Wednesday, February 9, 2011

Give me Liberty, or give me Health Insurance!


Great horny toads! Steve, stay where you are. I'll be over as fast as I can with a priest to exorcise the spirit of Patrick Henry...

Before I get to the meat and potatoes, a few appetizers:

FIRST: "Obamacare"? Please. For Pete's sake, If you insist on using pejorative portmanteaus, at least have the courtesy to call it Romneycare, inasmuch as Romney's Massachusetts plan is the model on which the Affordable Care Act was based.

SECOND, you say: "...the "you've got to buy car insurance" argument is bogus.". Well no, no it isn't. You may not like the law in this case, but the 1986 Emergency Medical Treatment and Active Labor Act (the EMTALA) requires: "...hospitals and ambulance services to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay." And, "There are no reimbursement provisions."

The argument here is neither tenuous nor hard to understand. On account of the Emergency Medical Act, anyone who can and yet fails to obtain insurance is receiving a tangible benefit at no cost.

Consider Joe Blow: a man of average means who decides not to get health insurance because, well, he's healthy as an ox. One morning while Mr. Blow is crossing the street he gets hit by a car. Subsequently, he's rushed to the nearest hospital, where (thankfully) he receives a quarter million dollars in emergency medical care. Think I'm exaggerating the costs? Nope. My neighbor's health insurance company has thus far paid out over 150K for the surgery and complications resulting from the accidental severance of the tip of her little finger.

Don't worry, Joe's doing fine. But who pays the quarter mil? Not Joe. Heck, he can barely afford to make his house payment. So its the ambulance company, the hospital and the doctors who wind up footing the bill.

But not really Steve. Actually they just jack up their prices to cover the cost of having to take care of people like Joe. That means the insurance company pays more, which means you pay more. Which ultimately means the Federal government, charged with regulating the insurance industry (via the commerce clause), must find a reasonable means to plug this leak in the bucket. Ergo, the Individual Mandate.

So, I submit your real problem is not precisely with The Affordable Care Act, but with the EMTALA. Now think carefully here. Suppose that in Joe Blow's case, there was no EMTALA.

OK, Joe gets hit by a car, somebody calls the cops, the cops call an ambulance company and the ambulance company determines Joe isn't insured and can't afford their service. All of a sudden the ambulance company decides they've got a cake a'burnin in the oven and and can't pick the poor guy up. So the cops (or some tidy citizen) just pushes Joe off to the side of the road where he just bleeds out.

Steve really, seriously, do you think that's going to happen in the U.S.of A.? I mean, do you honestly believe a majority of voters, including yourself, could stomach that? Do you believe if Steve Green himself was a dispatcher at an ambulance company, or an emergency room doctor, or an administrator at a hospital... Do you believe that Steve Green could turn away a person in need of life saving care just because they didn't have the ability to pay for it? Come on man!

But, and here's the kicker, you're going to have to find people capable of making these kinds of decisions and living with them if you are seriously advocating the repeal of the Emergency Medical Treatment Act (which again, is entirely the onus for the Individual Mandate). Frankly, I don't think I would want people like that anywhere near our health care system - you wouldn't either.

THIRD, OK, yes, I've come around to the opinion that the individual mandate is not a very good idea. And my objection to it has nothing to do with the constitutional issue. To be blunt, I've come to believe the individual mandate is simply the only option the health insurance lobby would allow their trained monkeys in congress to vote for in - and as such it constitutes a sell-out of greater magnitude than another recent sell-out: The Medicare Prescription Drug Benefit. In essence, all the individual mandate is really doing is funneling more money to the private health insurance industry while the issues of high cost and poor service continue to fester. Let's wrap this up.

Steve, we live in a wealthy country, presumably filled with smart, able health care professionals and pharmaceutical companies. Yet despite these advantages, our health care system has become an international laughing stock. I wish I could think of a way to conclude this post with some kind optimism, but I really can't. Truth is, conservatives and liberals both have good ideas on how to solve this problem. But these days the only way you can get elected is to claim your side has all the answers and the other side has none - which makes finding the middle ground virtually impossible.


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