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Last week, while the Supreme Court heard the ObamaCare case, supporters and protesters outside the courthouse debated one another about the merits and constitutionality of the controversial law.
The main argument of ObamaCare supporters is that we need an individual mandate because the health care costs of the uninsured are being shifted onto the insured. Everyone gets care, even when they can’t pay for it themselves, and the rest of society ends up footing the bill. This cost-shifting, the proponents argue, is burdening hospitals, raising insurance premiums, and overcrowding emergency rooms across the nation. Opponents usually cede the policy point, but insist that the individual mandate is unconstitutional, regardless.
Are the supporters right? Do we all indirectly subsidize health care for tens of millions of uninsured Americans? We do, and it is a big problem. However, this isn’t the whole story. Part of the reason that the costs of health care are being shifted from the uninsured to the insured is because of a little-known, thirty-six-year-old government mandate called the Emergency Medical Treatment and Active Labor Act (EMTALA).
Passed by Congress in 1986, EMTALA mandates that hospitals provide emergency screening and stabilization care to those who present themselves at the emergency room, regardless of citizenship, immigrant status, or ability to pay. This mandate applies to every hospital that accepts federal payments on behalf of Medicare beneficiaries. In effect, this means that virtually all hospitals fall under this mandate. Therefore, the supporters of ObamaCare are clamoring for the federal government to wield massive new powers in order to fix a problem that the federal government itself helped to create in the first place.
The reasoning behind the EMTALA mandate is simple. By forcing hospitals to provide emergency care regardless of insurance status, we can reduce the number of deaths or amount of suffering due to the lack of universal health insurance coverage in America. The purpose is to improve access to health care for the uninsured, and EMTALA theoretically helps accomplish this goal.
However, forced charity of this nature has several negative effects on society. First, it reduces true charity. Hospitals that formerly provided free care of their own volition are now forced to provide that care. The virtue of compassion is lost. Second, it creates a disincentive to purchase health insurance. If you know that you will receive treatment at the emergency room if you need it, why purchase insurance?
(This problem, incidentally, is exacerbated by Medicaid, which allows poor people to wait to sign up for government health insurance until after they get sick. That policy, like EMTALA, causes tens of millions of lower-income people to think of an overcrowded local emergency room as the first place to go when they have a condition that is neither an emergency nor life-threatening. That just crowds out the people who suffer real emergencies.)
Third, the EMTALA mandate reduces the quality of the care provided. Crowded emergency rooms result in long waits and more suffering. Furthermore, once an uninsured person is sick enough to require emergency medical care, their treatment options will be sharply limited and very expensive. By encouraging people to go without insurance, chronic conditions aren’t treated and preventative care isn’t practiced.
Fourth, as mentioned before, this system shifts the costs of health care for the uninsured to hospitals. In order to avoid bankruptcy, hospitals must raise the costs of health care on health insurance companies, who pass these new costs on to the insured through reduced benefits and increased premiums. Public hospitals operated by state and local governments also shift these costs on to taxpayers in the form of increased taxes to pay off the debts incurred. And most hospitals also shift costs to federal taxpayers via uncompensated-care subsidies added onto the reimbursements they receive from Medicare and Medicaid.
Hospitals have scarce, limited resources. These resources are insufficient to meet the demand for health care. Therefore, hospitals must triage, or prioritize who receives care, in order to best use those resources. Before the EMTALA mandate, overburdened hospitals could tell those new arrivals who weren’t in danger of dying that they ought to go to another, less busy hospital. Not infrequently, they would go so far as to arrange or even pay for transportation to an alternative facility. However, with the EMTALA mandate, each hospital must accept all comers. Undoubtedly, hospitals can still triage by prioritizing who receives care first, but they can do nothing to alleviate the inevitable overcrowding and long waits that EMTALA creates.
So, are the supporters of ObamaCare correct in saying that we need to focus on making health insurance coverage universal in order to avoid these problems? Probably not. Increasing the size of government in order to fix a problem caused by big government is usually a bad idea; and it certainly is here. We don’t need to add an unconstitutional individual mandate to purchase government-controlled health insurance to the existing misguided EMTALA mandate on hospitals to provide screening and stabilization care “free of charge.”
Instead, we need to repeal the individual mandate and change or repeal the EMTALA mandate. This would allow for true charity, incentivize people to purchase health insurance voluntarily before they get sick, reduce health insurance premiums across-the-board, improve the quality of health care provided, lessen emergency room overcrowding, and reduce the cost burdens on hospitals and taxpayers. In short, freedom works, if we let it.
Would patients suddenly start “being left to die on the sidewalk”? No. That wasn’t happening before EMTALA was enacted, and it won’t happen after EMTALA is reformed or repealed. Decent people don’t let their suffering neighbors “die on the sidewalk.” They help them first, and figure out how to pay for the care later. But more importantly, this boogeyman scenario won’t happen because creating a more market-oriented, patient-centered system will actually reduce costs, shorten wait times, and improve access to care for everyone.
Could there be a few gaps in a free market that someone, somewhere might fall through? Of course. Gaps are unavoidable—even under today’s mandate-heavy system. But gaps can and should be filled as they were pre-EMTALA, through voluntary charity and ordinary human compassion.
Freedom works. Even in health care.
Representative Paul Broun’s (R-GA) Patient OPTION Act would apply common sense to the EMTALA mandate by revising the definition of “emergency medical condition” to be more in line with what we think of as a true “emergency,” and by re-legalizing the practice of preliminary triage by qualified emergency screeners.
Of course, we need to do more than just that. By passing the Patient OPTION Act, a comprehensive package of proposals designed to remedy the most pressing problems in our health care system, we would drive down health care costs and thereby make care more affordable for all Americans.
Everyone wants health care to be more accessible. The only question is how we’ll make that happen. Will we rely on government mandates on individuals and hospitals to achieve that end, or will we lower health care costs so that all Americans can afford to purchase insurance?
The individual mandate addresses a real problem, but it isn’t a real solution. We need to move away from government interference and cost inflation in the health care market, and toward affordable, patient-centered health care.
TAKE ACTION: Urge your Members of Congress to cosponsor the Patient OPTION Act!