The United States Already Has Universal Healthcare
Wonks Anonymous has recently heard a great deal of talk on the right about the wisdom and feasibility of offering universal health care, particularly when no provision is made to prevent illegal immigrants from enjoying this benefit.
Wonks Anonymous would like to inform these concerned citizens that they are wasting their breath because the United States already has a government mandated universal health care program. The Emergency Medical Treatment and Active Labor Act, EMTALA, was passed in 1986 to insure that no one in need of emergency medical treatment or in active labor was turned away from a hospital emergency department or labor and delivery facility because they did not appear to be able to pay. Our president is correct. People can always go the the emergency room.
EMTALA is in fact a worthy emblem of our health policy. It originated from a real problem. No one wanted to pay for medical care for the poor and uninsured so hospitals did their best to avoid providing care to these patients whenever possible. Some people died and some others lost their babies while they were trying to get care. This created a situation with identifiable villains, bad hospital administrators. A law was passed to force them to behave and the problem of medical care for the poor was "solved". The legislature could go on to the next problem and the next law.
The solution is quite characteristic of our health policy for a number of reasons:
- The simple law has spawned a great many implementing regulations, legal cases, official and unofficial compliance reports and so on. Hospitals and providers that care for the indigent try to recover some of their costs creating employment for collection agencies. This is job creation at its finest.
- Care is only mandated at the point where an individual's life is threatened. This gives poor people with chronic conditions, like diabetes, ample time to suffer permanent damage to their health before they seek treatment and begin to take steps to improve their health. Better yet, even when a person has a chronic condition, only emergency situations are covered.
- The costs of treatment are borne by individuals and organizations that are foolish enough to try to make their living by providing care to sick people. We all know that people in the helping professions got there because they were suckers for those in need. When they work for free this just demonstrates their bona fides as helping professionals.
Wonks Anonymous would like to ask the reader to consider the fairness of the last point. But even the reader who does not give a fig for fairness should consider the first two points carefully.
The costs required to administer the law and the costs incurred for attempts to collect from poor patients are significant. These administrative and enforcement costs, economists like to call them 'transactions costs', are one of the reasons that our health sector manages to spend so much and get so little.
Another reason is the institutional preference of our system for high cost interventions on very sick people. If it is an emergency we will do everything in out power to save you. EMTALA is a part of this problem.
Wonks Anonymous would like you to consider that it might be easier if hospitals knew that someone would pay for any and all medically necessary care that they offered, for everyone.
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