ACA in the Supreme Court Catch-All

Malor, health care costs are up 40% in the last decade alone. Should we not address that somehow? And what's your plan for the uninsured, in the absence of universal coverage? Just lock them out of the hospitals?

I have to ask, at what point did we toss the universal option out of the window? Wouldn't it be far simpler for everyone involved to increase withholdings for Medicare, and allow everyone to opt in? Further, I have been paying into that for years.

That has been my sticking point for awhile. You pay into 3 insurance programs from your paycheck, but can only use one.

That was tossed out by the Republicans in the early 90's with a compromise that kept private insurance intact as an industry. That plan became the core of the current one, in an attempt to garner bipartisan support. But apparently the "anything but Obama's policies" crowd took over and vilified the same ideas they'd championed throughout the previous 20 years...

Well, let's just say increasing demand for healthcare services doesn't strike me as an ideal way to decrease costs.

The whole insurance model is broken. It doesn't work properly. The demand for healthcare is unlimited, as long as someone else is footing the bill. So structuring healthcare so that other people pay the bills for keeping you alive means that costs will inevitably expand until the rest of the economy starts buckling under the load. Which, in fact, it's doing.

I just don't think that it's something that's a universal right, at least past the age of majority. Health insurance should be like it is for other insurance -- for catastrophic problems, not for routine care, and it should have defined limits on how much treatment you can incur. If the bill to keep you alive exceeds your coverage amount, then yes, it's time to let you go. We might offer some basic anti-suffering measures, like lots of morphine and a soft bed, for free, but not much more.

Believing that the system owes you life at any cost, no matter the systemic cost of doing so, is ridiculous. It's just about the ultimate in wishful thinking, trying to pretend that a life is infinitely precious, when it just isn't. If lives were infinitely precious, then keeping just one person alive for ten extra minutes would be worth the entire GDP of the United States for the next century.

It's pretty clear that life, like all other things, has a price and a value, and while we really don't like to admit it, it's not always worth keeping people alive. It's loony fantasyville to think otherwise, in fact. Like everything else, it comes down to resources; are the resources we would expend worth it to keep you alive? That's the hardest decision of all to make, and letting our emotions make it, instead of our heads, is bankrupting us.

All the countries that offer socialized healthcare are having a tough time paying for it; the cheerleader for socialized healthcare, England, is in Greek-level fiscal straits, with the only difference there being the ability to print money to pay their debts. And the bills only get worse with each passing year. The demand is infinite, but the ability of the economy to supply healthcare is sharply finite.

This is just hard reality, and if our systemic policies don't reflect reality, they will not work over the long haul.

SpacePPoliceman wrote:

If bearing the full and crippling financial burden of expensive emergency life-saving treatment, requiring most to declare bankruptcy and so on counts as a "gift", do not expect a birthday invite from me.

Aye. I, personally, have been in this situation. Only reason I'm alive today is because of mandated emergency care. (Then, because I'm a poor kid, getting shot is my idea. I cannot imagine how much worse it'd have been if I wasn't a geeky white kid. To be fair, lying in hospital and using polysyllabic words to vehemently dismantle the idea that it was gang related would easily go on a highlight reel of my life.)

So, you know, I have an issue with a potential solution being denying people lifesaving care because they're poor.

Edit: Malor, there is no delicate way to say this. So I want you to know that I do like you, as a person. I even appreciate your willingness to go to bat, and well, for your beliefs.

However, there are miles, miles, and MILES between "entire US GDP to keep someone alive for 10 minutes", and the rest of your post.

I dunno about you, but when I look at healthcare, and human life? f*ck money. f*ck magical wealth tokens. No one, anywhere, ever, at ANY TIME, deserves to die, just because they're poor. This is on the edge of one of those things I've got a hell of a time debating sanely. It hits way, WAY too close to home. If you're going to put people's lives at lower standing than a few dollars out of your check, I'm not sure there's a common ground to be found.

Robear wrote:

There were several mentions of previous penalties for inaction on day 1, mostly to do with administration of (presumably interstate) financial transactions. I believe one involved required paperwork for complicated wills. If you don't do the required paperwork, you will be fined; but you won't be arrested if you pay the fine.

Right, but financial transactions are not *in*action: they're action--trans-actions to be precise, as opposed to cis-action presumably. Making out a will is an action too.

Malor wrote:

Well, let's just say increasing demand for healthcare services doesn't strike me as an ideal way to decrease costs.

The whole insurance model is broken. It doesn't work properly. The demand for healthcare is unlimited, as long as someone else is footing the bill. So structuring healthcare so that other people pay the bills for keeping you alive means that costs will inevitably expand until the rest of the economy starts buckling under the load. Which, in fact, it's doing.

Why are you intentionally ignoring how the system currently works? The demand for healthcare may be unlimited but the cost for providing it can be dramatically changed. Providing insurance for the 20 million that are current uninsured doesn't increase demand. Those people go to the emergency room when they're sick instead of going to their physician. Those cost differentials are astronomical. Preventative care will have a massive impact on the admissions acuity and that alone will yield exponential savings.

You also keep ignoring that someone else IS already footing the bill, the insurance model is just acting as the administrator. Basically what's going on here is a giant game of cost shifting because no one really wants to rebuild the system.

Malor wrote:

the cheerleader for socialized healthcare, England, is in Greek-level fiscal straits, with the only difference there being the ability to print money to pay their debts. And the bills only get worse with each passing year. The demand is infinite, but the ability of the economy to supply healthcare is sharply finite.

Wait, isn't England the poster boy--to horribly mix images--for letting people die when their care becomes too costly?

http://www.telegraph.co.uk/health/he...
http://www.bbc.co.uk/newsbeat/10000983
http://www.dailymail.co.uk/news/arti...
http://www.cato.org/publications/com...

At the forefront of this cost-based rationing is NICE. It acts as a comparative-effectiveness tool for NHS, comparing various treatments and determining whether the benefits the patient receives, such as prolonged life, are cost-efficient for the government.

NICE, however, is not simply a government agency that helps bureaucrats decide if one treatment is better than another. With the creation of NICE, the U.K. government has effectively put a dollar amount to how much a citizen's life is worth. To be exact, each year of added life is worth approximately $44,305 (£30,000). Of course, this is a general rule and, as NICE chairman Michael Rawlins points out, the agency has sometimes approved treatments costing as much as $70,887 (£48,000) per year of extended life.

http://www.bbc.co.uk/news/health-168...

A drug that can extend the life of men with advanced prostate cancer by more than three months has provisionally been rejected for NHS use.

Draft guidance from the health watchdog for England and Wales says the drug's benefits are not enough to justify the price the NHS has been asked to pay.

Why are you intentionally ignoring how the system currently works? The demand for healthcare may be unlimited but the cost for providing it can be dramatically changed.

Temporarily, sure. Most estimates I've seen suggest that we'd maybe save about 20% in a single-payer system. But when costs are going up 6 to 8% a year, that means we'd buy three years, and suddenly we're in exactly the same place, except this time OUR CHILDREN are on the hook for our healthcare spending, instead of us funding it ourselves. What are they supposed to do about THEIR healthcare, when they're spending their entire lives paying off the debt we incurred for ours?

No doubt the government would then start imposing price controls, which would inevitably lead to shortages. Price controls always do.

We don't pay for sh*t in America. We absolutely cannot put healthcare under the stewardship of people who are running the country on debt issuance. The way it is now, at least it can fix itself, as people opt into lesser healthcare coverage schemes and just realize that, hey, we can't afford all the healthcare we want. If we nationalize it, by the time we're finished nationalizing it, we'll be right back where we are now, except this time the bills we incur are forever. The Federal government can't declare bankruptcy without terrible, terrible consequences.

Those people go to the emergency room when they're sick instead of going to their physician. Those cost differentials are astronomical. Preventative care will have a massive impact on the admissions acuity and that alone will yield exponential savings.

Or, you can just not make emergency care mandatory. This sucks for people like Kannon, but it'll suck even more if we bankrupt ourselves on the rock of unlimited demand.

A substantial chunk of the problem goes away, poof, if we just don't require hospitals to give away care to the uninsured. And the rest of it will self-regulate and fix itself.

We can't have all the healthcare we want. It's a limited resource.

Wait, isn't England the poster boy--to horribly mix images--for letting people die when their care becomes too costly?

So, even with fierce attempts to contain costs, they're still in the worst shape of probably any First World nation, except maybe Japan, in such serious fiscal trouble that they're passing from even being a second-rate power in the world.

Why would anyone think American politicians would do any better?

Malor wrote:
Wait, isn't England the poster boy--to horribly mix images--for letting people die when their care becomes too costly?

So, even with fierce attempts to contain costs, they're still in the worst shape of probably any First World nation, except maybe Japan, in such serious fiscal trouble that they're passing from even being a second-rate power in the world.

Why would anyone think American politicians would do any better?

Whether we can attribute their fiscal trouble to their health care system or not, we can't blame their problems on a system where you are owed life at any cost if that's not true and they've actually set a cost.

Well, let's just say increasing demand for healthcare services doesn't strike me as an ideal way to decrease costs.

And yet, it's actually happening. Medicare spending projections have dropped from exceeding the rate of economic growth to roughly in line with it. This is due to Medicare providers looking for ways to cut costs, because they know they can't arbitrarily raise prices anymore. And I'm sure you're aware that Medicare costs growth is a huge weight around the economy's neck. This is a great sign that the ACA is actually doing good.

At the same time,

In June 2011, 2.5 million more young adults had health insurance than in September 2010, a direct consequence of parents now being allowed to keep their children on their own healthcare insurance until age 26. Prescription drugs are more affordable for the elderly. Millions of Americans now have access to free preventive healthcare. Children with preexisting conditions can no longer be denied coverage.

So this is actually doing positive things. It's increasing coverage, it's saving money.

The whole insurance model is broken. It doesn't work properly. The demand for healthcare is unlimited, as long as someone else is footing the bill. So structuring healthcare so that other people pay the bills for keeping you alive means that costs will inevitably expand until the rest of the economy starts buckling under the load. Which, in fact, it's doing.

Who else is footing the bill? In this model, everyone pays. That's not "someone else footing the bill". Today, it's true, we do have freeloaders. But the way to stop that is either to get everyone to contribute (and benefit), or to exclude around 1/7 of the population from health care unless they can afford the average $7300 for a 3 day stay. Which one benefits more people?

I just don't think that it's something that's a universal right, at least past the age of majority. Health insurance should be like it is for other insurance -- for catastrophic problems, not for routine care, and it should have defined limits on how much treatment you can incur. If the bill to keep you alive exceeds your coverage amount, then yes, it's time to let you go. We might offer some basic anti-suffering measures, like lots of morphine and a soft bed, for free, but not much more.

Wow... Just, wow. Especially when we can *afford* to do otherwise, that's hardcore.

Believing that the system owes you life at any cost, no matter the systemic cost of doing so, is ridiculous. It's just about the ultimate in wishful thinking, trying to pretend that a life is infinitely precious, when it just isn't. If lives were infinitely precious, then keeping just one person alive for ten extra minutes would be worth the entire GDP of the United States for the next century.

No one is arguing that it should be done "at any cost, no matter the systemic cost of doing so". The ACA is a framework for doing this while *reducing* what we pay today as a society (which is growing pretty damn fast, because it's been left to the providers to price it for profits). This is a straw man; you're arguing a case no one is making.

It's pretty clear that life, like all other things, has a price and a value, and while we really don't like to admit it, it's not always worth keeping people alive. It's loony fantasyville to think otherwise, in fact. Like everything else, it comes down to resources; are the resources we would expend worth it to keep you alive? That's the hardest decision of all to make, and letting our emotions make it, instead of our heads, is bankrupting us.

When did this become about end of life heroic measures? It's not. I'm not sure where you're getting this idea that this is all about getting an extra day for a vagrant at a million dollar cost. Again, this is not the argument that's in play, because this is not what the ACA does.

All the countries that offer socialized healthcare are having a tough time paying for it; the cheerleader for socialized healthcare, England, is in Greek-level fiscal straits, with the only difference there being the ability to print money to pay their debts. And the bills only get worse with each passing year. The demand is infinite, but the ability of the economy to supply healthcare is sharply finite.

This is not "socialized" in the sense that England or Canada or other countries do it. This is a private provider system with minimum quality standards, some regulation for price control, a functional system for competitive offerings in the market at all different levels of care, and a system that offers *everyone* coverage, albeit not always at the level they'd like to have. It does not give infinite care at infinite cost. It is not about heroic measures. This is about *cost control* as much as helping people. It does limit what people can consume; it tries to establish quality controls so that what you get is more cost effective than it is today.

But it's a private provider system. It's not single payer, it's not NHS, it's not what would be described as "socialized medicine", which is usually provided to everyone without regard to cost. This system does not do that. Check out the ACA website if you don't believe me.

This is just hard reality, and if our systemic policies don't reflect reality, they will not work over the long haul.

That's just it - you're *wrong* in your assertions and assumptions. It's already working, and parts of it that didn't have been changed, and other parts will be changed too, as problems are discovered. But you've got so many mistakes in your assumptions that you're not even talking about the real law. The fact is that single payer and socialized, everything for everybody health care plans died in the US in 1993. We've got a private system instead, and this at least should please you. The government is not going to provide your medical care under this plan, nor is it going to write you a blank check and bankrupt your local hospital.

Robear wrote:

There were several mentions of previous penalties for inaction on day 1, mostly to do with administration of (presumably interstate) financial transactions. I believe one involved required paperwork for complicated wills. If you don't do the required paperwork, you will be fined; but you won't be arrested if you pay the fine.

Right, but financial transactions are not *in*action: they're action--trans-actions to be precise, as opposed to cis-action presumably. Making out a will is an action too.

Just like health care. So I don't see the objection. You *will* use health care services during your life; you can buy insurance, or not, but if you don't, you'll contribute to the services that eventually will pick up part or all of your bill when you need it. Isn't that, you know, fair? Or do you know someone who has never needed to go to the doctor, get prescription medicine, or talk to a therapist?

I'm having trouble figuring out what health care inactivity is, over a lifetime. Seriously.

Malor wrote:

A substantial chunk of the problem goes away, poof, if we just don't require hospitals to give away care to the uninsured. And the rest of it will self-regulate and fix itself.

We can't have all the healthcare we want. It's a limited resource.

You're using a broken system to justify a broken system. There's not a damned thing forcing medical expenses as high as they are besides f*cked up crony capitalism.

Layering rust on structural failures on a poorly designed system isn't going to help, on this I can agree.

Besides all that, we're already going to be hosed up the river if we don't control spending on things entirely less important. I'm not one to invoke the Perfectionist Paradox, but saying "Oh, sorry, you've got to die" for curable problems on account of, what amounts to, an imaginary construct is... well, really, really dumb.

I'm not talking about cosmetic surgery or free vasectomies for all. I'm talking about someone able to go to the gorram hospital after getting ventilated for being in the wrong place at the wrong time.

If, as a society, we are willing to put imaginary wealth tokens ahead of people dying from preventable causes, we're all f*cked, every one.

We already do all the time. We fight stupid wars for stupid resources and stupid reasons. We kill people for being in the wrong place at the wrong time. We'll let people starve in the street so we can save on our tax bills.

Adding modern medicine to the list of things that poor people can't have isn't going to help anyone.

Temporarily, sure. Most estimates I've seen suggest that we'd maybe save about 20% in a single-payer system. But when costs are going up 6 to 8% a year, that means we'd buy three years, and suddenly we're in exactly the same place, except this time OUR CHILDREN are on the hook for our healthcare spending, instead of us funding it ourselves. What are they supposed to do about THEIR healthcare, when they're spending their entire lives paying off the debt we incurred for ours?

No doubt the government would then start imposing price controls, which would inevitably lead to shortages. Price controls always do.

This, right here, tells me you have not read and understood the ACA and it's goals. It's not "all the healthcare we want", that's just your not knowing what it *is*. It *is* about increasing efficiency, offering private health care to everyone, and lowering costs while raising quality (and, yes, lowering profits).

I strongly encourage you to know your enemy, because right now, you're warning us that Frederick the Great will bring his bow-wielding horsemen down from the Peruvian Altiplano to attack Paris. Let's at least discuss the actual terms of the law.

Robear wrote:

There were several mentions of previous penalties for inaction on day 1, mostly to do with administration of (presumably interstate) financial transactions. I believe one involved required paperwork for complicated wills. If you don't do the required paperwork, you will be fined; but you won't be arrested if you pay the fine.

Right, but financial transactions are not *in*action: they're action--trans-actions to be precise, as opposed to cis-action presumably. Making out a will is an action too.

Just like health care. So I don't see the objection. You *will* use health care services during your life; you can buy insurance, or not, but if you don't, you'll contribute to the services that eventually will pick up part or all of your bill when you need it. Isn't that, you know, fair? Or do you know someone who has never needed to go to the doctor, get prescription medicine, or talk to a therapist?

I'm having trouble figuring out what health care inactivity is, over a lifetime. Seriously.

That's the point: you have to qualify it with "over a lifetime." That's why those things are not "just like health care." Especially if we're still talking about the broccoli argument, because I don't know too many people who don't eat, either.

This is not a matter of what is fair or not: it's a matter of what is constitutional or not, what's a valid exercise of the Commerce power or not.

Justice Kennedy is probably going to be the swing vote in this case, and he said something interesting today (LINK):

"[T]he government tells us that[] . . . the insurance market is unique. And in the next case, it’ll say the next market is unique. But I think it is true that if most questions in life are matters of degree, in the insurance and health care world, both markets — stipulate two markets — the young person who is uninsured is uniquely proximately very close to affecting the rates of insurance and the costs of providing medical care in a way that is not true in other industries. That’s my concern in the case."

The case could come down to a ruling that finding the ACA constitutional would involve something "different from what we have in previous cases and that changes the relationship of the Federal Government to the individual in the very fundamental way"...and that's fine.

In other words, as I understand that, it could be both unprecedented AND constitutional. The court could wind up deciding to interpret the Constitution as giving Congress more power than it had before the ruling.

In other words, as I understand that, it could be both unprecedented AND constitutional. The court could wind up deciding to interpret the Constitution as giving Congress more power than it had before the ruling.

Yep, and if it does, the last vestiges of the idea of having a central government with limited powers goes away. I submit that grabbing at the dangling healthcare candy, in exchange for ignoring the central foundational idea of the Constitution, is a bad, bad trade.

The government is supposed to be limited in what it can do, and this interpretation of the Commerce clause is so expansive that it is no longer limited in any significant way. It changes the tenor of the entire Constitution -- instead of a list of granted powers, it becomes a list of excluded powers. The part where it says 'any power not granted here is reserved to the states, or to the people' becomes null and void, because there is essentially no situation that couldn't fall under this interpretation of the Commerce clause.

It is wrong to do it this way. It is wrong, wrong, wrong, wrong. Even if the Supreme Court agrees, it is still wrong. Any interpretation that invalidates the central idea of the document, that the Federal government had only a very limited set of powers, is dangerous, irresponsible, and absolutely will be abused. It will mean that the Supreme Court has 'living documented' the Constitution out of its most central meaning.

We have a process for changes this major. This could happen through a Constitutional amendment. For those of you who say, "Sure, but then we couldn't get this passed", then I reply, "then that means you shouldn't be allowed to pass it." No matter how good your intentions are, that document is supposed to mean something.

That interpretation of Commerce means you're losing every right that's not explicitly documented in the Constitution, even though it clearly says that you do not. Society as a whole did not agree to this massive change.

You're trading away Manhattan for a few shiny beads.

Note that they could absolutely ban abortion under this interpretation of Commerce, for example. Or they could require abortions for children with, say, Down's syndrome. They can do anything with an interpretation of the Commerce clause that allows the government to directly force people into transactions.

Malor wrote:

They can do anything with an interpretation of the Commerce clause that allows the government to directly force people into transactions.

If by directly force you mean assess a fee, sure. There is a point to be made on that part, but I highly doubt the hyperbole helps make it.

They can assess a large fee, and then when you don't pay it, take everything you own. Or, presumably, put you in jail, as I imagine not paying the Federal government when it says you owe it money is probably criminal behavior.

They can take everything you own, hypothetically, only if everything you own is of lesser value than the assessed fee. (Fee will be between $695 and 2.5% of annual income) So, that doomsday scenario only plays out if everything you own if you are very poor. There are waivers available for the very poor.

In the end, it walks like a tax and it quacks like a tax. So much so that the IRS will be collecting the assessed fee. So you won't see "taking everything you own" most likely you'll just see larger withholdings.

Again, I think you have a point of principle, but the practical effects of this principle are small. Decidedly not some hyperbolic doomsday scenario. The practical effects are a small tax assessed on a very few. It brings to mind the children's story of Chicken Little. *Something* is happening, but the sky is not falling.

All they have to do is make the penalty high enough, Oso. And they can set it so that the penalties compound very quickly, no matter how large or small the initial amount is.

And they can do that for ANYTHING.

They're saying that they have the right to take 2.5% of your income, because you don't want to enter into a contract with someone for a product you don't want. That same logic can be applied to ANY product, ANY scenario.

How about a $500 charge if you're homeless? You scumbag, you're refusing to participate in the housing market properly, and you're driving down property values in your area. Then, when you don't pay, they toss you in jail. Voila, homeless problem solved.

I think the key factor that makes me believe medical issues are in fact "different" has to do with what assumptions we make when someone cannot choose for themselves.

We do not assume that someone who cannot speak for themselves wants to buy a car, or a house, or broccoli, or a cellphone.

We do assume that someone who can't speak for themselves wishes to receive life-saving medical care. (And yes, that sometimes includes providing food and shelter to them.) We have debates about when it is ethical to remove medical support from someone who can't answer for themselves. Even before hospitals were required to do so by the EMTALA, they generally provided emergency care to stabilize patients before trying to find out if they had insurance. (And if they did otherwise, we would be appalled. Just because someone can't tell you their insurance details doesn't mean they don't have it. And more importantly, most of us find the idea of letting someone die in an accident when they could be saved to be scandalous.)

EMTALA just formalized what we already expected hospitals to do. It's one thing to let somebody's house burn down because you have detailed records and know that they chose not to pay for fire protection. It's another to let someone die without knowing whether they have elected to do without medical coverage.

We don't get to choose when we need emergency medical attention. We do not expect hospitals to turn away those who need emergency medical attention. Neither side of the equation is elective.

In a sane world, the right thing to do would be to socialize medicine, as we've done with other emergency life-preserving services (fire and police, in particular). However, that avenue has been closed for the moment. The main difference between the individual mandate and socialized medicine is ideological. This is an attempt to achieve the same goal without most peoples' money flowing through the government on its way to service providers. To avoid the word "tax", and to avoid completely restructuring a major sector of the economy to be a government service.

And that's being attempted only because the words "tax" and "government" have been demonized so thoroughly, which is ridiculous.

CheezePavilion wrote:

As far as I can tell, the EMTALA doesn't mean hospitals have to waive the charges if you walk in without medical insurance. It only means that hospitals have to treat you, and then you owe them money: they 'put it on your tab'. Can anyone confirm that before I go further with this line of thinking?

Yup. You're right. Hospitals are allowed to bill patients for the services provided under EMTALA, though that has been modified to follow the letter of the law: hospitals can only charge for what it takes to get a patient "stabilized" and not for their entire stay. Hospitals can also make inquiries about a patient's ability to pay (i.e., insurance) as part of the admissions process.

This is also why some hospitals are shutting down their ERs: it's damn expensive and there's not a chance in hell most of those bills are going to get paid.

Hypatian wrote:

EMTALA just formalized what we already expected hospitals to do. It's one thing to let somebody's house burn down because you have detailed records and know that they chose not to pay for fire protection. It's another to let someone die without knowing whether they have elected to do without medical coverage.

We don't get to choose when we need emergency medical attention. We do not expect hospitals to turn away those who need emergency medical attention. Neither side of the equation is elective.

I've looked around, and best I can tell, the EMTALA only makes hospital emergency care "free" for the poor; my guess is those people are going to get "free" Obamacare anyway, so they're not being mandated to go buy something, they're being mandated to go help the government buy something for them. So we're not talking about those people.

It looks like if you do not have medical insurance, the hospital can still come after you with debt collectors. The EMTALA is not "FREE MEDICINE!" it's "we'll put it on your tab." Some people will pay their debt. So we're not talking about those people.

So what kind of people make the hospitals eat the cost? Well, it's not people who don't get sick before they get medical insurance. So we're only talking about people who don't get medical insurance before they get sick, and who don't pay their debt.

Is that really a big deal, that slice of the population? People who are shady enough to dodge their bills and people who could pay their bills but pull a strategic bankruptcy? I mean, if medical costs of EMTALA care are going to legitimately bankrupt you, would your premiums have defrayed that much of the cost that is being passed along to society?

Like I said earlier: the ACA does a lot of great things, including good things that come from medical care being purchased by group pools vs. individual consumers. If you think the problem it's solving is the one created by those people who don't want to buy medical insurance who then wind up getting treated for 'free' however, I think that's wrong because as far as I can tell it misunderstands how insurance works at the most basic level.

OG_slinger wrote:
CheezePavilion wrote:

As far as I can tell, the EMTALA doesn't mean hospitals have to waive the charges if you walk in without medical insurance. It only means that hospitals have to treat you, and then you owe them money: they 'put it on your tab'. Can anyone confirm that before I go further with this line of thinking?

Yup. You're right. Hospitals are allowed to bill patients for the services provided under EMTALA, though that has been modified to follow the letter of the law: hospitals can only charge for what it takes to get a patient "stabilized" and not for their entire stay. Hospitals can also make inquiries about a patient's ability to pay (i.e., insurance) as part of the admissions process.

This is also why some hospitals are shutting down their ERs: it's damn expensive and there's not a chance in hell most of those bills are going to get paid.

So we're still pretty much making society 'pay' we're just making sure hospitals don't get screwed. Like Justice Kennedy said, this is really about making the young pay for the old, and I think the rich pay for the poor. And hey--that's not necessarily a bad thing. But it is a very different thing from saying this is about decisions that have to be made when someone cannot choose for themselves.

Besides, the ACA is medical insurance, not just emergency medical care insurance.

I brought up EMTALA primarily to deflect the "we should just get rid of the law that makes hospitals heal people who can't pay!!!11!" line of reasoning which has previously been present in this thread.

NPR did a fascinating interview with a physician who recently wrote a book about America's problem with end-of-life care. Pretty much every other nation in the world tries to mitigate spending hundreds even millions of dollars to prolong someone's life by a few weeks or months, and instead focus on pain management and quality of life. What's worse is it's all big business for the medical industry. No doctor wants to admit that he can't save a patient with a half-million dollar medical treatment, and of course Big Pharma is more than glad to sell those miracle drugs that work maybe 10 percent of the time.

jdzappa wrote:

NPR did a fascinating interview with a physician who recently wrote a book about America's problem with end-of-life care.

Yes, but DEATH PANELS!