There are only two arguments about the health insurance package of regulations, HCRA, that passed last year.
Financially, either this law is intended to reduce the expense on each person, on average, of the fastest inflating cost sector of our economy, or it is an attempt to bankrupt the nation by "nationalizing health care."
Legally, this is either a standard regulation issued by Congress under the 'Commerce Clause' of the Constitution, or the imposition of dictatorial power over the citizens of this great nation, and over the great states that should have the right to nullify this law.
I'd like to look at it a little differently.
I'd like to say a magic word, an incantation over this argument, to see if I can change it into something else.
Here's my magic word.
Emtala!
I see two parts to the actual problem of medical care in this country, the actual problem being it costs too damned much to get medical care in this country.
These parts are mirrors of each other: no one wants to be required to pay for it, but everyone is already required to pay for it.
Hunh?
First, as a nation, we're doing exactly nothing to bring down costs. No wonder so many people not only do without insurance, they do without care. "I'll ignore it. It'll go away."
But the other is that, as a nation, we're required to provide, and pay for, emergency care for anyone who walks into any emergency room and asks for it. Even if the emergency room determines the person doesn't need service, it's required to have a medical professional make that determination. And it costs money to know when to say 'No.'
Emtala!
I kept wondering, is it true that the law that now says that in 2014, if you don't have medical insurance, you could be fined, is constitutionally void? Not because it manages commerce but because it forces commerce onto everyone, requiring them to buy something from an insurance company?
Because if that's the case, then something else is unconstitutional.
Something that even that great constitutionalist, George W Bush, has held up as a shining beacon of our health care system.
Because it, too, requires each of us to buy something from a private company, usually a hospital corporation, but often a doctors group, an emergency transportation service, or some other provider involved in emergency care.
And it is...Emtala!
The Emergency Medical Treatment and Active Labor Act, included in the Comprehensive Omnibus Budget Reconcilaition Act of 1986. The EMTALA of COBRA, if you will.
It codified and federalized the requirement to provide, to anyone who comes to an emergency room, (or maybe just within 250 yards of it,) all medical care needed to stabilize the person's condition, whether needing emergency care or in active labor. All this without regard to ability to pay. In fact, the prices of the services may not be discussed, due to the impact they may have on the person's willingness to receive service.
While all other civilized nations debated the moral obligation of universal health care, and decided in favor of it, our recent arguments have been exclusively about costs, and who should bear them.
Perhaps it is because we had our discussion on moral obligation back in 1986, when we decided, as George W Bush pointed out, that everyone has coverage. We as a nation required ourselves to pay for the emergency rooms provided by public or private hospitals and clinics across the country. Without asking what that cost might be.
Oh, the providers may try to bill the actual patients after the fact. Impose a financial debt on the newborn, or send the dying off with one last sheaf of bills. They may even make a good case for bankrupting a family whose child was in need. But ultimately, we are the guarantors of those debts. Each and every one of us has been forced into a financial transaction with a commercial institution, with our consent, because EMTALA was passed by our federal representatives, just as the HCRA was.
Maybe we should have linked HCRA to EMTALA explicitly. Because if one is unconstitutional, they both are. If one goes down, the other does, too.
Then, anyone who doesn't want to buy health insurance would be assured of not being a burden at the emergency room, since emergency treatment, like all medical treatment, would be based on ability to pay. Show your insurance card or go die in the parking lot.
And, since the emergency room could post its prices, any mother, as a sharp-eyed American consumer, could shop her son's broken arm or her daughter's bursting appendix around to the most cost-effective emergency room.
After all, isn't the best way to bring down costs to make everyone pay their bill?
