January 23, 2014

kirkwa:

And This Is Why You Shouldn’t Get Sick In America

Many believe that the US healthcare system is the best in the world. Not so according to the World Health Organization’s ranking of the world’s health systems. The US doesn’t even rank in the top 25. It ranks 37th and is the most expensive in the world. I would argue that even if we had the best healthcare system in the world, what good is it, if no one can afford to access it.

Most companies are buying 60/40-policys for their employees these days, but even if you are lucky enough to have good insurance with 80/20-policy coverage, that 20 percent your responsible for can drive you right into bankruptcy as easily as the 60-40 policy given the cost of healthcare.

Insurance cost have been going up dramatically in the last two decades, long before the new Affordable Healthcare Act has taken affect, in some cases as much as 35% per year.

But have you noticed the latest trick the insurance companies have roll out?

Yes, Higher Deductible… most averaging $5,000 per year, per person, but I have seen some as high as $10,000 per year. For those of you that are wondering, this tactic is specifically designed too stop you from using your insurance. It reduces the insurance companies out of pocket liability by shift costs onto consumers, especially those dealing with chronic illness such as diabetes and arthritis. Consequently, because consumers can’t afford the deductible they will avoid necessary care to save money.

Although insurance companies are a problem, the real crocks is the healthcare system it self. A corrupt and bloated system desperately in need of reform!

LTMC: Man.  Canadians have cheap healthcare, but they must be dropping like flies with all that socialized medicine.  

Wait a minute…

(via postracialcomments)

August 18, 2013
The Power Of Experience

Think Progress highlights the story of Clint Murphy, a former Republican staffer who left politics in 2010, and discovered how hard it is to get insured with a pre-existing condition:

Clint Murphy, now a real estate agent from Savannah, Georgia, who’s been involved with Republican campaigns since the 1990s, was diagnosed with testicular cancer in 2000 when he was 25 years old. Four years and four rounds of chemo treatment later — all of which was covered by insurance — Murphy was in remission. Insurance wasn’t a problem in his subsequent political jobs — he worked on John McCain’s election campaign in 2008 and Karen Handel’s Georgia gubernatorial run in 2010 — but when he quit politics in 2010 and entered real estate, he realized just how difficult obtaining insurance with a pre-existing condition could be.

In an interview with the Atlanta Journal-Constitution, Murphy said he thought after 10 years since his cancer diagnosis, the insurance companies might cut him some slack — instead, they found something else to charge him for.

“I have sleep apnea. They treated sleep apnea as a pre-existing condition. I’m going right now with no insurance,” he told the AJC.

Murphy now supports Obamacare:

That’s why Murphy had this to say to his Republican friends who oppose Obamacare on Facebook last week: “When you say you’re against it, you’re saying that you don’t want people like me to have health insurance.”

This might be a bridge too far.  There are many problems with the Affordable Care Act, and people are opposed to it for different reasons.  Many folks on the Right tend to oppose it because they feel it adds more costly government regulation of the private sector, raises taxes, and some of its provisions are hopelessly complex and impossible to implement.  Some folks on the Left oppose it because they feel that it’s an incomplete solution, doesn’t actually insure everyone, and constitutes a handout to private insurance companies, who are now guaranteed customers by the government.  Reasonable people can come to the conclusion that the Affordable Care Act is not the best solution to covering people with pre-existing conditions.

But what Murphy’s story really demonstrates is the power of personal experience to change a person’s mind.  Clint Murphy was convinced that the health insurance system worked.  He had faith that the insurance companies would “cut him some slack” once he had to re-enter the private sector and purchase his own health insurance.  But once he had a pre-existing condition, he learned the hard way how America’s health insurance system deals with the people who need it the most.

Personal experience is a potent source of knowledge.  It is the reason, for example, why people with gay family members and friends are more likely to support marriage equality.  It’s the reason why Black Americans are more likely to have a poor opinion of law enforcement than White Americans.  It’s the reason why Hispanic Americans overwhelmingly support a more humane immigration policy.  When you or someone you know is directly affected by a problem, that experience tends to change your worldview in ways that might differ from what you might believe in the absence of those circumstances.

But it’s important to remember that this is also a conversation about empathy.  When I was younger, I spent a large portion of my youth growing up in a mostly White suburb.  Despite this, I felt like I was racially conscious.  But as I grew older, I realized that my “racial consciousness” was basically a fraud.  A large part of this growth happened in law school, where I studied the criminal justice system, and realized that it is tainted by racial injustice at every level.  Suddenly, the anti-police narratives in hip-hop made sense.  Malcolm X seemed less like a violent rabble rouser and more like a legitimate voice for the frustration of the Black community.  The realization that my history books really had been “White washed” to some extent was frustrating, but also liberating, because it allowed me to see a deeper truth that had evaded me for so long.

This is relevant to politics, because most of us inform our political positions based on personal experience.  So when a small business owner tells me that he opposes Obamacare because he genuinely can’t afford to offer insurance to his employees, I don’t just shrug my shoulders—even though a part of me is glad that people with pre-existing conditions can get coverage under the law.  If I was a small business owner in his position, I might feel more strongly about the mandatory employer coverage provisions of the law.  In the political realm, being able to understand why others might feel differently is an important part of understanding how to change peoples’ minds.

In Clint Murphy’s case, all it took to change his mind was to be placed in a vulnerable position.  All of a sudden, the complaints of people with pre-existing conditions didn’t seem quite as trivial.  Of course, Clint spent years of his life believing the opposite.  If only there was a way that the wisdom he gained from his personal experiences could have reached him sooner.

If there was a way to achieve a critical mass of empathy in this country, one which allows us to more keenly learn from the personal experiences of others, we might see a public policy revolution.  Perhaps the Executive branch would stop dropping as many drone missiles in the Middle East, weary of the blowback caused by civilian deaths.  Prosecutors might be less anxious to rack up convictions, knowing the devastation that mass incarceration and criminal records have on poor communities.  We might actually see a humane immigration policy, knowing that 11-year old girls wouldn’t be torn from their fathers.  Drug use might be treated as a public health matter rather than a criminal one, knowing that incarceration has not only failed to prevent people from using drugs, but done immeasurable damage the lives of those affected.

Will it happen?  Who knows.  It’s probably wishful thinking.  But one can always hope for the change.  With same-sex marriage and marijuana legalization on the upswing, there’s plenty of possibilities on the horizon.  We’ll just have to wait and see.

May 27, 2012
Many hospitals, doctors offer cash discount for medical bills

logicallypositive:

latimes:

The lowest price is usually available only if patients don’t use their health insurance. In one case, blood tests that cost an insured patient $415 would have been $95 in cash.

Remember that entry I wrote about health care costs being a result of a disruption of the price mechanism viz. government-promotion of insurance companies? Yeah, this is my point.

LTMC: This is the exact opposite of what normally happens.  It is much more common for hospitals to charge patients without insurance more because insurance companies have the economic clout necessary to bargain with healthcare providers for lower rates.  Individual patients have no such clout, and even if they did, would be in a poor position to use it in most cases.  A person who is bleeding from a gunshot wound cannot defiantly refuse to patronize the nearest hospital because he finds their services “unreasonably priced.”

I suspect that the LA Times is failing to control for the income of the self-payers.  Giving out charity care through reduced rates is not the same thing as bargaining at arm’s length.  It’s an attempt to reconcile their bottom line with their responsibilities under EMTALA.

(via yung-lysenko-deactivated2014040)

March 26, 2012
"As a patient with a pre-existing condition, as a small-business person/employer in the healthcare industry, as the H.R. person for that small business and as an R.N., I have seen insurance evolve to where it is anathema to health care. We see exorbitantly rising premiums, cut-backs to coverage, tactics to avoid paying or at least delaying payment of legitimate claims, and of course the pre-existing condition clause. Some of which has or will be addressed by the ACA, but there is still an inherent conflict of interest. When all of that didn’t work to boost their profits enough, they decided to unilaterally start cutting their compensation to doctors to make up the difference. I think any system that is beholden to shareholders and attempting to amass huge profits should not be in charge of healthcare. While many people are fearful of the government being in the exam room, I fear having my insurance company in there with me even more. I believe a simple medicare-style single payer system for all ages would be affordable when you consider closing the E.R. expense for the under-insured. In addition, I believe having employer-based insurance is part of what is keeping employers from hiring. Just imagine a world where more people were working because employers weren’t burdened by the cost of health care. Better pay, more people working creating a larger tax base with which to pay for the single-payer system. Now if we could just get our political parties to give up the big contributions they get from insurance corporations, and start working for their constituents, we might have a chance to turn this thing around"

Comments, Ryan Plan May Lead To Single Payer Healthcare, by Ezra Klein

March 5, 2012
Another Reason Birth Control Should Be Covered By Health Insurance

It’s not just for contraception:

I have written a couple comments about my daughter regarding this birth control issue. She is on birth control and has been for almost a year now- not for sexual activity and pregnancy prevention, but even if that were the case so what?!?! No, instead beantown girl suffers from menorrhagia and secondary dysmenorrhea. That is, since almost the time of her very first period, she bled so heavily and suffered such severe pain and cramping that she was rendered immobile for the first 2-3 days of menstruation. She would become so violently ill that she would miss at least 2 days of school each month. PMS for this poor child was so horrible- she would rage, cry and be so very depressed that the entire family would try anything to avoid being near her. It ended up the safest place for her was her room for the week preceding her actual period and we all knew to just stay away from her if we could. I finally convinced her that she needed to see a doctor about this when her periods began to last for 8-9 days and she would become so pale and listless throughout the entire period that I feared she was becoming anemic. She was. After doing extensive testing, ultrasounds and blood work, the doctor diagnosed her with the menorrhagia and dysmenorrhea. She placed beantown girl on Ortho Tri-cyclen Lo, a low dose birth control pill in order to try to balance out the hormones. Since she has been on the hormones, her periods have become regular, 4-5 days of normal menstruation with less cramping and no more violent, raging PMS- an absolute godsend to my beautiful daughter, to be sure! 

Don’t worry Limbaugh.  This woman’s 16-year old daughter will have that sex-tape for you post-haste.

December 6, 2011
The Conservative Case For The Individual Mandate

The conservative case for an insurance requirement starts with the assumption that almost any responsible adult, and certainly one with a family, is going to get health insurance, at least so long as he can afford it. He may get it through an employer or purchase it himself. Unless one is extremely wealthy, the risks of not having insurance are simply too great. Thus, to the vast majority of responsible adults, the requirement to have insurance is no requirement at all — they already buy it. The reform simply imposes a penalty if they don’t do what they would do anyway. Some may object in principle, but the actual effect on those now buying insurance is near zero.

We can, of course, conceive of several groups that might be required to do something they are not already doing. There are those who because of illness or risk factors might be charged exorbitant insurance premiums they cannot afford. There are other individuals who, even if healthy, cannot afford insurance. But the reform law addresses the needs of these groups through reform of the insurance marketplace, expansion of the Medicaid program, subsidies for the purchase of insurance and, in some cases, exemption from the requirement to have insurance. As a result, most of these individuals will be among the biggest winners in the new system. They will either gain access to affordable insurance or face no burden or penalty for not doing so.

In fact, the only individuals who may actually be forced to do something they would not do voluntarily are those who can afford insurance but choose not to buy it. It is these individuals and families whose supposed rights to not have insurance are being defended by critics of the new law. Yet these are precisely the individuals with whom strong advocates of individual responsibility should be most displeased. These people are not just putting themselves and their families at risk by not buying insurance; they are running the risk that when they cannot pay their medical bills, someone else will have to pay those bills for them.

Here the principles of limited government and individual responsibility are at odds. What is more disturbing to conservatives— that government would impose a financial requirement on irresponsible individuals , or that government, in effect, would allow their irresponsibility to impose financial burdens on those behaving responsibly?

CNN’s Wolf Blitzer raised this issue while moderating a GOP presidential debate in September. What should happen, he asked, when someone has no insurance and needs care they cannot afford? None of the candidates had much of an answer. No one suggested the individual be denied care and possibly be left to die. Yet any other imaginable answer — hospitals and physicians should provide free services, the safety net should absorb the cost, charities or government should pay for it — entails shifting costs from someone who didn’t buy insurance to someone else. If the person needing care is poor, that cost shift would seem appropriate. But what if the person unable to pay could have purchased insurance and didn’t?

Ultimately, the cost in such cases will be paid by taxpayers, or those who have bought insurance. Tax dollars support clinics, public hospitals, programs for the uninsured and charitable organizations that provide free care for the uninsured. And premiums paid by the insured rise when hospitals and doctors charge the insured more because the uninsured are unable to pay.

Where is the conservative value in this scenario?

In considering the individual mandate, conservatives need to address three questions. First, why is it so troubling that the government is requiring responsible individuals to purchase what they would purchase anyway? Second, is it fair or appropriate to make the responsible pay more in order to protect the rights of the irresponsible? Third, what should be done when the principle of limited government clashes with that of individual responsibility?

Or, put another way, is the principle of limited government so compelling that it should cause us to penalize the responsible and reward the irresponsible?

LTMC: This entire argument, of course, is premised on the existence of EMTALA laws, which require hospital emergency rooms to treat individuals regardless of ability to pay.  While Libertarians view these laws as tantamount to healthcare slavery (which I find to be a rather inapposite comparison due to the nature of how human institutions actually work, and the fact that I’ve never met a healthcare professional who felt their legal duties were comparable to the yoke of a Hebrew Tribesman or Plantation Worker), I don’t think you will ever convince even a slim majority of Americans that people should be left to die if they can’t afford medical treatment.

Of course, the hospital guarantee is not a guarantee of access to healthcare.  It is a guarantee of access to “emergency” healthcare, meaning that individuals who cannot afford medical treatment will usually wait until their medical problems are so severe that they can no longer avoid treatment.  But by doing so, their medical problems become much more expensive to treat.  It’s much more efficient to create a system in which they can get access to care earlier to ward off more expensive treatment later on.  An ounce of prevention is worth a pound of cure.

Once you grant the premise that a person should not be denied access to healthcare for lack of ability to pay (which most Americans do), you’ve technically already socialized healthcare.  The question is whether you do it inefficiently, like we do today, in a way that forces indigent people to wait until their medical problems are exponentially more expensive to treat before seeking care, or if you do it in a way that allows those same individuals to seek care earlier despite inability to pay, thus reducing healthcare costs across the board.

It’s also worth noting that Americans tend to agree that an individual ought not to be denied health insurance coverage because of a pre-existing condition.  But there’s no way to guarantee access to the same in a “free market” health insurance industry without a mandate, because you need the premiums of profitable health individuals to pay for the unprofitable sick individuals.  For free-market advocates, the question then becomes: assuming that EMTALA laws are not going anywhere, which is the better option?  A mandate, or a government-run national universal health insurance plan?  The ACA is a messy bill, but on the question of mandates in an EMTALA world, the answer for Libertarians seems pretty clear.

October 29, 2011

miranistina asked: Hello Letters To My Country. Yes this is Miran from the article in the Guardian. Someone tipped me off that it went viral so I looked into it. I absolutely agree with your anger at our system for forcing me to choose between begging for my life, or consigning my death the the corporate entity than ensured it. I have ceased searching for help and now I consign my Life to insuring the protection of people like me around the world. I pray for the movement's success so that when they lay me to rest

Cont’d:

…that I may indeed rest in peace, knowing that I might have helped in that change in some way. I do hope that people will remember me not for dying for the cause, not for my disability, and not for my weaknesses but if I am remembered, that it’s for the people who have benefited from my work on their behalf. This is not about me, it’s about the ones whose lives still have a chance to be saved.

Thanks so much for your thoughts Miran.  I’m glad you’ve managed to achieve a state of Grace.

Your situation is a perfect example why delivering healthcare on a for-profit basis does not work.  Human bodies are not genuinely insurable.  Our bodies aren’t like cars, which an insurance company can write off as totaled past a certain point of damage.  One can’t total a human body.  And as you unfortunately found out, a health insurance company has less incentive to insure you the more you need their product.  It’s the only industry in which that phenomenon is true.  The Profit Motive, in all of its glory, cannot work in favor of the consumer when greater demand for a product leads to intransigence, apprehension and escapism on the part of the entity who provides it.  The alternative may mean bigger government, but I welcome it if it prevents people from being rejected by a system clearly capable of treating them.

I’ll be keeping an eye on you Miran.  I hope for the best.


October 29, 2011
Occupy San Francisco: the teenager who was refused cancer treatment.

jonathan-cunningham:

socialistscum:

Occupy San Francisco protester Miran IstinaOccupy San Francisco protester Miran Istina stands outside the US Bank building on Market Street, San Francisco. Photograph: Martin Lacey

As Miran Istina puts it, she has been living on borrowed time since she was 14. Diagnosed with cancer, she was given just months to live after her health insurer refused to provide her with life-saving surgery.

Now 18, Istina, from the city of Sisters in Oregon, has spent the past three weeks living in a tent at the Occupy San Francisco protest and says she will stay there indefinitely, despite her illness.

She was inspired to take part in the protest by the refusal of her insurance company to pay for treatment for her chronic myelogenous leukaemia.

She said: “They denied me on the terms of a pre-existing condition. Seeing as I had only had that insurance for a few months, and I was in early stage two which meant I had to have had it for at least a year, they determined it was a pre-existing condition and denied me healthcare.”

Treatment would require a bone marrow transplant and extensive radiation therapy and chemotherapy, at a cost of several hundreds of thousands of dollars. Coming from an ordinary middle-class background, her family has no way of paying for the surgery that would save her life.

Following her insurer’s refusal, she spent three years travelling the US looking for a healthcare provider who would give her a chance at life.

Istina said: “I went all over the place, looking for someone to give a damn, really, someone to care enough to treat me. Because we were middle class, we couldn’t afford to treat my disease. We’d be in debt for the rest of our family life.”

After repeated refusals to offer her treatment, she said: “I decided I was going to spend the rest of my life doing whatever my heart wants.”

The Occupy movement attracted Istina as she ties the corporate influence on American politics to the decision that has sentenced her to death.

She said: “The corporate influence on politics influences just about anything that happens, seeing as politicians write the plans that healthcare has to follow. It directly links the fact that insurers only pick and choose those who are actually worth it [financially]. I just happen to not be one of the ones they wanted to be around much longer.

“The decision was absolutely influenced by some corporation or some bank saying, ‘we can’t afford her. She’s not worth our money.’ In end terms, corporate greed is going to cost me my life.

“I used to be really upset about it. I’m not as much any more. I’m angry, for sure, but I think me being here might help it never happen again. That’s why I’m here. It’s that there are other people this is going to happen to if this movement doesn’t succeed and that’s not healthy. I’m done being the victim. However long I have left is dedicated heart and soul to this movement, no matter what it takes.”

She has immersed herself in the movement, becoming the chief media relations officer for Occupy SF and organising fundraising events around the city. On Thursday afternoon she led a CNN television crew on a walk through the camp, to show how they were living, explain their motives and refute claims that the living conditions are unsanitary.

She said of her new life: “My heart is finally satisfied.”

The Occupy San Francisco movement has seen up to 300 protesters take over the Justin Herman Plaza, at the Embarcadero in the downtown district since October 5.

The occupiers are given food by local restaurants and have received donations from supporters to provide supplies.

Health professionals from the San Francisco General Hospital are providing round-the-clock care for Istina, who needs strong pain killers and constant monitoring of her condition. Earlier in the month she suffered a kidney malfunction which required urgent hospital treatment.

Throughout the afternoon four police officers kept a watchful eye over the groups of tents and makeshift shelters but the atmosphere was relaxed. When the officers staged a walk-through some of the occupiers shared jokes with them. One said: “Please leave the automatic weapons outside the camp. This is a peaceful protest.”

Another said: “We’re not doing any harm. We’re just a bunch of peace-loving hippies.”

But a raid on the camp is possible at any time. San Francisco mayor Ed Lee has repeatedly insisted that the camp is illegal and all tents should be removed but so far little has been done to enforce the law.

He has threatened a raid and on Wednesday night occupiers expected police to move in, sparking a larger than normal demonstration. Two candidates for the upcoming mayoral election joined with the protesters but despite the presence nearby of riot police, the raid did not go ahead.

 

This should be a crime.

I want to ask the Free-market healthcare advocates out there:  what is your answer for this girl?  What is she supposed to do?  The Libertarian response to her situation seems to be that she should just do her best to seek the charity of others in an attempt to garner the money necessary for treatment.  Yet she claims that she’s done that: she traveled across the entire country, for years, looking for an institution that would help pay for her illness.  Not a single one would help her.

Does that mean she now has a duty to die?

Meanwhile, if she had gotten cancer in France, she’d have been able to start treatment within days of her diagnosis, and paid nothing:

In France, the sicker you get, the less you pay. Chronic diseases, such as diabetes, and critical surgeries, such as a coronary bypass, are reimbursed at 100%. Cancer patients are treated free of charge. Patients suffering from colon cancer, for instance, can receive Genentech Inc.’s (DNA ) Avastin without charge. In the U.S., a patient may pay $48,000 a year.

But wait, you might say:  France has (partially) socialized medicine, so obviously the downside must be that she’d have to wait YEARS to receive her care, right?

Wrong.  France has very few waiting lists for serious illness, and its medical system out-performs America’s like a boss:

In a [2000] World Health Organization health-care ranking, France came in first, while the U.S. scored 37th, slightly better than Cuba and one notch above Slovenia. France’s infant death rate is 3.9 per 1,000 live births, compared with 7 in the U.S., and average life expectancy is 79.4 years, two years more than in the U.S. The country has far more hospital beds and doctors per capita than America, and far lower rates of death from diabetes and heart disease. The difference in deaths from respiratory disease, an often preventable form of mortality, is particularly striking: 31.2 per 100,000 people in France, vs. 61.5 per 100,000 in the U.S.

Now I know America doesn’t literally have a free market in healthcare.  But distinctions between corporatism and capitalism aren’t going to help someone who has cancer today.  And I think most free market advocates would still argue that, within the American system as it stands now, she still has a duty to seek charity first rather than seek healthcare reforms that would lead to even more coercion (as I’m sure she is, given  her seeming opposition to America’s for-profit system).

Now would her healthcare literally be “free” in France?  Of course not.  All french citizens are paying it forward through the tax system.  But by doing so, they end up a) paying less per capita than we do now., and b) when you get sick and can’t afford payment, everybody else’s tax dollars pay for your treatment.  This allows you to spend more time working and being productive rather, than say, wandering around the country for years begging other people and/or institutions to treat you so you can, you know, live.

Is this fair to the taxpayers of France?  Free market advocates would argue no.  In fact, they would argue this even if it was clear that socialized medicine, with all the coercion inherent to it, resulted in more people getting access to healthcare, increased life expectancy, and lowered per capita costs; because under Libertarian ideology, it is axiomatic that freedom always trumps physical utility.  So even though a system based on coercion could at least conceivably increase human flourishing (and thus increase real freedom for a great many people by giving them to choice to receive care, which they are still free to deny in a socalized healthcare system), a lover of Liberty and Freedom must still reject it, because paying taxes is a form of tyranny worse than not being able to afford to pay for your cancer treatments, and certainly worse than the humiliation of being forced to beg for charity from other people.

This seems like a good time to quote Hayek, whom “true” lover’s of liberty have apparently disowned all together for his early-career apostasy:

[T]here is some reason to believe that with the increase in general wealth and of the density of population, the share of all needs that can be satisfied only by collective action will continue to grow…

Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance, where, in short, we deal with genuinely insurable risks, the case for the state helping to organise a comprehensive system of social insurance is very strong.

At the end of the day, this teenager’s situation boiled down to a matter of luck.  If her parents had been lucky enough to have a job that included her on their health insurance, she wouldn’t be in this position.  If she had been lucky enough to get cancer after her parent’s insurance kicked in, she wouldn’t be in this position.  The insurance company would be paying for her treatment.  Why should she be denied care simply because her parents couldn’t find a job with health insurance in time?  Why should she be denied care because she can’t predict when she’s going to get stricken with cancer?  Her situation is a function of temporal and biological fortune.  I don’t think we should structure society in a way that penalizes her for that when it doesn’t have to be that way.

I guess at the end of the day, it really does boil down to a fundamental disagreement at the ethical level, as Kohenari pointed out to me recently  I believe freedom is a means of achieving utility, not an end in itself.  Libertarians, while generally believing that liberty inherently increases utility, nonetheless concede that in the hard/coneptual case where it doesn’t, they would still choose liberty over physical utility.  I can’t do that.  I think it is fundamental moral error to do so.  I think it is fundamental moral error to tell this girl, or any similarly situated individual, to beg for charity or consign herself to death, while the girl who got diagnosed with cancer down the street gets treatment and lives, because dad was lucky enough not to get a pink slip in 2008.

September 14, 2011
On Ron Paul's Vision For Healthcare

E-mail from a Sullivan reader, discussing EMTALA (Emergency Medical Treatment And Active Labor Act), which is the federal law that requires hospital emergency rooms to treat you regardless of ability to pay:

Eliminating the emergency room care law [EMTALA] does not seem practical. How would paramedics or doctors in an emergency room deal with an unconscious patient lacking ID who requires immediate lifesaving care? Even if the hospital could determine that the patient was insured, how would they know if the patient had enough money to pay the deductible?

I don’t think this is a hypothetical question. And I’m pretty sure that anyone who needs emergency care wants and expects the paramedics/doctors to begin treating them immediately. This would end up affecting the insured as well as the uninsured, and it’s not hard to imagine the outrage that would occur when someone whose life could have been saved dies because precious time was wasted verifying that the patient had adequate insurance.

Also, in Ron Paul’s answer he claimed that churches and private charity would take care of the sick in the absence of government. I hear this a lot from libertarians, and private charities certainly do provide a great deal of care. It would be wonderful if private charity could solve our social problems without any need for government programs. But if they had been able to solve the problem on their own there wouldn’t have been any need for government programs. And the idea that care for the poor is strictly the domain of churches and private charities isn’t just pre-New Deal, it’s practically pre-Renaissance.

Along a similar vein, another reader demonstrates in the same post that privatizing/abolishing Medicare, as Paul Ryan has suggested, would effectively make EMTALA unenforceable:

The Emergency Medical Treatment and Active Labor Act (EMTALA) requires “participating hospitals” to provide care to anyone needing emergency health care treatment, regardless of citizenship, legal status, or - most famously - ability to pay.  ”Participating hospitals” are those who participate in the Medicare program.  In practice, virtually every hospital participates.  But, for example, Shriners Hospitals, Indian Health Centers, and VA Medical Centers are not subject to the law.  Nor would be any hospital that opted out of Medicare.  

EMTALA has to be structured this way to be constitutional. Congress can impose virtually any restriction, even ones that would otherwise be unconstitutional under the Tenth Amendment, through Medicare conditions of participation, with the result that it applies only to participating facilities.

The Ryan budget and other proposals from the libertarian/Tea Party right pledge to put the government out of the business of paying for healthcare.  If Medicare becomes a set of subsidies beneficiaries use to purchase private health insurance, then EMTALA is dead.  If hospitals no longer participate in the Medicare program, then there is no way for Congress to require such treatment in a manner that would survive constitutional scrutiny.  In this way, the GOP has put forward a proposal to end EMTALA.

August 13, 2011
Would Free Birth Control Save Money?

An NRO editorial claimed no. Jonathan Cohn counters:

When you make people pay more for medical care, they consume less of it. This was the basic insight of the Rand Health Insurance Experiment, which most economists consider the gold standard for this sort of research, and countless studies since then. Conservatives should know this as well as anybody, since the whole point of consumer-directed health care – the approach they generally favor – is to increase cost-sharing so that people will use fewer services and wares, thereby spending less money. Of course, the problem with higher cost-sharing (and the reason folks like me are wary of it, depending on the details) is that it can discourage use of medical care that’s beneficial. Studies have shown, for example, that seniors react to higher cost-sharing on prescriptions by cutting back on their hypertension medicine. That’s bad medicine, because it increases the likelihood they’ll get a heart attack or stroke. That’s also bad economics, because heart attacks and strokes are incredibly expensive to treat.

[Cohn] cites multiple studies that followed free family planning services for low-income women in California, including one published in the American Journal of Public Health:

Family PACT contraceptive services provided in fiscal year 1997–1998 are estimated to have reduced the total number of births in California by 7% to 8% in the fiscal year 1998–1999 … The reduction in births also reduced public expenditures for health care, social services, and education for these women and for their children. … averting 108,000 pregnancies saved the federal, state, and local governments more than $500 million at a ratio of $4.48 saved to every dollar expended on family planning services.

emphasis added.

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