Kevin, that would all be well and good, if there weren't already a right to medical written into law in the US. If you really believe there is no right to health care, you should be pushing to repeal EMTALA, asking that people with no insurance not be responded to by 911 calls and pushing for the rights of doctors to commit malpractice.

Of course, this is not the case. Any 911 call has to be responded to regardless of insurance, and anyone who presents to an ER has to receive care regardless of insurance. So we have already decided the question of whether health care is a right or not and we can move on to the question of whether we deliver the care that right entails adequately or not.

To put your head in the sand and act as if we don't already have that right under current law is absurd. Most especially it is absurd from someone who frets about getting sued and prays for tort reform with every 4th or 5th post. The underlying theory of all malpractice suits is ... once again that people have a right not just to healthcare but a right to healthcare that meets the community standards of care.

Please, stop with the "there is no right to health care" unless you want to start going on about how ambulances should leave the dying by the side of the road, ER's should turn away patients with chest pain and the fact that doctors can't amputate the wrong limb with impunity is a national disgrace.

Please, stop with the "there is no right to health care" unless you want to start going on about how ambulances should leave the dying by the side of the road

You're equating being humane and not leaving a dying man on the side of the road to the "right" to get a tummy tuck? I must of missed something. Probably the part about not taking extreme examples to "prove" a point by some absurd situation.

Too bad that you guys lost any moral high ground on the issue by colluding with the government through the implementation of the findings of the Flexner Report and the use of legislative feat to oligopolize vast swaths of the the health care market. Organized medicine made the deal with the Devil and now that the contract is due...

"Second, we are not some third world country that should be allowing our poor to just rot and die. Of course that is what is happening here and you know it as well as i do."

Please point to a place where people are rotting here in the USA.

Have you people heard of Medicaid? In fact 1/3 of the 47 million people that are "uninsured" in this country are eligible to sign up for Medicaid but don't. Maybe we should fix that first by somehow enforcing enrollment. The other third of the “uninsured” can pay for insurance, but don't make it a priority. With this group we need to offer a barebones HDHP stripped of the all the lobbyists state mandated entitlements and again enforce enrollment. The final third of the “uninsured” do not qualify for Medicaid and do need help to purchase some sort of coverage. With this group we can offer means tested government vouchers to get them into the previously mentioned barebones HDHPs.

The fix is simple, and it does not require the entire country to be forced into a single payer government run healthcare nightmare, but all the lobbyists in state and federal government are muddying the water so badly that nothing will get done.

To the poster who thinks everyone can sign up for medicaid because they are eligible for it, you are wrong.

In many states now, to be eligible for medicaid you must prove disbility the same as you would to receive disbility and Medicare through social security. In fact many states use SS guidelines now for approving medicaid. this does NOTHING for the working poor in the country. You make your remarks so easy that its like you really believe them. Also if a person has more than 1,500.00 in assets they will not qualify for medicaid. Which means if you have your own home or a car then you automatically wont get it.

Those are the people who are dying for lack of medical care. They don't qualify and are NOT eligible for medicaid. They can not afford medications and you are a fool if you think it isn't happening.

Postal delivery actually is enshrined in the constitution as one of the jobs of the government. It's there in article I:

To establish post offices and post roads

So people have a constitutionally protected right to getting mail, but no right to medical treatment in an emergency?

Fact is, getting medical care in an emergency is widely recognized as a right in this country. Since we have recognized the right to care in extremis, it is perverse to assume such a right does not exist de facto if not de jure. Again, there does not seem to be a "let 'em die" constituency in the US that is supporting the abolition of 911 and EMTALA.

Please, ask any EMT if they think people consider 911 a "privilege." Since it is a right that people believe they already have, I suggest all of you anonymous commenters join Criminal in pushing for a repeal of these rights as they exist right now.

Okulus,

Thanks for leaving a name and a reasoned argument.

The fact is that the constitution provides that congress will make post offices available. If they are to be available, what possible use could they be if not to deliver mail? If the constitution provided that congress must make hospitals available ... what would that imply?

The constitution doesn't do this of course, but several laws including the ERISA and EMTALA make certain aspects of health care delivery mandatory for most areas of the health care market. Now these may be "squatter's rights" but there are in fact certain legal rights that squatters do have. And to get rid of a squatter you have to go through a procedure. So, if Kevin and you genuinely believe there absolutely is no right to health care you oughta be pushing for the repeal of these things.

Now you may be legally correct about whether it meets the current standards for being considered a "constitutional right" but the fact that it is considered a right by virtually everyone in the US who is having an emergency is not something anyone is debating, so I assume that you agree that people do in fact consider it one, even if it is a "squatter's right".

Thus, if you believe as Kevin does that it ABSOLUTELY is not a right, then you should be working to reverse that perception.

In other countries where I've lived, there is no 911, there is no being seen in the emergency room unless you can pay, and people most definitely do not believe they have a right to such a thing.

The US could go back to that. You, Okulus, personally, in your state, could push for a constitutional amendment to the federal constitution that repealed the EMTALA. Nothing is stopping you.

Also I don't know where you live but our 911 system is run mostly by a private ambulance system which makes a profit, yet they still have to answer all the calls and transport to the hospital all patients who request transport. Again, this is a de facto right and not a de jure right but if it's absolutely wrong that people think this way, we should be pushing to abolish these things that give people that impression.

Doctors could push for the repeal of EMTALA the way they push for things like tort reform and push against Medicare pay cuts. They could lobby congress to repeal EMTALA. Yet they don't. So ... again I ask, why don't they, if we assume that "health care is absolutely not a right"?

That's because I think mail is objectively less important than health care. I wasn't the one who brought up mail in the first place. I'm not arguing for free mail delivery but I bet if mail were unaffordable for 45 million Americans someone would be. But it says a lot about your reading comprehension skills or your biases, mr. anonymous, that you think I ought to.

Okulus,

So what you are saying is pretty clear cut. I'm pretty sure that Kevin's position is different from yours, and I'm also quite sure that a majority of Americans would not be interested in what you are selling. That being said, you are consistent and logical.

Just realize that under your belief set, a child with new-onset type I diabetes who is in a coma and could easily be rescued with a couple of days in the ICU and inexpensive insulin shots would be allowed to die if the child had no insurance. If you think that's unlikely, it might be, but amortized over 40 million people, it's a certainty. If EMTALA were abolished and 911 no longer existed a LOT more people would probably die sooner than they otherwise would have, and you think that's a good thing. Not something you'd fight for evidently, but a good thing nonetheless. The only remaining question is whether Kevin agrees with that, and he's quiet about this thread so far.

Okul,

You said:

No, I don't think there is a right to treatment of an acutely ill child, even here, any more than there is a right to kindness or to charity.

That means you think that a society that does not offer such a right is objectively better than one that does. Therefore you think that a society that does not mandate the care of a child in a diabetic coma is worse in some fashion than one that does.

If you think such a thing is a bad outcome, one that is worse than having a society that mandates health care, you would work to assure that no child ever died due to lack of necessary medical where it was available solely due to cost. That is pretty much the opinion of Americans as codified by the law of the land in EMTALA. You want to repeal EMTALA.

So ... how in the world is it possible that I am "wildly overdrawing" and making assumptions. What did I say that was dishonest? I'm just pointing out what you support, which in the paragraph above your accusation of wild overdrawing and making assumptions you agree with.

You think that such a child may be lucky enough to get charity, but you would under no circumstances obligate anyone to offer such charity to any child they chose not to. You are writing this, yet you are accusing me of telling you what you think when I say the same thing.

If you don't like the implications of what you support, you have the opportunity to explain how such a thing would:

(a) never happen if EMTALA was repealed

(b) be a good thing on balance even though a few people would die needlessly

or (c) be a dishonest example, presented by a person undermining you without addressing a single statement you consider dishonest.

That you chose to do the third suggests that you are unwilling to do the first or second. At any rate, the fundamental point is no longer being argued here. You think that EMTALA is a bad law. EMTALA gives Americans rights to emergency care by law.

My position that this is a de facto right to health care cannot be argued against and you've only marshalled your willingness to suggest that somehow people are complying with EMTALA out of the goodness of their hearts, which I strongly doubt.

I remain very curious about Kevin's opinion on the repeal of EMTALA though.

Evan:

Preferring a society that chooses to provide medical care to those in dire need while recognizing that those called on to provide that care in a timely fashion deserve fair (not merely what is available from meager budgets, or chance) compensation for providing that care does not require that I concede that health care is anybody's right. It simply never is. Providing emergency care is the mark of a just and compassionate society--and a necessarily wealthy and advanced society-- in our contemporary understanding. But that does not make an absolute right, nor is it a carte blanche to seize the labors and property of others to further that end, without compensation. Unfortunately with EMTALA, that is exactly what we have: an entitlement to take without compensation, which itself is unjust. In my view, Congress had no right to pass such a law without providing fair and prompt compensation to those who have to provide that care, the hospitals and their affiliated staff. Accepting the status quo is endorsing injustice merely because it satisfies our notion that a greater benefit results to someone else. We do it because it is convenient and because we get away with it. That is not acceptable.

I do not see any disconnect between a moral imperative to render assistance and the idea that health care is not a right. It is a notion as old as our country and was the driving force behind the establishment of the first hospitals in the United States.

EMTALA can best be considered a tariff for the opportunity to practice what is-in my opinion-the noblest of professions in the country that has provided me with that opportunity. Most EPs such as myself would meerly like the government to come clean and abandon its role as extortionist vis-a-vis Medicare funding and take a stand; if the US is going to be in the medical screening and appropriate treatment or speedy transfer business they need to start accepting the financial responsibility for such mandated care.

Truth is, I have not yet met any EPs who would even consider not treating a patient if they needed help but were unfunded. Hell, I don't even have a clue as to my patients' insurance status until I have to find an admitting doc and have to call the correct physician based on their coverage (or lack thereof). I am not naive enough to believe a for-profit hospital system would ever allow itself to tip the budget into the red becasue of my or my colleague's charitable practices but I work on an RVU system where I only make money on what the group collects. EMTALA may state that I have to screen the patient and provide a certain level of care, if warranted. But Hippocrates told me I had an even larger, nobler obligation long before I had even heard of EMTALA. We as a nation have decreed-through EMTALA-that it is the responsibility of a hospital to offer a minimum level of care to our citizens when they are at their neediest, regardless of ability to pay (assuming the use of ERs is limited to only true emergencies or what the layperson has determined to be a true or potentially true emergency; a shaky premise.) This is actually one of several examples of what makes ours a great society in that we as EPs accept this responsibility as our own, doing our best to give our neediest the best care possible using all that is available to us. Healthcare-as has been defined by the single-payer crowd- is not a right at all, much like it is not my right to deliver it. It is my privilege to practice medicine and it is a privilege to benefit from the labors of others, even if you really, really, really want or need what they have to give. The best example I can think of off the cuff is the tremendous expenses incurred at the end of life. Day after day, I respond to codes in the ICU that nearly always involve an elderly patient who-by all reasonable standards-had very little quality of life for previous days or longer while the hospital honored the family's wishes to do all that was medically possible, utilizing a bed that could have been used for Evan's DKA kid. (Now this part may sound uncomfortable but I am speaking in terms of The Big Picture.) I go to their bedside and push expensive drugs, utilizing expensive critical care nurses and RTs, allowing sick patients in the ER to build up and slip further into their respective pathologies, all the while knowing that-for so many of these patients I encounter-the return of a heartbeat may be the last thing they would have wanted, given the choice but, since the family's wishes were made clear we do all that we can anyway. I am a tremendous proponent of elderly rights but I also believe in the humane treatment of our sick. Who exactly determines what is the scope of mandated care? The government? The patient's family?

By saying "healthcare is a right", exactly how much healthcare are you referring to? Lifesaving treatment that results in a worse quality of life than you would otherwise want to live with? Are we going to mandate advanced directives? For the kid in DKA, what if he has a bad outcome and his kidneys are shot? Do we mandate organ donation? What if your local ophthamologist is not a retina specialist and you have a detachment that requires urgent attention? Do we mandate the appropriate specialist fly out to treat you, neglecting their other patients and-in the EMTALA model-not getting compensated for their expertise but still assuming the significant liability?

The simplest rebuttal to whether health care is right or not is already well documented. Entire counties in the US do not have EMS systems or hospitals to serve its citizens, for reasons financial and logistical. This leaves thousands of Americans without access to healthcare in a timely or any other fashion. How do they exercise their "right" to health care, emergency or otherwise? No, the availabilty of healthcare services is determined by the responsibilities we have ascribed to those who decide they will provide them. I think we need to better define what constitutes "healthcare" as a nation, with reasonable expectations to what our society can afford and what we as physicians can provide.

As for EMTALA, I have no problem with my country telling me that it is my responsibility to help its citizens in their time of need. It would just be nice if they didn't hold a gun to my head as they said it. The hungry man doesn't go into a restaurant, take food from the oven, eat it, then demand the cook's wallet before letting his hungry friends in to do the same. Isn't food even more basic than healthcare?

I just read the sultan's post again. He said "But Hippocrates told me I had an even larger, nobler obligation long before I had even heard of EMTALA."

This is a very common misconception, even among physicians. There is absolutely nothing in the HO that says that a physician has a moral obligation to take care of anyone. This is logical since that would be a positive right. Every positive right invariably results in the erosion of the rights of another. That is why the the United States was founded on negative rights. This is the reason for our preeminence in the world.

I would like to hear from the sultan regarding the Oath. What line in the Oath actually states that a person has a right to your services? What line even states you have a moral obligation to provide your services?

vincent

there is no right to health care. the philosophical difference here is that the "right to the pursuit of life, liberty, and happiness" is a right given to man BY NATURE and protected by the government, not given by the government. The government is a protector of rights, not a giver of rights. Therefore, the government declaring they are going to give you a right is a lie! They have no rights to give. Emtala is a bold act of thievery and if you look up the definition, in economics any product or service as a result of labor is "property." Medical care is property, and, just like all private property laws in the united states, violence is being done. Emtala is simply eminent domain abuse. If the government says you have a right to housing, would you consider it fair that every hotel give up their rooms?