“It is a duty
certainly to give our sparings to those who want; but to see also that they are
faithfully distributed, and duly apportioned to the respective wants of those
receivers.” Thomas Jefferson
There has never been a time in this country where the
destitute were denied basic medical care. Doctors made allowances in their
billing, and the poor could find hospital care when needed. Prior to 1986 that
hospital might not be close by or provisioned with the best doctors and equipment.
In those bad ol’ days, the poor were treated at county hospitals. This changed
with passage of The Emergency Medical Treatment and Active Labor Act
(EMTALA) as part of a larger bill called the Consolidated Omnibus Budget
Reconciliation Act, something many of us are familiar with by the name COBRA.
(Some politician once muttered that Americans should be fearful of any bill that
contained the word Omnibus.)
EMTALA mandated that hospitals provide emergency service to
anyone who showed up at their door, regardless of citizenship, legal status, or
ability to pay. Any hospital that had ever billed Medicare or Medicaid was
required to comply. (Government-run Veteran Hospitals were excluded, of course.)
There were no provisions in the bill for any payments to hospitals for these
services.
As any reasonable person would guess, EMTALA greatly
accelerated cost shifting as hospitals were forced to increase fees to those
who did pay to make up for the huge influx of non-paying patients. Although
there were always places the poor could get basic medical care, EMTALA
redefined access to mean free equal service in the hospital of your choice.
This, of course, was the broken system the Affordable Care
Act was intended to fix—they just forgot to tell us that politicians broke the system in the first place. Granted, there are other cost-shifts
going on, but most of these are less important than providing free or
subsidized care to those who haunt ERs without insurance.
The fatal flaw of the Affordable Care Act is that there is
an unlimited demand for highly valuable free stuff ... and nothing is more
valuable than health. To solve this quandary, healthcare providers will attempt
to slow demand through bureaucratic rules. What they can’t slow or deflect,
they will ration.
Free is always an illusion. If health insurance companies
are mandated to provide free services, they will bury the cost in another fee,
just as hospitals shifted costs to make up for mandated free services. The
choice is between the market—meaning all of us—deciding on how to price and
allocate goods and services or bureaucrats making decisions for us.
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