What happens to people without health insurance?

[quinnox]

I was wondering this the other day, lets say some Joe Blow walks into the emergency room because he has no insurance, and they find out he has cancer or some other serious illness that requires a lot of care and treatments.

What happens? Does the hospital say "Sorry, but you have no insurance or money so we don't want to give you these expensive treatments that you need, so you are out of luck" Guy says "But I will die without them!" Hospital "Sorry no can do without the money"

Or does the hospital give them a little "bandage type" treatment but not the comprehensive treatment they need and then sends them on their way.

Or will the Joe Blow get the treatment and the hospital bills them but knows they won't get paid.

Our health care system definitely is broken but I was curious about this, does anyone know?

[HopeHoops]

1. Emergency rooms are required to provide care.

We ultimately pay one way or the other.

[Demobrat]

2. Emergency rooms don't do cancer treatments

I think the poster is wondering what happens to people after the initial diagnosis. It's a good question.

[HopeHoops]

5. Oh, in that case they just get to languish and die.

I must have misinterpreted the OP.

[Kalyke]

17. And they don't admit.

My step-father died as a result of lack of insurance and a doc who wouldn't admit him for further testing as a result.

[blueworld]

21. Only "public" ER's are required to provide care, not private ones n/t

[HopeHoops]

23. Agreed. A little ironic that most of them are church-based.

Would Jesus turn anyone away? They do.

[roguevalley]

38. They do what my sister-in-law's brother Dennis did. They die of

totally preventable things. He died of asthma and left a 19 year old widow and an unborn son.

[valerief]

3. I think they have to quit their jobs and give up their assets so that they can apply for Medicaid.

Months later, if they don't die in the meantime, they might get it.

Not sure, but that sounds like the American Plan.

[rubberducky]

18. I lost my job and my home, so basically no assets,but denied Medicaid.

It`s froze here in MI, they are not accepting more people at this time.

[enid602]

34. really?

How could that be? I always thought that Medicade was given to those who have no assets and make less that the poverty line.

[rubberducky]

35. Really! I was totally shocked when I was denied.

I have 4 heart blockages and other health problems. The lady that I was dealing with said the freeze should only last 3 mos., but that was 5 mos. ago.Now the state is talking about dropping hundreds and hundreds of people off medicaid so they can balance the budget.

[enid602]

36. yuck

God bless you. Every day we hear more and more of these stories. And yet the Gov't always seems to find a few trillion to keep wars and defense spending going.

[Warpy]

4. It's called spending down

If the person wants to live, he undergoes treatment. He pays what he can, sells what he can, signs away his house, quits his job if he still has one, and becomes destitute, owning only his next couple of months in rent, maximum. At that point, he can get Medicaid.

He can live if he's willing to lose everything he's worked for all his life, in other words.

[supernova]

11. It's very routine for older folks

sadly.

:-(

It's so horrible that they have to give up whatever legacy they might want to pass on to their families in order to get gov't sponsored care.

[pitohui]

13. and if he's willing for his family to lose everything as well

then after all that if he dies anyway i guess his wife is supposed to just kill herself

[Warpy]

19. If he's got access to savvy people, they will tell him to divorce his wife

and makes sure she gets the house in the settlement. If not, then they will both get dragged into penury for the rest of their lives.

[tekisui]

6. Off topic, but on the forum board this thread lists 0 recs and 0 replies,

When I opened it up there were several responses and two recs?

[prolesunited]

7. What ERs are required to provide -- way less than many think

In a nutshell, the federal patient-dumping law entitles you to three things: screening, emergency care and appropriate transfers. A hospital must provide "stabilizing care" for a patient with an emergency medical condition.

If you're not having an emergency, then the hospital emergency room does not have to treat you. The hospital most likely will direct you to your own doctor or to a less-intensive-care setting, such as a community health clinic.

If you don't have health insurance, then you still will have to make payment arrangements with the hospital.

http://articles.moneycentral.msn.com/Insurance/KnowYourRights/KnowYourEmergencyRoomRights.aspx

[CTyankee]

8. Wouldn't that person be eligible for Medicaid? A hospital usually has social workers.

They would be able to counsel the guy on state and federal programs he could access.

If the guy had so many assets he couldn't qualify for Medicaid, well, then he would have to spend them down and basically "pauperize" himself.

That's our system. Isn't it wonderful?

[pitohui]

9. i had no insurance for 15 years, could not receive any treatment except paying cash

the only exception would be in an emergency they would have to stabilize me, for instance, a homeless friend collapsed on the street, hit her head, and was taken unconscious by ambulance to the hospital

having no paperwork or $$$ she was given the minimal treatment and then kicked back out on the street with no follow-up as soon as she could walk

if you have cancer, you can't get chemo w.out insurance because it costs many tens of thousands of dollars, you simply do without treatment until such point as you are having seizures, hallucinations, etc (it has gotten in the brain) to where you can get emergency treatment to keep you from continuing to seize


medicaid may exist in theory but don't expect to get it w.out an attorney, a process that can take many years in louisiana, you'll be dead way before then she said cynically


people w.out insurance are not dying because they're too proud to ask for help, they're dying because they're being killed -- deliberately being denied treatments that we have the technology to deliver

[inna]

25. what an absolutely horrid, brutal, immoral, EVIL system.

:shudder:



How do we allow ourselves - US, The People - to be treated this way????


:grr:

:argh:

[cbayer]

10. Generally, they are stabilized and then attempts are made to transfer to a state

or county hospital, but this isn't always possible.

If they continue to need hospitalization, the hospital will generally keep them while attempting to obtain medicaid, which is easier to get once the total medical bill reaches a certain level. They are definitely tracking all the charges and will try to recoup any way they can.

Once the patient no longer needs the hospital, things become much more difficult. As doctors, radiation centers, labs, etc, are not required to accept patients who can not pay, hospitals try to arrange treatment at state or county facilities. This is where the patient can really fall through the cracks, as they may be refused treatment everywhere they turn.

Patients who have some, but not much, money, will be forced to "spend down" until they qualify for medicaid. Medicare isn't available for a full two years after a person is considered "disabled" by an illness, so it's not an option.

[Oregone]

12. ERs treat then overcharge for it knowing the person can't pay. They get a tax write-off on fake sum

Thats my experience in rural Oregon in multiple towns. Theyll cut the bill down below 25% of the artificial cost and send it to collections, then write off 75% of it as a lost to the taxman.

Sometimes they make more money treating people at a "loss". This was standard protocol in a lot of different places (that I experienced, or friends, or had friends/family that worked in them)

No one wants to talk about this though

[TorchTheWitch]

14. you die or go bankrupt or both

The ER is only required to stabilize you and you're sent on your way once you are even when they know you will be back in less than 24 hours. And you get billed at outrageous non-insured prices for your ER care.

[and-justice-for-all]

15. They die...nt

[LiberalAndProud]

16. There are people in the health industry

who are expert in reallocating assets to help you qualify for government programs. Some folks get a divorce and the divorce settlement awards everything to the spouse. Some people gift their life savings and all assets to their children, using various slights of hand.

That is the truth about what happens in catastrophic cases under our current system.

[NMDemDist2]

20. a coworker of mine in AZ just went home and died

he finally went to the emergency room and had liver cancer, 3 months later he was dead

[blueworld]

22. Depends on several factors, but none are pretty

My 4 year-old future granddaughter was put on Medicaid when diagnosed with leukemia because her mother's employer didn't even offer insurance. However, "all" the treatments were paid for only because she participated in an experimental program, otherwise there still would have been out of pocket expenses.

An adult who showed up in ER with a kidney stone in my hospital was handed a bedpan to throw up in & left in the waiting room without even an aspirin for 3 hours until the insured patients were handled.

When the stone had to be surgically removed, the person had to negotiate to get an OUTRAGEOUS bill down to $12K & took years to pay it off while the hospital sic'd a collection agency on them.


It's disgusting & it has to stop.

[ejpoeta]

24. all the er is required to do is to get you stable. so unless this guy has a great

cancer hospital nearby that is free for him, I don't know what he could do. If he is poor, he could get medicaid i guess... but most of us are like John Q.... who have inadequate insurance but make too much to qualify for medicaid or even a state subsidized healthcare plan for those who work. My guess would be that his family and friends would end up putting jars in the stores and having fundraisers to raise money to pay for any treatments he would need... or else he would end up having to mortgage his house or something.

[OHdem10]

26. Emergency Rooms only do emergency care. They do what they

can at that visit. They tell you to find a regular doctor.

[sinkingfeeling]

27. In most communities, there are organizations that will assist someone with cancer as much as they

can. They might advise that the cancer patient lose their assets so they can qualify for Medicaid. They may pay for the treatments. There is the National Breast and Cervical Cancer Early Detection Program (NBCCEDP)and the 2000 Breast and Cervical Cancer Treatment Act that provides money to pay for breast and cervical cancer treatment in certain uninsured women. The NIH, American Cancer Society, and state health departments have information on getting care without insurance.

[Tierra_y_Libertad]

28. They are given 2 aspirin and a comfortable spot under the bus.

[Louisiana1976]

29. Some hospitals will provide charity care if Joe Blow meets income qualifications.

I don't have insurance but am qualified to receive charity care from not only the hospital I go to but from physicians (my rheumatologist and gynecologist) whose practices are affiliated with that hospital.

[undeterred]

30. If the person has no assets they can file for medicaid.

Otherwise its a choice between liquidating your assets and dying of cancer.

[Matariki]

31. Well, a search right here on DU for "Andy Stephenson" should give you a sad answer to your question.

[Javaman]

32. Two things: bankruptcy and death. not necessarily in that order.

that is of course if it's a major medical issue. if not, you will relegated to a lifetime of poverty.

trying to catch up on med bills, work, buying food and taking care of yourself via over priced meds will eat up any and all "extra" money.

we had an expression back East, it was called, "shoveling shit against the tide".

45 million Americans are doing that right now.

[Vinca]

33. Unless you are very, very poor and qualify for Medicaid or

very, very rich, you are dead meat. That's why I don't bother to get annual mammograms anymore. If anything shows up I couldn't afford to treat it, so there's no need to spend money I don't have on the test in the first place. Those opposing health care for everyone seem to live in a fantasy world where the benevolent doctor and hospital come to the rescue when an uninsured person becomes deathly ill. 99.9% of the time they do not.

[sinkingfeeling]

37. Over 60% of the members of my cancer support group had no insurance when they began treatment.

All of them have survived via surgery, chemo, and radiation theraphy provided by a multiple of groups.

[DailyGrind51]

39. "Study Links 45, 000 U.S. Deaths to Lack Of Insurance"

Study Links 45, 000 U.S. Deaths to Lack Of Insurance

By REUTERS
Published: September 18, 2009

Filed at 8:22 a.m. ET


WASHINGTON (Reuters) - Nearly 45,000 people die in the United States each year -- one every 12 minutes -- in large part because they lack health insurance and can not get good care, Harvard Medical School researchers found in an analysis released on Thursday.

"We're losing more Americans every day because of inaction ... than drunk driving and homicide combined," Dr. David Himmelstein, a co-author of the study and an associate professor of medicine at Harvard, said in an interview with Reuters.

Overall, researchers said American adults age 64 and younger who lack health insurance have a 40 percent higher risk of death than those who have coverage.

The findings come amid a fierce debate over Democrats' efforts to reform the nation's $2.5 trillion U.S. healthcare industry by expanding coverage and reducing healthcare costs.

President Barack Obama's has made the overhaul a top domestic policy priority, but his plan has been besieged by critics and slowed by intense political battles in Congress, with the insurance and healthcare industries fighting some parts of the plan.

The Harvard study, funded by a federal research grant, was published in the online edition of the American Journal of Public Health. It was released by Physicians for a National Health Program, which favors government-backed or "single-payer" health insurance.

An similar study in 1993 found those without insurance had a 25 percent greater risk of death, according to the Harvard group. The Institute of Medicine later used that data in its 2002 estimate showing about 18,000 people a year died because they lacked coverage.

Part of the increased risk now is due to the growing ranks of the uninsured, Himmelstein said. Roughly 46.3 million people in the United States lacked coverage in 2008, the U.S. Census Bureau reported last week, up from 45.7 million in 2007.

Another factor is that there are fewer places for the uninsured to get good care. Public hospitals and clinics are shuttering or scaling back across the country in cities like New Orleans, Detroit and others, he said.

Study co-author Dr. Steffie Woolhandler said the findings show that without proper care, uninsured people are more likely to die from complications associated with preventable diseases such as diabetes and heart disease.

Some critics called the study flawed.

The National Center for Policy Analysis, a Washington think tank that backs a free-market approach to health care, said researchers overstated the death risk and did not track how long subjects were uninsured.

Woolhandler said that while Physicians for a National Health Program supports government-backed coverage, the Harvard study's six researchers closely followed the methodology used in the 1993 study conducted by researchers in the federal government as well as the University of Rochester in New York.

The Harvard researchers analyzed data on about 9,000 patients tracked by the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics through the year 2000. They excluded older Americans because those aged 65 or older are covered by the U.S. Medicare insurance program.

"For any doctor ... it's completely a no-brainer that people who can't get health care are going to die more from the kinds of things that health care is supposed to prevent," said Woolhandler, a professor of medicine at Harvard and a primary care physician in Cambridge, Massachusetts.
(Editing by Xavier Briand)

http://www.nytimes.com/reuters/2009/09/18/news/news-us-usa-healthcare-deaths.html?_r=1

[DailyGrind51]

40. "Death by no Insurance": Chicago Tribune

Posted on April 4, 2007
Death by no insurance?
PRINT PAGE
EN ESPAÑOL

Doctor and patient had colon cancer. She was uninsured and died. He is alive, convinced she could be too.

By Lindsey Tanner
Associated Press
Published April 4, 2007

Dr. Perry Klaassen lived to tell about his frightening ordeal with colon cancer.

His patient did not.

Same age, same state, same disease. Striking similarities, Klaassen thought when Shirley Searcy came to his clinic in Oklahoma City. It was July 2002, a year after his own diagnosis.

But there was one huge difference: Klaassen had health insurance, Searcy did not.

His treatment included surgery two days after diagnosis and costly new drugs. He is alive six years later despite disease that has now spread to his lungs, liver and pelvis.

“I received the most efficient care possible. I was 61 years old and had good group health insurance through my workplace,” he wrote in a medical journal essay that contrasts his care with that of his uninsured patient.

The doctor didn’t name Shirley Searcy in his March 14 article. After all he’d been through, he couldn’t remember her name. But he dug for days through old medical files searching for her identity after he was interviewed by The Associated Press, hoping to shine a more powerful light on the plight of the uninsured.

The widowed mother of eight grown children, Searcy had little money. When she began to sense she might be sick, she put off going to the doctor for a year because she knew she couldn’t pay the medical bills. Deeply religious, she put her faith in God, according to her family.

By the time she saw Klaassen, her cancer had spread from her colon to her liver. She had surgery but rejected chemotherapy.

“She just really didn’t feel like she wanted to endure what that would cost physically or financially,” said her daughter-in-law, Karen Searcy.

Shirley Searcy died Dec. 22, 2003, about 18 months after her diagnosis.

Searcy’s is a story that’s far from unique. An estimated 112,000 Americans with cancer have no health insurance, according to Physicians for a National Health Program.

Klaassen’s essay in the Journal of the American Medical Association illustrates the issue “close and personal,” said the publication’s editor, Dr. Catherine DeAngelis.

It underscores that insurance can be a life or death issue, said Paul Ginsburg, president of the Center for Studying Health System Change, a non-partisan policy research organization.

Klaassen, now 67, no longer sees patients but works part-time as medical director of an Oklahoma City group that recruits doctors to give free care to needy patients.

Always healthy and vigorous, his diagnosis in 2001 came as a shock.

Klaassen had a colonoscopy within two weeks after seeing his doctor for pain in his lower abdomen. When the specialist with the results asked, “Is your wife with you?” Klaassen wrote, “I knew immediately that I had colon cancer.”

Surgery two days later showed the disease had spread outside the colon wall and to nearby lymph nodes. It was not as advanced as Searcy’s, whose disease had spread to the liver.

Searcy married young and had her first child in her teens. Her mechanic husband died in a 1978 car crash, leaving her to raise the family alone. Social Security helped, but the Searcys never had anything extra, family members said.

“Life dealt her more I guess than some people have been dealt,” Karen Searcy said.

She didn’t work outside the home, didn’t venture often beyond her 4 acres and the ranch house where she raised her children in Blanchard, about 30 miles from Oklahoma City. In her later years, reading stories to her dozens of grandchildren was a favorite pastime. She’d figured she’d live long enough to qualify for Medicare at age 65, family members said; she missed it by a year.

“She put off because of no health insurance, and she wanted to trust the Lord. She was hoping to be healed,” said her daughter, Melba Spalding.

Klaassen knew immediately that it was colon cancer when she saw him. A colonoscopy weeks later confirmed the diagnosis and that it was incurable.

It was “heartbreaking to all of us,” Spalding said. The family had always been close, and Searcy “was pretty well the hub of it,” she said.

With insurance, Searcy would have sought treatment sooner, family members said.

“I believe with all my heart that if she had gone to a doctor early on, that she would still be living,” Karen Searcy said.

Klaassen also thinks things would have turned out differently if she’d been insured.

“If she had survived at least a year more, she would have had new pills available to her,” the same ones that have helped control his disease, Klaassen said.

“People say … nobody ever dies because they don’t have insurance, and I say, ‘Yeah, they do.”

Copyright © 2007, Chicago Tribune

http://www.pnhp.org/news/2007/april/death_by_no_insuranc.php

[olegramps]

41. They die.