Paduda is right that EMTALA is a hidden tax, but he's wrong about where the burden lies.

These days, there is very little cost shifting to “paying” patients. Medicare, Medicaid, SCHIP, and managed care patients comprise the lion’s share of a typical hospital’s case mix, and their services are paid at fixed case rates.

Thus, raising prices adds nothing to a hospital’s net revenue, which means that it can't "pass on" the costs of treating uninsured patients to anyone. The hospital eats the cost of treating those patients.

So, the “hidden tax” is on hospitals rather than the public. This is one reason why so many hospitals (30%) are operating in the red.

With a single-payer system, we would be discussing not cost shifting but the availability of services under the established rate of single-payer reimbursement.

The costs of the care for the presently uninsured and under-insured (which in some cases includes those with Medicare and almost all insured by Medicaid) would be more likly to force closure of facilities and reduce available care if there were no higher-paying sources from which to shift unpaid costs. "Single payer" wipes out those higher-paying sources.

Since the money has to come from somewhere, it will have to come from higher taxes, once whatever inefficiencies of dealing with multiple payer claims and collections are wrung out from the present system.

With your single-payer, we might end up with what Canada now has, but probably less, since the American tolerance for taxes is so much less than the Canadian. The Canadians do not have home mortgage interest deductions and have a lower public burden for defense than we presently have, yet pay higher gross percentage to income taxes than do most Americans, both directly in income taxes proper, and indirectly through higher point-of-sale taxes on consumption ( GST, VAT and very high fuel taxes). Despite this, Canadians suffer delayed availability of smany "elective" medical services we Americans take for granted, all this for some sense of universality.

No, we would be having a different conversation were we to have "single payer," but conversations no less serious.

EMTALA is tied to eligibility for Medicare payments and also to state medicaid payments, as they are partially subsidized by the federal government. No hospital anywhere, even pediatric hospitals, can survive without federal or federally-subsidized state funding. Americans are as a group not solvent enough to afford hospitalization, even if the costs of a hospitalization are offset by private insurance. A hospital refusing Medicare would lose nearly all its patients over age 65 and all those eligible for Medicare coverage as disabled. Hospital-affiliated dialysis centers would close as nearly all dialysis done for patients of any age is paid under Medicare.

So sure, the hospital could refuse to comply with EMTALA, but they would then have to close.