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Maybe part of the problem is the mindset "banged my head on a table, time for the ER"

???

If you're young and healthy and you lightly bang your head on a table, you don't need the ER! It sounds like she wasn't even concussed! Sure, get checked out by a doctor, but this isn't a life or death situation, so don't clog up ER triage with your BS.

That's like breaking your toe and calling an ambulance.




Maybe. But possible one in a hundred times, the "banged head on table" could lead to complications. I'm familiar with such a case.

Somehow, everywhere in the developed world except the US, people can go to the ER-or-equivalent (many places have 24-hour clinics/triage centers that would send you to an ER only if needed) after they've banged their heads, and 99% of the time be told "go home, it's fine" without being bankrupt. I would say the problem is with how the US healthcare system is run.


  People go to "ER-or-equivalent".

  Immediately mentions a place that is not the same as ER that the US also has (clinics).
As I said -- she was wrong to go to the ER. She lives in NJ. I know for a fact there are loads of clinics she could've gone to and been sent home with a clean bill of health for $50 copay.


I left NYC 5 years ago. But at the time I was living there, there was essentially no option other than an ER after 3pm (and very few before).

And my point is that the European system does not require you to make decisions in such a case. You just go and get checked without going bankrupt.

Where I live now I have 3 hospitals within 20 minute drive, one of which is walking distance, and 20 triage/clinic locations. I can go to any; I prefer the triage because they are quicker and nicer.


Really? I live in NYC and can't agree[1].

Yes, you are correct -- with a socialized system, you don't need to worry about "triaging yourself". But that is not a good thing. You don't want patients to mis-utilise the services available to them, just because they are free and therefore they don't need to worry about the associated costs.

Ambulances / ERs / MRI / etc -- these things are EXPENSIVE to operate. It's too bad, but it's the truth. Just because you can use them in the UK or wherever doesn't mean you should, and there is nothing to disincentivise people from this because they're not footing the bill (directly, that is). I literally wrote my undergraduate dissertation on various ways the cost of MRI could be brought down, and it's not an easy problem, regardless of who is paying for it. Getting medical care that you don't need is no small thing in the scheme of things.

1: https://www.google.com/search?q=urgent+care+center+nyc


At the time I lived in NYC (2007-2013), Me and family had needed urgent care services 3 times. In all three times, we called insurer (Aetna once, United twice), and they told us to go to ER because there is no better option.

Things may be different now, last time I visited manhattan a few months ago indeed there were several walk-in clinics between 8th street and 23th that weren't there 5 years ago, but (at least from the sign on the window), not all accepted all insurances, and none had a chargemaster listed outside, which means there's a nontrivial possibility one would go bankrupt going into them.

> Just because you can use them in the UK or wherever doesn't mean you should, and there is nothing to disincentivise people from this because they're not footing the bill (directly, that is).

That's true. And if people did misuse them significantly, I'm sure the (dis)incentive structure would be put in place. But it turns out that most people in the UK and EU and other places are not jerks, and do not call an ambulance needlessly.

It is a mathematical certainty that there is always a false-positive / false-negative tradeoff; The US system (and your recommendation) prefers false negatives, the EU system and other single payer systems prefer false positives. And .. what do you know? Bang for buck, single payer systems triumph greatly, have lower infant death, and higher life expectancy.




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