Just Go To The Emergency Room

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?

Christine O’Donnell: S.C.R.E.A.M. (Socialist Cash Rules Everything Around Me)

The only happy trail she’s concerned about is the money trail

OMG, you guyz!! The Virgin Saint of Financial Mismanagement is going to investigate leftist socialistlibrulists groups because GEORGE SOROS and JEWS, that’s why:

Failed GOP Senate candidate Christine O’Donnell is back, and she’s telling supporters she wants her newly formed political action committee ChristinePAC to “investigate and counter attack leftwing groups.”

O’Donnell, who wrote that her losing campaign sent “shockwaves” throughout the nation, said in an e-mail to supporters Tuesday that her group will look into the groups “funded with one million dollars or more from billionaire leftist George Soros.”

“The Left keeps after me because they consider strong, Republican women a danger to their status quo,” O’Donnell wrote. “Your donation also enables me to speak out in many venues from Coast to Coast, thereby helping support a nationwide effort. This is a way that will help me counter attack our opponents and bring the battle to them.”

ChristinePAC is based out of O’Donnell’s Delaware home, raising concerns for ethics groups given that O’Donnell is already under investigation for alleged misuse of campaign funds.

Christine, honey — you’re never going to achieve full Palinosity until you stop running your PAC from your fucking house. You should totally demand that Fox News build you a house! They built Sarah her own studio! Aren’t you, like, totes jellis!? Well, you should be. I heard Palin talking shit about you during the pep rally. I heard from this one chick that Sarah calls you thunder thighs behind your back, like all the time. I know! What a slutbag! What’s her damage, anyway?

Run along, now. Aren’t you late for your weekly virgin sacrifice? Here: you can borrow my pentagram pendant.

[via TPM]

[cross-posted here at Angry Black Lady Chronicles]

Circa 1949

Here’s a little video in honor of St. Ronnie’s 100th birthday. As far as I’m concerned, this is pretty much a documentary of the Reagan attitude, plus or minus Grenada and cocktails with Tip. His presidency marked the beginning of the nostalgic, “America fuck yeah” non-response to real problems. Even so, he’d be called a RINO today, because he governed as a center-right President who raised taxes and signed an amnesty bill for undocumented immigrants.

More of This, Please (SocSec edition)

I really like the analogy Bob Herbert uses in his latest NYTimes column to rebut the catfood-commissioners “Raising False Alarms“:

When you see surveillance videos of some creep mugging an elderly person in an elevator or apartment lobby, the universal reaction is outrage. But when the fat cats and the ideologues want to hack away at the lifeline of Social Security, they are treated somehow as respectable, even enlightened members of the society.
We need a reality check. Attacking Social Security is both cruel and unnecessary. It needs to stop.
“If we didn’t have Social Security, we’d have to invent it right now,” said Roger Hickey, co-director of the Campaign for America’s Future. “It’s perfectly suited to the terrible times we’re going through. Hardly anyone has pensions anymore. People’s private savings have taken a huge hit, and home prices have been hit hard. So the private savings that so many seniors and soon-to-be seniors have counted on have just been wiped out.
“Social Security is still there, and it’s still paying out retirement benefits indexed to wages. It’s the one part of the retirement stool that is working.”
The deficit hawks and the right-wingers can scream all they want, but there is no Social Security crisis. There is a foreseeable problem with the program’s long-term financing, but it can be fixed with changes that do no harm to its elderly beneficiaries. One obvious step would be to raise the cap on payroll taxes so that wealthy earners shoulder a fairer share of the burden…
The folks who want to raise the retirement age and hack away at benefits for ordinary working Americans are inevitably those who have not the least worry about their own retirement. The haves so often get a perverse kick out of bullying the have-nots.

This would be an excellent column to forward to all those Facebook friends and teabagged relatives, IMO.

A Death Trap, A Suicide Rap

This list of 100 programs the Republican Study Commission wants to cut to balance the budget is a political death sentence for the Republican party, since it cuts a number of popular and necessary programs.

To pick on just one, consider “Essential Air Service”, a subsidy that allows rural areas to have a couple of commuter flights in airports where airlines would otherwise pull out. When a town that’s 200 miles from the next nearest airport loses air service, saying “it saved $150 million” is not going to get the Republican who voted for this bill re-elected.

Even so, most of the named cuts are mice nuts compared to where they think they’ll get the real savings. For example, it only takes the removal of the $150 million subsidy to DC’s mass transit to shut the place down, but I have no doubt that once they cut that, the federal government will “save” $150 million in the very short term. I can’t say the same for cuts like:

  • Sell excess federal properties the government does not make use of. $15 billion total savings.
  • Require collection of unpaid taxes by federal employees. $1 billion total savings.
  • Prohibit taxpayer funded union activities by federal employees. $1.2 billion savings over ten years.

These reek of ideological bullshit and fiscal stupidity. Yes, let’s dump as much federal property as possible in a depressed real-estate market – we’ll surely get $15 billion selling low. And I’d like to see the fine print on the other two.

But my nitpicking is obscuring the big picture. The real savings from the plan is from a rollback of discretionary federal spending to 2006 levels and a freeze through 2021. I’d love to see John Boehner sell ten years without pork-touting press releases to his caucus.