Challenge the constitutionality of EMTALA

Here is a letter to the editor in a recent Philadelphia Inquirer:

… In 1986, Congress passed and President Ronald Reagan signed the Emergency Medical Treatment and Active Labor law, which requires hospitals to admit all who arrive at the emergency room and treat them without regard for their ability to pay.

In essence, we had federally mandated national health care – signed into law under a Republican administration. What we did not have is a rational way to pay for the mandated health care.

Those who seek to repeal the federally mandated insurance requirements in the health-care law should also seek to repeal EMTAL[A], a deeply immoral proposition if I ever heard one….

Hear, hear! Riddle me this, Batpersons: how come no one ever challenged the constitutionality of EMTALA? Is it some kind of truism in American politics that Ronald Reagan could do no wrong? I suppose it would be pretty difficult politically to try arguing a position where you’re basically advocating throwing laboring women out onto the streets if they can’t pay. No one, not even a politician, wants to appear that heartless. So they went and essentially enslaved hospital emergency departments, forcing them to provide services without any guarantee of payment. Immoral indeed!

That’s just the tip of the iceberg. Most Americans seem to feel that the Hippocratic oath — few, if any, of whom have actually read it — somehow compels the rest of us doctors to do the same thing. You wouldn’t believe how indignant some people get when they discover that I expect to be paid cash money for my time and expertise.

But medical care is important, especially in emergency situations. We as a society refuse to condone the heartlessness of letting the seriously ill and injured suffer without care just because they happen to be without financial resources.

Oh yeah?

Hunger is rampant in this country as well. It should be morally unacceptable for anyone in this great nation of plenty to starve to death. So why hasn’t anyone proposed the Emergency Feeding and Maintenance of Adequate Libations (EFMAL, pronounced “Eff ‘em all”) Act, which compels restaurants to serve anyone who walks in the door regardless of their ability to pay? What’s that, you say? Restaurants are in business to make money? It’s unconstitutional to make them give stuff away?

Makes about as much sense as forcing emergency departments to provide uncompensated (that means “free”) care. It’s no way to run a business, unless by “running a business” you really mean running it into the ground. Could that really happen? Look around: plenty of recent ER closings in the news.

So to all those politicians looking to repeal the new health insurance reform legislation, how about a little moral consistency. Dump EMTALA while you’re at it. Then again … what am I saying? “Politicians,” “morality,” and “consistency” all in the same sentence? Forgive me. I think we may have more luck with my restaurant proposal. After all, this Congress sure seems poised truly to “EFMAL.”

Lucy Hornstein is a family physician who blogs at Musings of a Dinosaur, and is the author of Declarations of a Dinosaur: 10 Laws I’ve Learned as a Family Doctor.

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