zlacker

If they could get the guy with asthma regularly seeing a PCP, the money the public is spending on his constant ER trips would more than pay for housing and the time the ranger has to spend on helping him.

>>sarche+(OP)
If

(Also note that if that's your general policy then you effectively allow anyone to blackmail you to get whatever they want, just by making it slightly more expensive to not give them what they want)

>>lmm+U2
Is this not only reductive reasoning, but also both devils advocating, and functionally an artefact of the US health system economics?

>>ggm+y6
> Is this not only reductive reasoning

Maybe. Reductive reasoning is usually a good idea.

> devils advocating

No.

> functionally an artefact of the US health system economics?

So what? If and when you manage to fix the US health system for the working poor then it might become reasonable to provide free healthcare to the disruptive homeless, sure. But until then it isn't.

>>lmm+U2
Do you have a moral objection to a homeless man with asthma getting a primary care provider paid for by the government?

>>lmm+lg
I think we have fundamentally different views on this. It's also true that disruptive homeless have to be managed in state funded healthsystems worldwide and that includes denying them service when they do bad things, I'm not naieve enough to believe somehow this is a uniquely american problem (disruptive people) but I do think the aspect of reductive health economics here is a pretty unique problem to the US health economy. And I say that living in an economy which has private emergency services alongside the public ones. We just don't have the same problem at scale, because we don't have the underlying health charge model.

>>freeon+Ko
I have a moral objection to the government providing more support to a socially disruptive person than they give to someone who is more prosocial. I'm all for a government-provided healthcare that's free for everyone, but prioritising person A because they're more disruptive than person B is morally bankrupt.

>>lmm+Or
You've made quite a jump here from "has asthma" to "socially disruptive".

>>crooke+hs
The post I replied to was arguing from "the money the public is spending".

>>lmm+Or
It's not about morality, it's about incentives. Under the current system in the US, if you're broke and you have no insurance:

1. The ER is free to you, because they legally cannot refuse to treat you based on your ability to pay.

2. A regular doctor's visit costs $250 and your medicine costs $5-$500/month depending on what you need, because those businesses won't give you things they don't think you'll pay for.

One need not be morally bankrupt to make choice #1. We all choose things that are more expensive for society because they are more convenient or less expensive for us - lots of regular activities of what patio11 calls the professional/managerial class have negative externalities that the rest of society pays for: air travel, personal automobiles, and lawns all come immediately to mind.

If you want people to get their medical care from a PCP and their medicine from the pharmacy, then make it cheaper for them. Health insurance companies know this; that's why many plans lets you see your PCP for a small fixed price even before your deductible is met - because they want to incentivise you to get your care in the way that's cheapest for them.

>>repire+Hy
> One need not be morally bankrupt to make choice #1

I'm talking about the people making the decisions about who gets free doctor's visits, not the people on the receiving end.

> We all choose things that are more expensive for society because they are more convenient or less expensive for us - lots of regular activities of what patio11 calls the professional/managerial class have negative externalities that the rest of society pays for: air travel, personal automobiles, and lawns all come immediately to mind.

That doesn't make it ok. Most people have at least some semblance of conscience and try to cut down on those things - of course no-one is perfect, but that doesn't mean we should allow whataboutism to get in the way of good policymaking. (FWIW I'm all for taxing those things at a fair rate that covers the costs of those externalities)

> If you want people to get their medical care from a PCP and their medicine from the pharmacy, then make it cheaper for them.

Sure. But make it cheaper for all of them. I agree that "it's about incentives" - so don't make it so that the incentive is to do the antisocial thing until the system pays you to stop. It should be easy to extrapolate where that leads.

>>lmm+Xs
On ER care.

>>lmm+Tz
It’s worth pointing out that he probably qualified for expanded Medicaid in California, so the PCP visits would be covered by that. It’s just a matter of getting him to actually go.