You believe what you want, that is not what happens at my facility nor
any other tertiary facility.

If anything happens to them and they are booted early then the doctors and
hospital are held liable.
many surgeries are done on those who can not pay. Anyone having a baby can
go and have a baby there as most illegals know. The ER is full of people who
can not pay for services and for anyone who argues otherwise just doesn't
know what they are talking about.
The ER is crowded for a reason and if there is no benefit then they would be
going to Canada instead. It is also crowded in their ER's, the reason being
it is "free" for everyone.
If you look at both ER's you see both are full of people getting "free"
treatment.

Welcome to the real world where people have to pay for services and goods.
What do you have in your house I can take because everything is free?

Medicare and Medicaid is free. If they don't like that then work or go to
Canada or Cuba or North Korea. All three of those countries are the only
ones making it illegal to provide private medical care.

http://www.ahrq.gov/data/hcup/factbk1/

I wasn't able to get any medicade CABG stats immediately. However, I
was able to find that medicade pays for 54-35 = 19% of all hospital
stays in this country, and an additional 5% are people uninsurred (they
don't even have medicade). Here is how things were in 1997 in the US:

Government (Medicare and Medicaid) is billed for over half (54 percent)
of all hospital stays.
About 13 percent of the U.S. population is over 65, but about 35
percent of all hospital stays are paid by Medicare, the most common
insurer for the elderly.
About 17 percent of the U.S. population is uninsured, and about 5
percent of all hospital patients are uninsured.
Among uninsured patients, 3 of the top 10 conditions are for substance
abuse or mental health. It is not possible to determine if this is
because insurance does not pay for these conditions or if these
conditions occur more frequently among uninsured patients.
Nearly 20 percent of hospital stays for alcohol-related mental
disorders, and 23 percent of stays for substance abuse are uninsured.

Almost 12 percent of the U.S. population is covered by Medicaid;
however, Medicaid is billed for:
Over a third of all stays for babies born in the hospital.
Over a third of all stays for fetal distress.
Nearly 42 percent of all stays for complicated pregnancy.
Over a fourth of all stays for depression and half of all stays for
schizophrenia.

If I could summarize, it looks like there's a lot of hospitalization
paid for by medicade, but the single biggest medicade hospital use
group is pregnant women.

SBH

COMMENT:

I'd like to know where you get your statitics for this. I can find
statistics easily enough for angioplasty and CABG rates by payor for
people who have had heart attacks, as you say. And they are lower for
Medicaid patients than Medicare and insurance, but not zero-- they are
lower by 30% or something. Indeed, rates of invasive heart procedures
like angio and bypass are lower for lower-income groups in every
country, including Canada

(Mea Culpa, see below, it seems Canadians who can pay out of pocket ARE
willing to pay for a few more angios and bypasses, though it does them
no good mortality-wise.  They didn't ask about quality of life, but
rich Candadians did generally complain more, so it's hard to tell ;).

So, how do YOU know what happens to the average medicaid person with
chest pain and EKG changes (or positive stress tests), but no acute MI?
Hospitals I've worked at certainly bypassed a number of them.

=============

JAMA. 2004 Mar 3;291(9):1100-7.

Socioeconomic status, service patterns, and perceptions of care among
survivors
of acute myocardial infarction in Canada.

Alter DA, Iron K, Austin PC, Naylor CD; SESAMI Study Group.

Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
david.alter@ices.on.ca

CONTEXT: Some have argued that Canada's uniquely restrictive approach
to private
health insurance keeps the socioeconomic elite inside the public system
so that
their demands and influence elevate the standard of service for all
Canadian
citizens. The extent to which this theory is a valid representation of
Canadian
health care is unknown. OBJECTIVES: To explore how patients with acute
myocardial infarction from different socioeconomic backgrounds perceive
their
care in Canada's universal health care system and to correlate
patients'
backgrounds and perceptions with actual care received. DESIGN, SETTING,
AND
PATIENTS: Prospective observational cohort study with follow-up
telephone
interviews of 2256 patients 30 days following acute myocardial
infarction
discharged from 53 hospitals across Ontario, Canada, between December
1999 and
June 2002. MAIN OUTCOME MEASURES: Postdischarge use of cardiac
specialty
services; satisfaction with care; willingness to pay directly for
faster service
or more choice; and mortality according to income and education,
adjusted for
age, sex, ethnicity, clinical factors, onsite angiography capacity at
the
admitting hospital, and rural-urban residence. RESULTS: Compared with
patients
in lower socioeconomic strata, more affluent or better educated
patients were
more likely to undergo coronary angiography (67.8% vs 52.8%; P<.001),
receive
cardiac rehabilitation (43.9% vs 25.6%; P<.001), or be followed up by a
cardiologist (56.7% vs 47.8%; P<.001). Socioeconomic differences in
cardiac care
persisted after adjustment for confounders. Despite receiving more
specialized
services, patients with higher socioeconomic status were more likely to
be
dissatisfied with their access to specialty care (adjusted RR, 2.02;
95%
confidence interval, 1.20-3.32) and to favor out-of-pocket payments for
quicker
access to a wider selection of treatment options (30% vs 15% for
patients with
household incomes of Can 60 000 dollars or higher vs less than Can 30
000
dollars, respectively; P<.001). After adjusting for baseline
characteristics,
socioeconomic status was not significantly associated with mortality at
1 year
following hospitalization for myocardial infarction. CONCLUSIONS:
Compared with
those with lower incomes or less education, upper middle-class
Canadians gain
preferential access to services within the publicly funded health care
system
yet remain more likely to favor supplemental coverage or direct
purchase of
services.

PMID: 14996779 [PubMed - indexed for MEDLINE]

yes he is.

yes he does.

no it's not

no there haven't

Look, there must be 10,000 hospitals with EDs in the US, at least. They
see 100 million people a year, and admit about 14% of them.  EDs see
more medicaid patients than they do medicare patients. Medicaid
patients are big users of EDs.

If you know some hospitals with ED's near you where people with chest
pain who need to see a cardiologist, can't see one, and aren't admitted
or transferred, please provide me with a specific hospital and place,
and I'll call them up and see what's up. You're beginning to piss me
off with your allegations that I don't know what I'm talking about (and
just who the hell are YOU, and how many ER/EDs have you worked in?), so
I'm asking you to provide some specific information, not just blather.
Do so, and will see who lives in the real world and who doesn't.
Provide me with some real world examples.

COMMENT:

I have a good understanding of the facts. Provide some examples, since
you're the one making the odd claim.

COMMENT:
I doubt it. But again, since I don't know the medicare structure of
every state, why don't you provide me with a state and some hospitals
who run EDs and turn away people with chest pain who can't pay? If it's
common, you should have no problem coming up with examples.

COMMENT:
That's because more people are using Medicaid. What do you expect?
Eventually the system will collapse.

SBH