bring him in, put a breathing tube down, nurse him back to baseline at a huge cost. This process takes weeks because his lungs are shot from smoking. We finally get him patched up and discharge him, then he's brought back in the same condition less than a week later because he once again drank himself into a diabetic coma. I'm not sure how to solve this one, but it's a huge drain on the system and a significant part of the patient population.
We are all paying for these folks, and we can't afford it anymore. I don't mind paying more to cover someone who makes less, but we're paying for people who are abusing the system.
I'll off my soapbox now, 'cause I could go on and on about this. Nothing's going to change.
