It has become fairly obvious to me that the rank and file of the GOP have no clue what they are talking about when it comes to health care policy, law, and economics. This term ‘Socialized Medicine’ is getting way over used and used incorrectly.
It has been correctly identified that Obamacare is not the solution and that a new system complete with massive insurance and legal reforms has to be put in it’s place. Just repealing Obamacare takes us back to 1986 where something called EMTALA was placed into coercive FedZilla law. Signed into Law by Ronald Reagan in 1986, this massive Unfunded Mandate has caused horrible economic damage to hospitals. This Unfunded Mandate is in fact socialized medicine because we ALL pay for it one way or the other. EMTALA is still law of the land for those who have no insurance by the way. “What is this ‘EMTALA’ ” my conservatives friends ask? “Why, I have never heard of this!” Well, dear reader let me ask you a few questions:
How about I come to your business and make you work and provide services for free? You have to eat the costs and you have no control over how much free work and service you have to provide.
How about I take away the largest percentage of your cash inflow if you don’t provide these free goods and services?
Oh, and you have no legal recourse against nor legal way to collect a fee from the people for whom you provided the services.
How will you recoup these loses, loses that are nearing $50, 000,000,000 a year? Why is it assumed that medicine can function in a bubble where capitalism and rules of economics are suspended?
The Emergency Medical Treatment and Active Labor Act (EMTALA)[1] is an act of the United States Congress, passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospital Emergency Departments that accept payments from Medicare to provide an appropriate medical screening examination (MSE) to individuals seeking treatment for a medical condition, regardless of citizenship, legal status, or ability to pay. There are no reimbursement provisions. Participating hospitals may not transfer or discharge patients needing emergency treatment except with the informed consent or stabilization of the patient or when their condition requires transfer to a hospital better equipped to administer the treatment.[1]
EMTALA applies to “participating hospitals.” The statute defines “participating hospitals” as those that accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program.[2] “Because there are very few hospitals that do not accept Medicare, the law applies to nearly all hospitals.”[3] The combined payments of Medicare and Medicaid, $602 billion in 2004,[4] or roughly 44% of all medical expenditures in the U.S., make not participating in EMTALA impractical for nearly all hospitals. EMTALA’s provisions apply to all patients, not just to Medicare patients.[5][6]
The cost of emergency care required by EMTALA is not directly covered by the federal government. Because of this, the law has been criticized by some as an unfunded mandate.[7] Uncompensated care represents 6% of total hospital costs.[8]
That 6% is for charges in the Emergency Room only and does not cover inpatient admissions, THAT is where the real lo$e$ happen.
Cost pressures on hospitals
According to the Centers for Medicare & Medicaid Services, 55% of U.S. emergency care now goes uncompensated.[13] When medical bills go unpaid, health care providers must either shift the costs onto those who can pay or go uncompensated.
Here is how EMTALA is Socialized Medicine, YOU are already paying for it:
In the first decade of EMTALA, such cost-shifting amounted to a hidden tax levied by providers.[14] For example, it has been estimated that this cost shifting amounted to $455 per individual or $1,186 per family in California each year.[14]
However, because of the recent influence of managed care and other cost control initiatives by insurance companies, hospitals are less able to shift costs, and end up writing off more in uncompensated care. The amount of uncompensated care delivered by non-federal community hospitals grew from $6.1 billion in 1983 to $40.7 billion in 2004, according to a 2004 report from the Kaiser Commission on Medicaid and the Uninsured,[13] but it is unclear what percentage of this was emergency care and therefore attributable to EMTALA.
Financial pressures on hospitals in the 20 years since EMTALA’s passage have caused them to consolidate and close facilities, contributing to emergency room overcrowding.[15] According to the Institute of Medicine, between 1993 and 2003, emergency room visits in the U.S. grew by 26 percent, while in the same period, the number of emergency departments declined by 425.[16] Ambulances are frequently diverted from overcrowded emergency departments to other hospitals that may be farther away. In 2003, ambulances were diverted over a half a million times, not necessarily due to patients’ inability to pay.[16]
I know of one hospital in PGH, a level 1 trauma center and world class facility that has a $3,000,000,000 dollar operating deficit and loses over $1,000,000 a month because they hemorrhage EMTALA $$$. How long can they stay in business? How long could you stay in business?
So, how do YOU ensure that the hospitals get paid for services that they provide, ya know, just like you like to get paid for your work. I know no one here likes Unfunded Mandates nor do they like coercion form FedZilla. Repeal is a good start, but there has to be replace as well. So, politically possible solutions? Comments?
