continue to keep things private pay or paid through third party insurance then we need to allow hospitals and doctors the ability to turn people away who are likely abusing emergency services. Right now no matter how obviously crazy you are or how obvious it is that you cannot pay for services or how non-emergent your apparent medical need is you can show up at the ER at any time and receive a state of the art emergent evaluation. Whether it is appropriate or not. In order to continue with private pay it is my opinion that we need to give doctors and hospitals the ability to turn people away who are abusing the system. We need to recognize that occasionally someone will have a bad outcome because the triaging person got it wrong but that is what is needed to allow for private insurance or out of pocket pay to continue. There needs to be less risk of litigation in these cases.

OR we treat healthcare as a public good. Make it a single payer thing. Government controlled. Quality of care will likely go down and wait times will go up but I think not by much in either case.

Now I know 90 percent of you are fuming right now ready to rip me a virtual new one and now I'll give you even more ammunition. I'm a libertarian. I'm also a cold-hearted jerk. I would favor turning people away who lack ability to pay or AT LEAST develop a mechanism by which they are forced to pay in the future (it really doesn't happen now). I don't think anyone should be FORCED to pay for anyone else. If we were to develop the kind of system that I favor I think what would happen is that charitable care would develop and charitable care would be available for people who actually need it.

Flame away