Health care

[Otherguy Overby]

While watch TV this morning to get my daily dose of rage I listened to some commentary on health care and insurance.

So, with this in mind, I've a question:  If a person needs emergency health care and has no insurance, he's taken care of.  Why then will they deny treatment to someone else who doesn't have an insurance card?

I guess I don't understand...

[Fly320s]

I think that emergency health care is required under state or federal statute.  All other health care, e.g. non-emergency, and elective, is still allowed to be a business decision for the hospital/doctor.

I was watching the same segment on Fox News and I was equally outraged by the talking heads.

[Art Eatman]

Federal law requires that anybody who shows up at an emergency room will be treated.  So, many poor people routinely go to the emergency rooms for treatment of colds and minor injuries.  

Elective medical tratment is not covered by this law.  Many health-insurance policies do not cover elective treatments.  Cosmetic surgery, for instance...

Ask somebody in the health insurance business what would happen to premiums if "malpractice" were limited to actual negligence in order to bring a lawsuit, and if policies only covered major events--broken bones, bad gashes, cancer, heart attacks, and that sort of medical needs.  Forget colds and stubbed toes and other band-aid stuff.

Art

[MillCreek]

The Federal law referred to is EMTALA: the Emergency Medical Treatment and Active Labor Act.  It is a non-funded Federal mandate designed to eliminate 'patient dumping': a hospital turning away an emergency patient solely because they have no insurance.  EMTALA generally applies only to hospitals and hospital-owned facilities and coveres emergency treatment only.  A patient can be treated and stabilized and then discharged or transferred if necessary.  Private practice physicians are not subject to this law nor is a hospital obligated to provide non-emergency treatment.  Most of them do to a degree, and write it off as a cost of doing business.  

The sticky wicket, however, is that just because you provide free care does not mean that your staff works for free, you don't have to pay the building mortgage and your suppliers send you drugs, bandages and other medical supplies for free.  Those costs continue.  Knowing a fair amount about healthcare finances, as I do, once a healthcare facility starts getting above the 20-30% (the percentage varies by location) level in providing free, uncollectible or written-off care, it is in financial jeopardy and the long-term viability of the facility is at risk.  Many government owned hospitals (county or city) or some charitable hospitals with higher percentages of free care survive only thanks to government subsidies.   These hospitals are generally too important in providing healthcare to be allowed to fail.

[Art Eatman]

Remember the sheriffs' lawsuits about the costs of the background checks under Brady?  Unfunded mandates; two out of the three cases were held to have that part of Brady as unconstitutional.  Hmmm...

Anyway, I ran across one article which claimed that some 64 hospitals or hospital emergency rooms in the greater LA Basin (IIRC; disremember did it include San Diego.) had closed, and 25 more were in danger of closing due to non-pay.  The staff people generally agreed that about one-half of the non-pay were illegals.  (I don't mean to hijack the thread, but that is a part of the health-care cost problem.)

Art

[MillCreek]

My healthcare administration colleagues in south California and south Texas, especially, tell me about the huge amounts of money they are losing in providing labor and delivery services that go unpaid.  Apparently, many pregnant women near term make an effort to cross the border and deliver on American soil, thus granting American citizenship to the child born here.  Again, under EMTALA, if a woman presents to your hospital in active labor, you must admit them and do the delivery.  You can only transfer the patient to another hospital for clinical reasons, such as it is a high-risk delivery, and your facility has no neonatologist or neonatal ICU.  EMTALA applies to all patients, American citizens or not.