I agree with Lawrence Tribe that the legal challenges to the PPACA are “a political objection in legal garb” but the Republican refusal to engage in any kind of serious dialogue on health care outside a courtroom means that it’s up to us to ask them questions on what they have in mind.
When I read the conservative proposals for tort reform or high deductible, low value health insurance plans, I keep running into this inconvenient truth, and I’m wondering whether anyone dares to approach GOP elected leaders and ask about it:
In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual’s ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented.
We don’t even have to bring this law up, actually. Republicans raise it all the time, whenever they’re asked about what they plan to do with the tens of millions of uninsured and under-insured that will remain uninsured or under-insured under the conservative approach to health care:
McCONNELL: Well, they don’t go without health care. It’s not the most efficient way to provide it. As we know, the doctors in the hospitals are sworn to provide health care. We all agree it is not the most efficient way to provide health care to find somebody only in the emergency room and then pass those costs on to those who are paying for insurance. So it is important, I think, to reduce the number of uninsured. The question is, what is the best way to do that?
Well, now, not exactly, Mitch.
McConnell lied, because McConnell knows better. It isn’t an oath that guarantees universal access to the emergency rooms of those hospitals that accept Medicare (so virtually all hospitals). It’s a federal law. A federal law that passed with wide bipartisan support under the sainted Ronald Reagan. Republicans have been dodging the implications of that law ever since, but, incredibly, in some soft-bigotry-of-low- expectations kind of way, they have been able to get away with both relying on it in the abstract and ignoring it as a practical matter.
In fact, at the time of EMTALA’s passage, despite what McConnell would have us believe, only 22 states had laws that guaranteed that no emergency patient was denied emergency care because of inability to pay; 28 states had no such law. The emergency room treatment guarantee has become such a part of the background of the health care system in this country that we keep forgetting to ask Republicans to explain how they can support and rely on this guarantee, while proposing no way to pay for it. I guess they’re in favor of “cost-shifting”, because that’s how we’re paying for it now.
Here’s what it was like before, under the state’s rights approach:
The Emergency Act was passed in 1986 amid growing concern over the availability of emergency health care services to the poor and uninsured. The statute was designed principally to address the problem of “patient dumping,” whereby hospital emergency rooms deny uninsured patients the same treatment provided paying patients, either by refusing care outright or by transferring uninsured patients to other facilities.
The EMTALA is really unusual because it mandates that private, public or non-profit entities provide goods and services (health care) to anyone who walks in the door, with no prior payment or promise to pay.
We subsidize some essential life-sustaining services in this country. Examples are food stamps, housing subsidies and heating assistance. But I can’t enter a supermarket and announce I’m there to receive my federally guaranteed emergency food ration. I can’t show up at a motel and ask for my federally guaranteed emergency shelter. I can’t contact a private power provider and assert my emergency HEAP rights.
I have to pay for those goods or services prior to receiving them. I can use a voucher, like with food stamps, or I can use cash, or I can promise to pay with credit or insurance, but I don’t get the good or service prior to payment or promise to pay.
Further, I have to qualify for a federal/state voucher for food or housing or heating assistance. Those services are not universal. The level of assistance varies from state to state, and I can’t take my guarantee across state lines. None of those restrictions apply with emergency medical care. If I’m traveling through any state and I have what I perceive to be a medical emergency (or an actual medical emergency) any emergency room must assess, treat and stabilize, whether the hospital is public, non-profit or private, regardless of income, even if I’m not a citizen of this country, let alone residing in a certain state or county, just because I’m alive. We did that at the federal level.
And Republicans know it. They endorse it. They rely on it.
Here’s former President Bush:
“The immediate goal is to make sure there are more people on private insurance plans. I mean, people have access to health care in America,” he said. “After all, you just go to an emergency room.”
Easy! Just go to an emergency room! Well, that’s settled then. Let’s get on with the tax cuts.
Since 1986 we’ve been relying on an emergency stop gap because we flat-out refuse to grapple with health care. We’ve relied on it so long, incredibly, it has become part of the conservative argument against health care reform.
It’s the single reason why conservatives can simultaneously oppose any health care reform while claiming to be humanitarians, or just minimally decent human beings. They’re monsters without EMTALA, and they could not continue to pass the buck on health care without it.
Read it again:
to ensure public access to emergency services regardless of ability to pay
It mandates rock-bottom safety-net health care delivery at the federal level and it’s universal. We passed the law in 1986, with broad bipartisan support under Ronald Reagan, but we forgot to make any provisions for complete payment on uncompensated care, so we use the completely non-transparent payment mechanism called “cost-shifting”. We hide the cost.
Republicans oppose Medicaid expansion and they oppose federal subsidies for middle class health insurance, while at the same time relying on this law as a safety net, which is what it is.
Is anyone going to ask them about that?
Allan
Thanks for raising this. I had this conversation with an aide to my loathsome R congressman. I asked the congressman’s position on unfunded federal mandates and he said, against, absolutely. Then I raised this very issue in the context of health care reform. He weaseled and said the congressman agrees that these costs should be addressed but that the PPACA did it wrong, blah blah blah.
Senyordave
The answer from Republicans would be that it is a red herring, and then they would talk about socialism for a few minutes. The media would just move on becasue there are no sound bites.
Very few Republican politicians want to engage in a policy debate, and most Democrats and all of the media accomodate them.
jharp
I’ve been asking about it for years.
I figure I’ve paid about $250,000 for health insurance/care over the past 25 years. That is for my 3 visits to a family doctor.
If I’d had played it like some do, don’t marry the mother of my children and simply have them use the emergency room, I’d be $250K ahead.
And many do exactly that. And the dumbass fucking republicans support this system.
Mind boggling.
Kay
@Allan:
I think this unfunded mandate is extraordinary, because the cost of those usually falls on states (and this does, partly).
This shifts costs to individuals, too.
Geeno
I brought this up repeatedly during the health care debates.
Idiot:”I don’t think I should have to pay for someone else’s health care; they can just go to the emergency room”
Me:”And who do you think is paying for that emergency room visit?”
Needless to say, it never seemed to make head way as they just retreated back to talking points.
debbie
Oh, Mitch, be honest. It’s not about poor people getting their health care in an inefficient manner. It’s about giving our buddies, the hospital CEOs, an under-the-table boondoggle.
JCT
My favorite part of this is what happens when any reputable newspaper dares to broach the subject. I trained in some large big-city EDs and it is hard to even describe the insanity of this “approach” to health care.
I think the NYT had an article about this last year and the online comments (90% blaming illegal immigrants for “hogging” the system) made me lost faith in humanity.
Bulworth
Just so I’m clear, the EMTALA ensures that uninsured patients will get treated but not that they won’t get billed. Right? They might not be able to pay the bill they get, hence the ultimate cost-shifting (but the person then faces other problems, such as declaring bankruptcy or a bad credit rating or both). But it isn’t as if emergency care is somehow “free” to any sick individual, Right?
kay
@Geeno:
I don’t know anyone, personally, who has not gone to an emergency room, either for themselves or bringing someone else. Maybe I run with a dangerous crowd, and there are millions of people who just don’t encounter this, but I don’t think so. I think it’s just become part of the background of the country.
Legalize
I’ve asked my republican congressman about it. But, no, no one important will ask this of republicans.
Sly
The underlying “inconvenient truth” is that Republicans are only willing to engage in cost-shifting if they can simultaneously kick the person receiving benefits in the teeth, because this is the only way their overdeveloped sense of pettiness can be sated.
That’s the theme that unites all Republican ideas vis-a-vis the safety net. “Yeah, I’ll help pay for you, but only if what you’re getting is so shitty that I get to feel better about what I got.”
You want healthcare? Well, you’ll have to suck it up and be content with a high deductible plan that may very well emisserate you should you ever actually need it. And if anything should accidentally befall you in this process, you won’t have access to the courts for remuneration.
It should also be noted that this sense of pettiness more than outweighs the desire to avoid economic harm, because a viable and efficient safety net helps everyone. Even the people who don’t rely on it as much as others.
kay
@Bulworth:
Absolutely. And they can chase you and get a judgment and garnish and everything else.
mk3872
When GOP leaders consider someone needing to go into an Emergency Room because they are sick as “health care”, you know we have a serious problem in this country with not-to-serious leaders.
Bulworth
But someone else is in fact helping to pay for this
idiot’sperson’s health care, if they get subsidized insurance through their employer. Not to mention what would happen if they needed Medicaid. And when they ultimately will need Medicare.Geeno
@Kay
I’m talking about people who say the poor should just use emergency rooms if they can’t afford a regular doctor.
I, too, have had my share of ER visitations, but that’s not my primary means of getting medical services.
Violet
In a related note, Republicans are learning that buying health care on the open market really sucks.
Typical Republicans. It’s not a big deal until it affects them.
kay
@Legalize:
That’s the part that amazes me. It’s such a lame brush-off. That they get away with it is criminal. It’s not like we haven’t been through this before. The patient-dumping bit was this huge godammned scandal. We were all shocked and ashamed and full of remorse.
All better! Tax cuts!
Bulworth
@kay: Thank you. This is a point that should also be brought up to our congresscritters and media elite.
PeakVT
They’re monsters without EMTALA, and they could not continue to pass the buck on health care without it.
Reason #94,345,761 that Republicans are dishonest shitstains.
liberal
My dad, who now despises Obama, claims O is proposing to cut that.
PurpleGirl
I recently went to a NYC hospital ER. They provided a prescription for two days worth of the medication I’d run out of. They made the appointment I needed to get into the adult outpatient clinic I need for continuing care. They have billed me. My next step is to apply for medicaid. But in no way is any ER the solution to ongoing, continuing medical care. It shouldn’t be used as the gateway to clinics, either. It is an inefficient and expensive way to do care.
kay
@PurpleGirl:
The language health care policy experts use to describe what you’re talking about is “fragmented”, and it is a horrible way to get basic health care. But it exists, and its existence allows the problem to go unresolved, because it’s invisible.
Bulworth
@kay: Of course I realize that what conservatives expect is that people should put down their tbone steaks and cell phone coverage so they can buy health insurance on the glorious free market (even if they have a pre-existing coverage in which case they’re just sol.)
Stillwater
@Bulworth: And don’t forget about the double-billing that often happens!
DBrown
Key word is “stabilize”. They do not need to keep you alive with treatments (I’ve seen the victims who die in hospitals who were denied treatment that would save them.) Emergency treatment only lets people with simple problems or trauma be saved – chronic illness (cancer, most late stage diseases, or organ failures) are allowed to die. This is NOT health care nor are even simple routine (and life saving) low cost care provided (except by doctors willing to bend the rules and thank god for them.) This is as bare bones and heartless a system as possible. To hell with those thugs and their god damn ass licking of the rich and powerful – amerika, land of the elite and all powerful corporations.
Michael
OT, but here is an interesting conservative perspective on Chris Lee by a conservative blogger (but plucked from FR). I’ve plucked his interesting observations, and wonder if he or anybody of a conservative bent who reads it ever make the connection on compensation, concentrated power, wealth worship, unequal voice or tax cuts for the wealthy.
http://www.freerepublic.com/focus/f-news/2671625/posts
Backbencher
I believe a real good case can be made that EMTALA regulates economic “inactivity.”
Legalize
@kay:
But it’s not surprising when you consider that those who should be asking the questions are wholly owned by the same people who own the GOP. It is not in the economic interest of anyone with power or influence in this country to scrutinize GOP rhetoric.
PurpleGirl
@kay: See, I had called the adult clinic about their program but was told because I had no insurance I had go to the ER first. Which I did and now I’m in the system. But it hits me as a wasteful way to do things.
ETA: FWIW, in the health care arena, I’m for a single payer program, either like the British NHS or Canada’s system.
Marmot
@Violet: I heard that story on NPR yesterday. Interesting — and I didn’t realize that Nugent was a Repub, though I thought he might be. Strangely, Nugent never really got around to the point, though, which is “what should we do instead?” He just voiced some frustration with the $1,200/month bill.
Agoraphobic Kleptomaniac
Everytime my sentor’s aid gets on facebook and proclaims for him that “Obamacare ruled unconstitutional!! Yay liberty!”, I just ask, calmly and kindly, why the EMTALA is constitutional, and why aren’t we just doing a backdoor mandate, and forcing the costs onto those who do have insurance, while allowing for freeloaders to exploit my responsibility to actually carry insurance.
Haven’t got a single answer in a year.
Marc McKenzie
Of course no one is going to ask them about it.
The MSM? No way. They’ll turn it into a ghastly version of “he said/she said”.
Conservatives? Nope.
Our side of the fence? Well…maybe a couple of voices, but they’ll be drowned out by the screams about how Obama sucks (add whatever body part you want); how it’s all his fault, and how all of this would have been avoided if we had just passed the f***ing public option; or how this is proof that the country’s going straight down on the express elevator to hell and screw the usual suspects.
Or something to that effect.
So, sorry to say, Kay, but that won’t happen. One can hope, but…
Marmot
Oh, and Kay, great post. As usual. Thank FSM we’ve got front pagers who’ll take time thinking things through, rather than interlacing parenthetical rants within a larger rant.
kerFuFFler
Leaders supporting making healthcare and insurance more widely available need to make clear just how expensive a fig-leaf emergency room care is. It is much more affordable to treat many illnesses before they progress to the point where they become life threatening. It’s just amazing how “conservatism” now has nothing to do with being prudent or even keeping expenses down.
rikryah
there are very few things non-race related, that push my buttons to the extreme and would get me to cross the line into possibly an attempted physical beatdown of whomever utters the words.
‘ JUST GO TO THE EMERGENCY ROOM’ is one of those sentences.
I will not pass go. I will not hold my tongue. IF EVER, I come across a mofo who utters these words to me, the cursing of their ass out will commence immediately, and if they aren’t smart enough to STFU, well…I’m just gonna have to remember who to call for bail money.
I’m not proud of myself to admit it, but it is what it is.
Suffern ACE
@Violet: 14,000 per year seems about right for (most likely) men in their (most likely) early forties and fifties. I think Congressment make between 150-200,000 per year in salary (plus whatever income they have from investments). So this shouldn’t really be a burden for them at all. Less than 10% of their income.
Now, we just have to get them to start “imagining” what it would be like if, say, they made 40,000 per year and had to pay that same 14,000 per year.
Loneoak
@Michael:
Never thought I would agree with a Freeper, but I would much rather have as a Rep an ideological, young Iraq War veteran than a rich carpetbagger.
Bill Section 147
@kay: This is slightly off-topic but is there an estimate of cost for the process of trying to reclaim the cost from the unpaid emergency room visit?
Example: Person has emergency visit costing $2K. They don’t pay and then some collection agency spends time/money getting them to pay. The person cannot pay in full but wages are withheld (again this requires time and money to manage and process). It would seem that the original 2K cost, by the time it is eventually processed, would end up costing much more.
Marmot
@Suffern ACE:
Ha! That’s always been the problem, hasn’t it? Well, I guess Nugent and 15 others who’re opting out are realizing how expensive it is in absolute terms. That’s a good step. But getting them to see it in relative terms might be impossible.
SenyorDave
@liberal:
IfObama cuts heating assistance substantially without a backup plan such as transfer to a more efficient program, etc., he’s lost me.
If I wanted a Republican prick, I would have voted for McPalin.
nestor
Both sides do it.
StevenDS
Great post Kay. Keep beating this drum, it is really important.
LGRooney
@Bulworth: My thoughts exactly. If I need to go to an emergency room, I have to show my insurance card and fill out the liability forms. Now, fortunately, I’ve never been faced with a life-threatening emergency where I wasn’t competent to do just that but…
Napoleon
@Bill Section 147:
Plus in some states, like Ohio which I am in, I think you can’t garnish 100% of the wages, so even if someone is working full time if they don’t have money in the bank or much in the way of assets they may effectively be judgment proof. In the last 3 months I had a hernia surgery and another medical scare that necessitated 3 rounds of testing and the total bill was for something around $15,000, for what was not really much in the way of medical care (there was not one overnight stay or any kind of rehab).
Now imagine you work at Costco and have to spend a couple of days in the hospital.
Bulworth
Second that.
kay
@Bill Section 147:
I don’t know. It’s a great question. The people I see are making tiny payments to keep the bill out of collection, or, they have a big bill and just give up and discharge it in bankruptcy. Hospitals (here, anyway) will take some on the dollar if you bargain with them.
HyperIon
This is STILL the line of my asshole republican brother-in-law doc.
kay
@Bulworth:
Thanks.
Bulworth
This is an important point I hope doesn’t get lost. It isn’t that hospitals are being all altruistic about this, and if we just left them and the docs alone they’d give us all we need. It’s because there actually is a law that requires it (although again, the law doesn’t make it “free” care).
NobodySpecial
@SenyorDave: Now, now, Senyordave. Sometimes in 11D chess you need a few frozen pawns…
(Plus it’s not happening.)
kay
@Bulworth:
It’s amusing to listen to them, because it’s EVOLVED from Bush and Delay to this “oath” argument.
I don’t know why they bothered. No one called Bush and Delay out on the original stupid premise. They didn’t really need to start lying.
Jose Padilla
@Bulworth:
EMTAlA does not guarantee treatment. It only requires that the hospital screen and stabilize. You can have a broken leg with multiple fractures and all the hospital has to do is put a splint on it and give you some pain pills.
Hedgehog
@HyperIon:
Break his thumbs. Then he’ll have to go the ER, and most doctors can’t do much with two broken thumbs (plus he won’t be able to hustle pool).
El Cid
‘Conservatives’ I’ve known don’t like the use of emergency rooms as a stopgap measure because they think free access to emergency rooms for trauma is too soshullist.
kay
@Jose Padilla:
The people I know who use emergency rooms for primary care use the “assessment” portion. They don’t (yet) know if it’s an emergency. What they want is a diagnosis. Which is horrible, for them, but that’s what they do.
I don’t know why we have to make people’s lives so chaotic and hard. At the end of the day, it’s just fucking stupid.
gnomedad
@Jose Padilla:
Interesting. I’d like to see this dialog:
Dems: You want socialized medicine? It started under St. Ron with EMTALA!
Repubs (response 1):
Repubs (response 2): We are introducing the “Repeal the Job-Killing EMTALA and Let ‘Em Die If They Can Pay Act” …
LGRooney
@El Cid: I’ve met a few of those and every single one of them is a middle-aged-on-up white guy.
Marmot
@El Cid: I call that healthcare plan “Let the Bodies Pile Up in the Streets!”
Flounder
Kay, one small request. When you mention that Republicans are for tort reform, could you take the little bit of extra time to call it “federally mandated tort reform”? We are trying to push a ball down the field.
Brachiator
The Republicans don’t care about a safety net, and increasingly, they are becoming more open about a stance that says, “If you are not deserving, you don’t deserve to live.”
They and many of their supporters refuse to believe that they themselves will ever be in dire need, and they see need itself as both weakness and a sign of personal failure. Since America is the greatest country in the world(tm), no one could ever fail who really tried.
On the other hand, the old conventional wisdom no longer applies. It is increasingly futile to talk about maintaining the “social safety net” when the middle class is being undermined. The GOP clearly understands that the best way to win a class war and to deflect attention from the oligarchs is to pit the poor against the remnants of the middle class for the last social services crumbs.
wenchacha
Take it from another angle: grandma is having chest palpitations, vomiting, and belly pain. It’s 11:30 on a Saturday night. Her doc tells her to go to the ED. She may end up sitting in chairs for a few hours because there is no free bed. When they do get to her, they stabilize her, and start running tests that will take several more hours. She finally gets back home about noon Sunday and anybody who helped take her to the hospital is exhausted. They want to keep an eye on her, but they are worn out and also have to take care of grandpa, who is not quite the same since his last stroke.
Some of this, not all, is the problem of too many people using the ED as their personal doctor’s office. People with actual primary physicians still need to use the ED during off-hours. Sure, there is triage, but to stick 80 year-olds and parents with babies in Emergency for hours while they wait for the help they need isn’t all that conducive to good health for anybody.
Add to that the non-insured people who wait and wait with minor but real illnesses. They can stick around and miss work (if they have it,) or give up and go home. Sick.
kay
@Flounder:
Hah! Okay. I saw this morning the Tea Partiers are raising faux-objections to the power grab from state courts that is federal tort reform. They’re pretending they care about state’s rights again.
They’re just bankrupt, on every level. It’s all bullshit.
El Cid
@Marmot: Yes, but we’re talking people either too damn stupid or too damn stubborn to think for a moment about the consequences of these types of policy changes would be.
These mean-souled nitwits either don’t think of the arrival of pestilence, or the horrors they’d face everywhere with people hobbling about with gaping wounds and dying in the street or malformed bones, or else they have weirdo tough-guy fantasy solutions which have zero to do with reality.
El Cid
@kay: States’ rights are incredibly important when it comes to things that conservatives don’t want the federal government to do.
When states might do things conservatives oppose, then it’s time for the federal government to step in and stop states from doing all the stuff they don’t want.
Mike G
These Repubican congressional assholes and loudmouth teatards should lose all health insurance connected with their position and all Medicare and VA benefits.
After all, in their own words, “They can just go to the emergency room”.
rs
@Bulworth: I’m writing this as someone who is a proponent of universal single-payer, realizing that my recommendation is only a solution to certain individual circumstances.
In the ER where I work, it’s not uncommon for people to register who’ve forgotten (or so they say) their wallet, ID, insurance card, etc. We treat them regardless, often with expensive diagnostic lab work and imaging, treating and discharging them after relatively simple procedures like suturing, or more rarely sending them to the cardiac cath lab or OR (for an appendectomy, for instance). I’ve (more than once) suggested to people in unfortunate financial circumstances and in need of medical care they simply make up a name, address, SS#, and get the treatment they need at an ER outside of their neighborhood (where they’re less likely to be recognized). It’s not their fault we have the fucked up healthcare system we do. Let the hospital billing department chase a phantom.
And ask for cheap generic prescriptions, if possible, and pay cash- my experience is that pharmacies don’t particularly care who they’re selling drugs to, so long as they aren’t controlled substances.
Obviously, this isn’t a solution to properly manage chronic health problems like diabetes or hypertension, but it can get otherwise healthy uninsured individuals through essentially simple, but budget busting, medical emergencies.
I’m aware of the ethical and legal aspects of what I’m recommending, but frankly, with what passes for law and morality on Wall Street and K Street, I can sleep knowing I might have helped someone who actually needed an assist get some essential treatment without going into hock.
Triassic Sands
@Violet:
@Suffern ACE:
The actual salary of a representative is $174,000 a year. Many undoubtedly have other income as well. So, generally speaking, a healthy representative will be able to afford insurance on the individual market. However, a few of these representatives may find out what having a pre-existing condition means. For example, if they have diabetes they may not be able to find insurance at any price. Of course, no one needs insurance more than someone with diabetes, but that’s the
beautyperversity of our system — the more you need it the less likely it is to be available.kay
@El Cid:
I think federal tort reform is outrageous. Their whole health reform state’s rights argument is ludicrous, too. Let’s see, they want to rescind state authority over insurance….something mumbled about the Tenth Amendment, something, something….
This simplistic ideology doesn’t even have the benefit of clarity. It’s too black and white to be of any real-world use, yet muddy and impossible to understand if you’re looking for consistency.
That’s an achievement, right there.
Brachiator
@Triassic Sands:
A member of Congress has few worries when it comes to health care:
Wait, there’s more:
The GOP should really explain why they are entitled to better health care than the citizens they represent.
Tony
Excellent post on a very important distinction in the health care debate. I’ve blogged about EMTALA in the past and how the GOP has their moral high ground by enacting an unfunded mandate on hospitals and doctors. EMTALA was necessary and it worked when there were only 4 or 5 million uninsured; hospitals and doctors welcomed it in order to prevent “dumping”. But with 40 million or more uninsured, the system is fracturing. Nice job.
cckids
@wenchacha: This. I’m somewhat ashamed to admit it, but back in the days when my son used oxygen only intermittently (as opposed to full-time use now), when we had to go to the ER I would leave it on him until we got there, take him in to get screened, his O2 sats would be on the low end & dropping, and voila! He’d get a room/bed right away. It was a cheap trick, but we sat in an ER once for 8+ hours, until he started having seizures from the fever/infection he came in with. Never again.
Best health care in the world, right?
kdaug
@DBrown: If you cut off your hand, they’re required to stop the bleeding.
They are not required to sew it back on for you.
kdaug
@rs: Thanks.
Ruckus
@Bill Section 147:
That’s why for a 10-15 minute face time ER visit the bill can be $3500. The cost of recovery, the very good chance that no money will be collected, means two things. Charge a lot so that what you do collect pays actual costs and a much larger write off on taxes is possible. It’s why a lot of hospitals never make much of a profit if any at all. On paper their losses can be huge, in cash flow they might not be that much.
flounder
With Jon Kyl announcing he is retiring from the Senate, I have to mention that last year at a townhall meeting I challenged him and John McCain on the whole B-S of whining about “unpopular”, “unconstitutional”, “federally mandated” changes to our health care law.
I pointed out that their only policy response was “federally mandated tort reform”, and that since tort reform was forbidden by the AZ State Constitution (caps on injury/death damages are forbidden), and 3 separate ballot measures by Republicans to change this wording had failed a popular vote, their actual policy they want to “federally mandate”, at least in the state they claim to represent, is “unconstitutional” and “unpopular”.
Jon Kyl then lied to my face. He said that the AZ State Constitution didn’t really forbid the type of tort reform they wanted to do, I sat there with a confused look on my face; he went on in some dissemination, and then casually mentioned they needed to make some small edits to the AZ Constitution to make it work. He then said he’d rather shove his tort reform down our throats at the state level, but that since we rubes kept screwing that up, he didn’t really feel too bad about going the federal mandates route.
Ruckus
@flounder:
Kind of makes you wonder about
conservativepoliticians motives doesn’t it?Curtis
Live in San Diego where another hospital announced that it was closing its ER. You see what you get when you don’t pay for it? Why should the hospital pay for your health care? I think we’re now down to 9 ER hospitals in San Diego and maybe 2 Trauma Care hospitals. Imagine how many doctors want to work in an ER treating illegals and poor who have lawyers on retainer ready and willing to sue for malpractice?
Thanks guys. You helped.
Oh, and the state passing legislation mandating that all hospitals pass retroactive new Earthquake Standards put dozens of hospitals out of business altogether. They couldn’t afford to rebuild, looked at the issues involved with borrowing to rebuild and said screw it and closed.
DougW
Let’s let that last a-hole head of state get emergency room health care.
Maybe we could even give his ass budget level security? Now that there are several nations who want to nail his ass for violations of the Geneva Convention, maybe we should make sure that he travels to one of several countries that really have an interest in “interviewing” him.
He’s already declined (at the last minute)to go to some country in Europe because they were planning to charge him… Maybe there will a Eli Wiesel style kidnapping… We can only hope…
Jamie
I thought emergency medical bills are the most common cause of Bankruptcy in the US. They still try to make you pay for it.