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Total Health Care Costs Fall When Poor Are Provided Insurance: Study

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First Posted: 02/10/2012 9:06 am Updated: 02/10/2012 9:06 am

The concept of support for universal health care is taboo among Republicans who scrutinize the Affordable Care Act -- dubbing it the "Job-Killing Health Care Law Act" -- and call for its repeal. But a new UC Irvine study challenges the GOP argument that the health care law is too costly, with data illustrating that health care costs on the whole fall when poorer, uninsured patients are provided with insurance.

"In a case study involving low-income people enrolled in a community-based health insurance program, we found that use of primary care increased but use of emergency services fell, and -- over time -- total health care costs declined," David Neumark, a co-author of the study, said in a release accompanying the findings.

The study -- which focused on uninsured people in Richmond, Virginia who fell 200 percent below the poverty line -- found that over three years, health care costs fell by almost 50 percent per participant, from $8,899 in the first year to $4,569 in the third after they received insurance. Participants who enrolled in health coverage made fewer trips to the emergency room, which are notorious for running up patient bills. Instead, insured participants went for more primary care visits.

"A lot of the debate about health care reform surrounds the issue of whether we're setting up something that's going to cost us more by increasing use of medical services or something that will cut costs through more appropriate and timely use of medical services," Neumark said in the release. "[O]ver time, costs can be reduced through increased use of primary care and reductions in emergency-department visits and hospital admissions, but it may take several years of coverage for substantive savings to occur."

Health care spending in the U.S. has been on the rise for years. Americans spent more than three times on health care in 2008 than they spent in the 18 years before, according to a Kaiser report.

Low-income, uninsured individuals tend to rack up exorbitant health-care bills because they often rely on emergency room visits instead of primary care. In the long run, these bills are paid by taxpayers. The Affordable Care Act "is set to extend Medicaid benefits to about 16 million uninsured, low-income adults and children by the end of 2014," according to the study.

In an extreme example of the societal cost of leaving some uninsured, New Yorker writer Malcolm Gladwell once chronicled the medical costs of a homeless man in Nevada who "used more health-care dollars, after all, than almost anyone in the state."

"It would probably have been cheaper to give him a full-time nurse and his own apartment," Gladwell wrote.

Mandatory health care already saw some success in Massachusetts last decade, when current GOP presidential candidate and then-Massachusetts governor Mitt Romney signed a health care law that inspired the Affordable Care Act. Today, Massachusetts has the highest percentage of insured residents of any state.

Though he initially supported the plan, Romney's rival, GOP candidate Newt Gingrich, continues to slam Romney for enacting the health care law.

"Your plan essentially is one more big-government, bureaucratic high-cost system." Gingrich said. Gingrich's views are reflective of a majority of Americans who say they are in favor of repealing the health care law.

A repeal of the act could potentially add "at least a trillion dollars to the deficit," according to HealthCare.gov.

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The concept of support for universal health care is taboo among Republicans who scrutinize the Affordable Care Act -- dubbing it the "Job-Killing Health Care Law Act" -- and call for its repeal. But a...
The concept of support for universal health care is taboo among Republicans who scrutinize the Affordable Care Act -- dubbing it the "Job-Killing Health Care Law Act" -- and call for its repeal. But a...
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Bellla
Trans & Proud
12:02 PM on 02/14/2012
I still want my single Payer universal health insurance! Equal access to health care for all should be considered a human Right not just a perk for the wealthy!
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Karissa36
Saving lost boys and fighting pirates.
11:43 AM on 02/14/2012
Regardless of universal coverage or not, we need to change the rules for hospitals that require them to accept all patients for ER visits. They should be allowed to divert non-emergency patients to 24 hour family practice clinics. Geographically close hospitals could get together to share a single centrally located clinic. Patients could be diverted after evaluation in triage. The clinics could also take walk-in patients, so many would not go first to the ER at all.
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paulhunterjones
A new age Republican
06:10 PM on 07/12/2012
This is an excellent point. Unfortunately the economics of the extensive reliance on emergency rooms services is something most politicians would like to ignore. No health service is truly free of costs. Most county (city) hospitals do not have the option of refusing to treat patients or referring them to another facility absent a medical reason. Many people who do have health insurance prefer to use the emergency rooms to avoid being denied service at the clinics, where services are dispensed using criteria. Local politics prevent the type of cost cutting measures you suggest. Obamacare might not just the culture behind using emergency rooms.
hx4354x0r
Computing geek, Hackysacker.
11:36 PM on 02/13/2012
We could save almost 20% on healthcare costs in the US if we just ditched the incredibly complex ICD medical coding system, which is the basis for all cost controls for healthcare in the US. The coding system was created by EDS (Remember Ross Perot?) for Medicare to computerize the payment system and institute cost controls. Since then, the cost control system has added at least 25% to the total cost of healthcare in the US. The entire system, once implemented, turned into an administrative war, with each side throwing more people, more granularity, and more administration to either get paid, or deny claims.

This isn't the only instance of cost controls and means testing taking a life of it's own and becoming more burdensome than what it was designed to stop. It's just the single biggest, most costly one.
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DMGMD
Your micro-bio is still empty
09:59 AM on 02/14/2012
What would you use to replace it?
hx4354x0r
Computing geek, Hackysacker.
05:06 PM on 02/14/2012
Universal health care, where doctors are simply paid a direct salary to see patients. No more forms filing, claims processing, claims denials, claims resubmissions, and patients caught in the crossfire of two third parties waging administrative war to see who can get and keep the most of the patient's money.
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dirtydog1776
rub my soft, furry, objectivist tummy
10:12 PM on 02/13/2012
The basic premise that relying on primary care versus emergency room is more expensive is a very valid premise.

However, the question that proponents healthcare reform fail to answer is where will all the extra doctors and medical support personnel will come from when another 43 million people are given coverage free of charge or at subsidized costs?

Many people wait 1 to 2 months to see a specialist at this point. It is only logical to surmise that the waiting time will increase dramatically. Consider the shortages of nurse and even necessary drugs, as well. It takes 4 years to train a nurse, 12 years or more for doctors.

No answer from those that believe that healthcare should be "free." They seem to believe that the things that make the health care possible are being secretly hoarded by evil businessmen and that all is necessary to give free health care to everyone is "liberate" them.

Many people who worked and saved all their life will be competing for care with those that have contributed little or nothing. Rationing is the only logical conclusion. (I won't use the phrase "death panels" because liberals will start frothing at the mouth but it is the same principle.)

Also consider that governments very rarely efficient or successful in handing out entitlements without huge cost overruns and lots of pork barrel and corruption. (It is happening already.)
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DMGMD
Your micro-bio is still empty
10:14 AM on 02/14/2012
Dirtydog,

Those people already DO come to the hospital. They arrive late in the course of their disease, and cost a bundle of money to treat acutely, and have extended stays in the ICU, and rehab centers.

By the way you are wrong. If you are counting from high school it takes 2 years to train a nurse (not every nurse is a BSN), it takes 11-15 to train a physician depending on the specialty, and a varying amount of time to train ancillary staff. If you look around at hospitals and physician groups right now, one of the greatest concerns is marketing, and attracting more patients.

News flash, we already ration healthcare, and we do it poorly (I see you tried to compare rationing to death panels--nice try. It's not just a difference in terminology). We have people rushing to the Emergency Department with non-emergent conditions because they have no primary care physician. Most people don't need to see a specialist, they just need to have early and consistent care. Medicare overhead costs less than private insurance.

This has all been explained to you before I'm sure.
10:35 AM on 02/14/2012
"Many people who worked and saved all their life will be competing for care with those that have contributed little or nothing." What about people who worked their entire life, were laid off for reasons out of their control, and now cannot find full employment to provide health coverage for their family? I understand your freeloading concern (it's definitely a valid one that needs to be addressed), but it seems a little presumptuous to assume that a person's financial situation at a given time correlates directly with the efforts they have made in life.

Also, your analysis of training times for doctors is a little off. While it takes 12 years for a doctor to start practicing medicine, they often don't specialize until eight years into it (after a bachelor's degree and four years in med school). At this point, residency time depends on whether the doctor goes into primary care, specialty fields, etc. Primary care physicians (the ones mentioned in this study) spend around 3 years in residency. This puts the timeline at slightly less than your average college degree. Do you really think a lead time of 3 years for supply to reach demand is prohibitive?
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dirtydog1776
rub my soft, furry, objectivist tummy
10:11 PM on 02/13/2012
Second of two posts:

Maybe Obama will get the Dream Act passed and all those illegal, I mean undocumented, aliens will start studying real hard to become doctors and nurses. More likely, lawyers, political science majors and social workers who think they are qualified to hand out freebies but have no idea as to what constitutes production and what it takes to train medical personnel.
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ringo3khan
02:09 PM on 02/13/2012
O.K., its really like this; trusting a UC Irving study of a Democrat socialist healthcare system is kinda like................relying on a 1942 Berlin University study that shows that societies that exterminate their Jew populations have a higher standard of living. Its like relying on a Tehran University study that proves a world without Israel would result in better acheivent scores in Iranian schools. Then there's the "David Duke" University study that show everyone takes home more money when societies re-introduce apartheid. Its no different than relying on a University of Southern California study that proves multicultural societies are more likely to economically outperform those which aren't multicultural.

Bottom line.......there is no truth; there is only propaganda.
04:50 PM on 02/13/2012
please, look up what socialist is before tossing it around. i really cant tell if youre simply trying to troll, or just an idiot.

also re take elementary and high school math. when you do, youll see why going to the doctor 20 times for 60 a pop is far less than going to the ER 5 times at 10,000 a pop. despite whatever movies or tv shows youve seen portraying doctors as evil, money hungry greedy snobs, they do not like having to see someone come in in an emergency situation where they have to pay thousands of dollars for the services when its something that could have been prevented with a few regular check ups.

if you truly believe helping the poor is an evil act, then by that logic, you must also believe people like mother theresa were pure evil, or community services like soup kitchens are evil.

the main reason the gop and republicians in general are against it is because it will (successfully) reduce health care costs. reduced health care costs equal reduced stock value. lower stock value means less money, and they cant have that. to counter this, they pull the old communist/socialist card that worked in the 50's, cause hey, if pointing and screaming that worked then, why not now? they are merely playing on old fears and they know that the majority of americans no longer know what true communisim or socialism is.
11:39 PM on 02/13/2012
THANK YOU!
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DMGMD
Your micro-bio is still empty
10:15 AM on 02/14/2012
I think he's both.
12:20 PM on 02/13/2012
Because healthcare can cost so much, I'm really hoping telemedicine services for online doctors to treat patients via telephone and/or video conferencing can be more widely adopted. It would save cost of travel and even copay.

www.ringadoc.com
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ringo3khan
02:13 PM on 02/13/2012
One small problem with that; what happens when smart crooks figure out they can pose as doctors online to make mega bucks while killing people with bogus diagnoses and worse cures?
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Sharkcellar
SUPPORT YOUR LOCAL LIBRARY.
03:31 PM on 02/13/2012
You really must have that bunker you live in fully stocked all the time, huh?
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dirtydog1776
rub my soft, furry, objectivist tummy
09:48 PM on 02/13/2012
Destroy all technology and let our society return to simpler times, when people lived in small villages and knew and cared for their neighbors. Technology is the tool of the devil!

I am sure people are looking forward to living to the ripe old age of 45 when they die, worn out from a lifetime of plowing the earth with a wooden stick.

Not much faith in mankind, hey?
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TeraWatt60
Cogito Ergo Sum
09:51 AM on 02/13/2012
The old addage "an ounce of prevention is worth a pound of cure" comes to mind. If everyone had access to health care it would obviate the need for the poor and many in the Middle Class to rely on extremely expensive ER's for treatment of illness.

Many in the US are forced to "grin and bear it" with common maladies or serious illness because of inadequate or cut-rate policies with high deductibles or numerous exclusions until their disease becomes so serious that only expensive and prolonged treatment can help.

What is the response of Teapublicans/Conservatives "Let 'em die!" or "So what? They "choose" to not be able to afford insurance" or the most callous of them all "That is what "freedom" is all about!"  Amazing how these slogans never seem to apply when it is people they actually know or love.

Instead of supporting taking care of everyone and removing the conflict-of -interest of private insurance ( treatment = less profit) we have those who choose higher cost/ lower return private coverage for some while everyone else is just one major illness from the morgue
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Tquin
09:16 AM on 02/13/2012
None of the statements represent any form of logic. The countries this has been tried in do not compare to the United States in volume of praticipants. The United States has more people on welfare and food stamps than those countries have people. This will be a rapid way for the United States to become just like Greece. You can not feed an additional 40 million people for free, nor can you give them "free" healthcare. Wake up for goodness sake!!!!!!!!!!
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reading2009
Down the rabbit hole and through the looking glass
01:23 PM on 02/13/2012
The countries this was tried in?? Do you mean like Massachusetts or Virigina? You know, those states that were what this article was about?

Try reading the thing first, next time, BEFORE you comment on it. It'll make you look smarter.
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BBackSoon
Hello, I must be going.
01:46 PM on 02/13/2012
How much would business save if they had zero healthcare costs?

How much more competitive would these same businesses be with their foreign competition if you magically got rid of their healthcare costs?
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ronp121
08:31 AM on 02/13/2012
Shoulda coulda sure doesn't solve the problem. Republicans want no part of logic especially if it lowers insurance companies profits. Should of put this article on the front page instead of burying it in the business section.
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kemcha
liberals are destroying this country
07:32 AM on 02/13/2012
Health Care costs do NOT go down. The actual cost that individuals pay may go down, but the costs for heath care will not go down. The government merely pays the balance of those costs.

If health care costs for an average stay prior to the Affordable Care Act are $1000 per day and the AFC lowers those costs to $600, the government will still pay the health care industry that remaining $400 balance.

It's the health care industry that's not lowering their prices. It's smoke and mirrors. Your costs may go down, but the Federal government will be paying the balance of those costs to the health care industry. The health care industry needs to lower its prices for medical care and for prescriptions and this is what the Affordable Care Act FAILED to do.
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reading2009
Down the rabbit hole and through the looking glass
01:27 PM on 02/13/2012
Yes, health care costs DO go down. To whit: You get sick, but because you have no insurance, you ignore the problem, hoping it goes away. It doesn't. It gets worse, and you end up forced into the ER because of your symptoms. At my local ER, it costs $1300 to walk in the door and give your name. That's if they do nothing for you at all, by the way. ( I know because I've gotten that bill) Plus, because you've let the illness go on for so long, it requires more medication and more expensive medication (perhaps). Now, you get the bill, but you're still poor and can't pay it. Sure, maybe it ruins your credit, but someone still has to pay. So the hospital eats the costs, and raises the cost of everything overall to compensate for expected loses like this.

OR:

You get sick. You have insurance. You go to your primary care doctor and he gives you medication. This visit costs, at most, $200 (total co-pay and insurance). Your medication costs could be around $50. You can pay your co-pay and the insurer (or the government) pays the rest.

Which one costs less?
11:49 AM on 02/14/2012
Thank you. I don't know why so many have such a hard time understanding this. Hospital ER bills are extreme. (I know, I've had my share of rides). When an ambulance can charge you $750.00 to drive you 2.6 miles to the nearest ER (this is with NO medications/IVs...zip)...then we have a problem in this country.
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BBackSoon
Hello, I must be going.
01:47 PM on 02/13/2012
That will be next. And it should be next.
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mmayrising
listen,truth,watch,think,care,love
12:47 AM on 02/13/2012
ignore the poor, they dont matter and who cares if they have health care, they dont matter. The poor are simply a burden and Americans are tired of footing the bill for them. If they get sick and die....oh well...they dont matter. This is the land of opportunity and the poor need to fix their own problems....let them eat cake...and oh yeah...they dont matter. Now the military industrial cmplx and big business....now they matter. More bombs, more money in politics....thats what matters in America. The poor let them drink TEA!!!!!!!
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Mister Grumpy
An Angry American
12:10 AM on 02/13/2012
Psst. Don't tell the GOP that giving the poor healthcare coverage makes the overall cost lower for everyone. These are the same people who refuses to believe in evolution.
12:50 AM on 02/13/2012
But math may be different? If I remember correctly there is not much about it in the Bible..so no there should be no controversy..
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reading2009
Down the rabbit hole and through the looking glass
01:28 PM on 02/13/2012
Also climate. They don't believe in that either...not really.
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Dragonwinds Spirit
I support Intelligence.
02:12 AM on 02/14/2012
Wait? What? There is a climate? No way!!! You just made that up! It's all lies! Fabrications by Illuminati! Admit it! You know it's true!

(p.s. for those of you who can't understand humor, the above is just that. Humor).
11:32 PM on 02/12/2012
Romney is too chicken **** to admit what he really believes is needed to reform HC..That's his problem on most topics with the GOP and everyone else. The way he folds up in these debates to Santorum on HC is just pathetic.
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Donald Kinge
07:57 PM on 02/12/2012
Even though it will cost less Republicans will reject this out of some misguided sense of self-righteousness. They would cut off their right hand just to spite their left one.