I have struggled with the question posed to me by numerous people over the last several years. “Do you believe health care is a civil right?” In the U.S. this is a key question. We have long had a law in place (EMTALA) that mandates that any hospital emergency room that accepts government payment for services, i.e. takes Medicare or Medicaid payments, must provide emergency care for anyone who shows up regardless of their ability to pay. This sounds like the government feels all persons in the U.S. have the right at least to emergency care. Because of this regulation emergency rooms have become the primary care providers for many Americans. If you cannot afford health care all you need to do is show up at an ER and you will receive at least urgent types of care. The cost of this uncompensated health care is made up by those who do have a way to pay for their own emergency care being charged higher rates. In essence the law mandates that everyone has a right to health care and that those who can afford health care must pay for the emergency care of those who cannot afford it themselves, a type of behind-the-back mandate.
It is difficult to argue that receiving all of your health care at emergency rooms is serving anyone’s best interests. Patients get at best piecemeal and intermittent care. The costs of any single episode of treatment in an emergency room is far higher than at a primary care office. Continuity of care does not happen at emergency rooms, because by definition ERs are for emergencies, not ongoing disease management or preventive care services. So what has been happening in the U.S. for years is lousy primary care in emergency rooms under government mandate to provide it paid for by everyone else who pays health insurance premiums or pays for their own emergency care.
So after considerable thought, perhaps spurred by the recent Supreme Court ruling upholding the constitutionality of the Affordable Care Act, I have concluded that unequivocally yes, I do believe that health care is a basic civil right in the U.S. Although there has not been a court ruling or a constitutional amendment clearly upholding that right, I believe we as a country are nearing the time when we need to openly face this fact. As the most powerful, arguably the wealthiest, and hopefully among the most compassionate nations on earth we need to face our civic responsibility and find a way to provide health care to all of our citizens.
How to meet this responsibility is very much open to debate. It seems that unlike every other first-world country we are not ready to have a single-payer system yet. Neither political party seems ready for this, and I don’t hear any widespread grassroots outcry for a single-payer system. So what do we need? We need our elected legislators and president to govern. We as citizens need to demand that our elected leaders stop the partisan bickering and posturing and govern.
I remember even 20-30 years ago our leaders somehow found ways to compromise and find common ground from which to make progress toward trying to solve problems. Now it seems that our elected leaders are so focused on pleasing elements of their political parties that they cannot risk even trying to find areas of agreement on which to base legislation and compromise.
It seems that it is more important to politicians today to make their opponents look bad than to risk sharing credit for good policy. Is this just a pipe dream? Will it take a yet more eminent fiscal crisis to force our elected leaders to take the needed risk and find a way to get this done? Probably yes, but it is likely to be sooner than anyone expects.
I also understand that healthcare is just one of many pressing crises facing the U.S. Still it seems like one where it should be possible for our leaders to find solutions on which members of both parties can agree, and where we can expect progress acceptable to elected leaders of both parties. We just need them to stop fearing the radicals in their own parties more than they fear doing nothing in the face of crisis.
Let’s all tell our elected officials that if they don’t begin to find ways to put the needs of our country, states and cities ahead of partisanship that we will never vote for them again, and will keep electing new people until we find ones who will try to govern with courage and compassion.
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On a somewhat related topic I enjoyed reading the commencement speech by Donald Berwick MD to the Harvard Medical and Dental Schools graduating classes this May published in JAMA.
To Isaiah
By Donald Berwick MD, MPP
June 27, 2012
Thank you for letting me share this glorious day with you and your loved ones. Feel good. Feel proud. You’ve earned it.
In preparation for today, I asked your dean of students what she thinks is on your mind. So, she asked you. The word you used—many of you—was this one: Worried read more
Sue,
Did you read the article? The reason your ER bill was so high is because the burdon of the uninsured is falling to everyone already. And even though you had a small write off, billed and now are in a payment plan you already received your care and someone else payed for it (maybe you will pay it back someday?) if it wasn’t for EMTALA you would have been turned away? You are the exact reason we need the affordable healthcare law even if you think you can’t afford it, I cannot afford to pay for your ER visit if I need to go to the ER
Wow. I sit to comment to this, and I’m finding myself at a loss for words.
“Amen” is the first thought that pops into my head, with regards to your blog, and then I read ‘Isaiah’ and I find tears in my eyes.
Both are thought provoking and full of compassion, and as a school counselor, I’m often met with some of these same barriers in real life human beings who try so hard to do the right thing.
Thanks for these thoughts to ponder….
I agree that health care is a civil right. However, I don’t see EMTALA as guaranteeing that right regardless of whether the patient can pay. Hospitals and their emergency rooms do not seem to understand that there is a large portion of Americans (I call them the ex-middle class), upon whom most of the tax burden falls. Therefore, since we provide a significant portion of tax dollar to pay for the healthcare of others (through Medicaid and Medicare and, of course EMTALA itself), it leaves us no income to pay for our own healthcare. And as far as “free” emergency care goes, at least in the area of the country I live in, EMTALA be damned. Right now I am paying down a $3200 emergency room bill (which the hospital magnanimously reduced from $4500)at $3.00 per week. How ridiculous is that, that my income is “too high” to qualify for free care, so they set up a payment program that will take nearly 267 years to pay off? Add to that that I did not receive several of the (expensive) tests that the MD recommended, simply because we both knew I could not pay for them, and the matter becomes outrageous.
Politicians are equally ridiculous. The problem I see with the Obama health care plan — or should I say the Republican-befuddled Obama health care plan, which lost much of its effectiveness when the public option was politically removed — is that it contains no provision for the ex-middle class, who, mandated or not, still cannot afford to pay insurance premiums but will no doubt continue to be heavily taxed to support public welfare programs that provide healthcare to others. This, again, is ridiculous. Add to that the no-doubt hefty penalty (“healthcare tax”) with which we will be saddled, it, too, becomes as outrageous as the failed EMTALA.
Excellent article! Triple A.