Socially Acceptable Healthcare

We have in the USA universal access to medical treatment via the most costly system possible.  What we need is a socially acceptable level of healthcare for all with a way for those who can pay more to get more.

Everyone on US soil regardless of citizenship has the right to medical treatment defined by the Emergency Medical Treatment and Active Labor Act (EMTALA) passed under President Reagan.  A frequently quoted court judgment about it says:  “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. Reports of patient dumping rose in the 1980s, as hospitals, generally unencumbered by any state law duty to treat, faced new cost containment pressures combined with growing numbers of uninsured and underinsured patients. Congress responded with the Emergency Act, which imposes on Medicare-provider hospitals a duty to afford medical screening and stabilizing treatment to any patient who seeks care in a hospital emergency room.”

Since essentially all hospitals are Medicare providers, EMTALA in effect mandates that anyone who comes to a medical emergency department must be examined and, if suffering from an “emergency medical condition”, provided with treatment.  A pregnant woman in active labor, for example, must be admitted and treated until delivery is completed.  We treat everyone regardless whether they can pay but only after they need the most costly treatment.  Our cockamamie approach means hospitals must recover the cost of treating those who cannot pay via higher prices for those who do.

Medical insurance in the US is a significant burden on US employers who provide it, a burden their competitors do not bear.  In 1986 we decided to no longer accept that many Americans were being denied treatment for a medical emergency, but we have yet to face up to the competitive issue.

We need all Americans to be productive.  Getting everyone to want to be productive must also be addressed but that is outside the scope of this post.  To be productive you must be healthy, which means you must have access to healthcare.  Since some treatments are extremely expensive and everyone is at risk of needing them, insurance is necessary for all.  Because most people will not in fact need the most costly treatments, universal insurance has the lowest per capita cost.  We currently insure only those over 65 years of age and to a lesser extent those with a serious health issue who cannot afford treatment, i.e., only the most costly to insure.

We need our health care costs to be affordable.  We currently have no defined limits on what treatment will be supplied yet ever advancing technology makes what can be attempted to prolong deeply and irreversibly impaired life astronomically costly.  Who should get what level of treatment is a value judgment we avoid discussing.  We should debate openly what judgments about treatment we want in our society.

There is, however, no disagreement that we want the finest possible healthcare.  That means those who can pay for the best should be able to do so, and the best should be affordable by as many as possible so as to maximize its supply in our society.  If great healthcare isn’t available affordably within our system, we will increasingly go to other countries for treatment.

So what in the end does “socially acceptable” mean?  It implies a level of rationing we agree is OK at a cost we agree is OK.  Achieving that balance is among the most difficult of all challenges.  We will get nowhere until we accept that a balance is necessary.

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