Affordable Care Act (AKA Obamacare)

[Diddy]

But we've got health care with no incentives for preventative care so it's not taken advantage of. ER's are full of people using them like primary care running up costs.

You need to ask yourself why people are using the ER as their primary care provider. Do you think they want to? Who would? Do you think that if they had access to affordable preventative care and checkups they would choose to be at the ER?

They are there because that is their only rational option open to them.

That needs to be fixed.

I believe they are there because they aren't educated enough to know that it's the most expensive and worst option they can use.

[33anda3rd]

But we've got health care with no incentives for preventative care so it's not taken advantage of. ER's are full of people using them like primary care running up costs.

You need to ask yourself why people are using the ER as their primary care provider. Do you think they want to? Who would? Do you think that if they had access to affordable preventative care and checkups they would choose to be at the ER?

They are there because that is their only rational option open to them.

That needs to be fixed.

I believe they are there because they aren't educated enough to know that it's the most expensive and worst option they can use.

But sometimes what we believe and what we know are different. Have you researched it?

[Joe Shlabotnik]

But we've got health care with no incentives for preventative care so it's not taken advantage of. ER's are full of people using them like primary care running up costs.

You need to ask yourself why people are using the ER as their primary care provider. Do you think they want to? Who would? Do you think that if they had access to affordable preventative care and checkups they would choose to be at the ER?

They are there because that is their only rational option open to them.

That needs to be fixed.

I believe they are there because they aren't educated enough to know that it's the most expensive and worst option they can use.

This is an anecdote but I think it is representative: I am a white, white-collar kind of guy. Always had health insurance and still do. When I moved to Alabama 7 years ago, i could not find a private family practice that was taking new patients. None. i had to go to Doc-in-the-boxes for my care.

Another thing - pick up the phone and call around your local primary care docs - ask who takes Medicaid and if they are taking new patients. Now go down to the poorer, blacker neighborhoods in the closest big city and repeat the exercise.

i think you will find that the primary care you think is universally available simply isn't there in many places.

[Tim]

Chiming in (it isn't policy, so I am going to allow myself). Joe is exactly correct. Docs don't want to take Medicaid. Reimbursements are miniscule, the paperwork is outrageous and you end up having to hire someone to just deal with it so you don't end up committing fraud.

[33anda3rd]

Joe is correct and universally so since access is the roadblock for a lot of poor people to a lot of things in this country. To a doc in their neighborhood, to coverage for that doc, to a supermarket that sells healthy food instead of a corner liquor store w/ Cheetos and Dr Pepper, to transportation that would get them to a good job, to education, to a life without fear, to a lot of stuff.

[Schlich]

Chiming in (it isn't policy, so I am going to allow myself). Joe is exactly correct. Docs don't want to take Medicaid. Reimbursements are miniscule, the paperwork is outrageous and you end up having to hire someone to just deal with it so you don't end up committing fraud.

Maybe we can toss them a few pennies out of the $1 trillion/year or so the health insurance industry makes when we render them obsolete.

[Diddy]

I'm not even talking primary care, urgent care facilities are pretty prevalent, take medicade, and are there for the exact types of things people are flooding Emergency rooms for. Except they are much cheeper.

[33anda3rd]

I'm not even talking private care, urgent care facilities are pretty prevalent, take medicade, and are there for the exact types of things people are flooding Emergency rooms for. Except they are much cheeper.

This is unfortunately not the case. Go to Google maps. I live on Logan Boulevard in Chicago which is one of the more desirable streets in town and lined with $1MM+ homes. Plug in 3000 W Logan Blvd, Chicago, IL then search nearby for urgent care. Within like 2 miles there are 8, with one being a Target Minute Clinic. An abundance of options. I can walk to a few of these, get a cab or drive to the rest in < 10 minutes.

Now go to Garfield Park, where the heat map of gang violence is worst in the city. Go to 4000 W Madison, Chicago, IL and search nearby for urgent care. The map zooms waaaaaaaaaay back, and the closest ones they give you are the ones up in my neighborhood, an option near UIC that's several miles away, and one in the West Loop. There's no access to urgent care facilities in that neighborhood. There is also no easy public transpo from this area to a facility--if you wanted to go from 4000 W Madison to the UIC urgent care you'd have to take a bus to another bus and it would take you about 45 minutes to get there.

[Diddy]

45 min? That's to far to go for urgent care? That does not seem unreasonable to me.

[33anda3rd]

You're a poor black woman with a baby who has a 102 degree fever. You're in a gang-infested neighborhood, but it's your neighborhood. You're uneducated. In the rare occasion that you do go down to the Loop or another "white" neighborhood (I know I'm not being terribly PC here, but it's the reality of our city that it's racially very divided) you feel out of place. You can take the baby with the fever to the hospital in your neighborhood around your people or you can take a bus to a bus to an urgent care facility four neighborhoods away.

Yeah, 45 minutes for that person is too long.