As long as as 911 and EMTALA remain, the answer appears to be yes.
EMTALA is the flawed, unfunded, mandate forcing hospitals to provide a medical exam to anyone who presents to the emergency department. Emergency physician White Coat envisions a scenario where a family who is denied care can simply call emergency services, or show up in the ER, to get the care they want.
For instance, what if Medicare decides to deny dialysis to those over 90-years of age?
No problem: “Most families will just call ‘911′ and the red taxi with the spinning light on top will come to pick grandpa up at his home and take him to the emergency department. At that time, grandpa will receive thousands of dollars in lab tests to document that he really is in renal failure and that he needs dialysis. If dialysis is necessary, grandpa will receive emergent hemodialysis thanks to EMTALA. He might even need a day or two in the hospital to make sure that he is ’stabilized.’ Then the red taxi with the spinning light on top will bring grandpa home where he will sit a few more days … until he needs dialysis again. One little phone call and the whole process starts all over again.”
This little charade will shift the burden of cost from the government to hospitals, which will cause more of them to simply shut their doors. And where will patients go then?
Related posts:
- Countries with worse health care systems than the United States
- What the United States health care system can learn from Mexico
- Citizens, not lobbyists, must reform health care in the United States
- Saving what’s good about the United States’ health care system
- What can health reform in the United States learn from Africa?
- "United States functions as Canada’s back-up medical system"
- Why more emergency departments are shutting down and becoming urgent care centers
{ 7 comments }
Agree with you on this, particularly the unfunded headache that is EMTALA, but dont’ know what the answer is.
Americans want 1907 prices on a 1997 salary. They want free healthcare, amazing tests, and revolutionary medications and treatments- all for free.
Maybe I am just trying to make lemonade out of lemons, but the much maligned malpractice system offers far, far more protection against government mandated rationing in my humble opinion.
Care is already rationed in this country by ability to pay. No matter what reform comes, however, the cost of care will always be an issue as it is even in countries that pay far less for care. This is not the problem. The problem is how we pay for this to get the most bang for the buck. As we add more services and professionals to the health care system, its price will go up. The decision making will continue to be a political football. If there are reduced barriers between patient and doctor perhaps treatment will not have to reach the confrontational stage. I notice that the private insurers are not mentioned in the above entry and frankly they are worse in ensuring services for people.
Two things most people ignore or fail to realize: 1. The emergency room is what provides universal medical care in the US, albeit very inefficiently. 2. Medical care is already rationed. If you are among the minority who pays your own way, you self-ration. If you use medical insurance, your medical care is rationed by the (private or government) insurance company. If you are uninsured with no money and use the emergency room as described in the blog entry, you won’t have access to non-emergency followup or preventive care.
The smarter hospitals won’t close down. They will simply opt out of medicare and other federal funds which will free them from needing to follow EMTALA. EMTALA is only a requirement for facilities that accept federal funds.
Large scale rationing will not work in America. The whole system is going to crash and burn. We are all going to end right back where we started before medicare. Except, in addition to your wallet rationing medicine, there will also be a high deductible insurance that functions as just insurance (not a guise to pay for everything).
Good points, Dr Green and Anonymous 11:21.
@Bad Medicine, Good Solutions – IIRC, Shadowfax and/or WhiteCoat discussed this topic during the UCMC ED dumping furor a month or two ago. The point was made that, if UCMC declined to accept Medicare/Medicaid pts, they would also have to give up federal funding for research grants, trials, and the like – meaning UCMC would essentially go out of business as a teaching hospital. It is my understanding that hospitals can open urgent care facilities that provide almost the same level of service as hospital EDs, but do not fall under EMTALA.
it’s possible that hospitals receive more in charity than they spend on emergency care for the poor
http://www.boston.com/news/health/articles/2009/05/31/much_is_given_by_hospitals_more_is_asked?mode=PF
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