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0 pointspyuser5834y ago0 comments

That’s bull.

I have a nasty medical condition that necessitates ER trips. I know all three ERs. There’s the good one, the OK one, and the terrible one.

The problem is I don’t get to chose my own insurance. My employer does.

I know exactly which doctors, specialists, and ERs are best for me.

Doesn’t matter. My employer, who is remote and employs nobody else in the state, has determined who I can and can’t see.

And they’ve done it completely blindly.

It’s a messed up system.

But the idea that people won’t avoid bad hospitals, including ERs, is untrue.

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EForEndeavour4y ago· 2 in thread

And what about people who haven't had a compelling reason to maintain a running comparative opinion of their local ERs, simply because they don't have a chronic condition that keeps sending them back to ERs?

OP's point is valid: it's reasonable to expect someone to look up information before deciding on, say, where to eat that evening. It's farcical to expect someone experiencing acute angina or stroke symptoms to inform themselves about their free-market healthcare options by looking up online reviews or whatever for local ERs.

pyuser583OP4y ago

My experience is people know the “good hospitals” and “bad hospitals”, much like they know “good schools” and “bad schools” or even the “good DMVs” and “bad DMVs”.

The problem is most people have no choice.

For ER care individual doctor ratings are unimportant, because you have no idea who the doctor will be.

What matters is the institution. And they absolutely do have reputations.

For example, Kaiser Permenante has a reputation so foul it’s known nationwide, despite only operating a few states.

Also, I’ve never had any difficulty getting an ambulance to take me to the ER of my choice (that is, my insurers choice), and I’ve done this many, many times.

EForEndeavour4y ago

Honestly, I appreciate reading about your experiences, and bottom line, I'm happy that you're able to access medical care.

Your experience hints at some of the flaws in US healthcare:

> For ER care individual doctor ratings are unimportant, because you have no idea who the doctor will be.

Right, and if the ER doctor you happen to draw is out of network for you, RIP your savings and/or credit score. Isn't this a decently common problem, where even an "in-network" institution employs practitioners who are "out of network" for you, so you thought you were covered by your insurance company's rules, only to be surprised days after treatment?

EDIT: this "out-of-network provider at an in-network institution" problem was so common and frustrating that Congress has had to ban the practice, as linked in the article: https://archive.is/50VQv

> take me to the ER of my choice (that is, my insurers choice)

Leaving the choice of ER to one's insurer doesn't sound like my idea of "free market" healthcare. What if they choose your area's "bad" ER? I suppose you can indirectly pre-choose your ER by choosing an insurer which covers the ER of your choice -- that is, unless you get insurance through your employer, in which case I guess you'd have to purchase private coverage for your ER of choice.

Different institutions have different reputations in single-payer publicly funded health systems too, so I'm not so sure if that's the crux of the matter. What upsets me is that those people who are in the most desperate need of healthcare are almost by definition in the worst possible position to make an informed choice. Picture an unconscious victim of an accident, violence, stroke, heart attack, etc. Oh, and it seems generally impossible for even an awake and alert person to "shop around" by comparing price quotes for the healthcare they need, preventing competitive choice.

Then there's the issue that ERs must stabilize and treat anyone who enters, regardless of ability to pay. Someone has to cover the cost of this.

What kind of "market" keeps prices secret from incapacitated consumers? I think MereInterest summed it up perfectly: The nature of medical emergencies prevents actual markets.

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