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View Diary: What you should know about health insurance industry lobbyists and their lies (276 comments)

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  •  Ok - I'll try again (3+ / 0-)

    In your initial post you raised the provision of the The Emergency Medical Treatment and Active Labor Act and said about this provision that:

    Right now, we do have universal health care in America -- it's embodied in the law that says that hospitals cannot turn away emergency cases. So, universal health care in America means that you can show up at your local emergency room and get seen.

    The thing is that EMTALA is not universal health care as emergent care makes up only a small part of the health care needs of a given individual or population.

    To understand a little more about EMTALA you can look here

    If you look in the FAQ there you will see that the statute says:

    Any patient who "comes to the emergency department" requesting "examination or treatment for a medical condition" must be provided with "an appropriate medical screening examination" to determine if he is suffering from an "emergency medical condition".
    If he is, then the hospital is obligated to either provide him with treatment until he is stable or to transfer him to another hospital in conformance with the statute's directives.
    If the patient does not have an "emergency medical condition", the statute imposes no further obligation on the hospital.

    This statute really cannot be considered in the same category as universal health care in the sense that most people mean it when they discuss universal health care.

    In reading through this latest question you pose I am beginning to see where you are headed with this:

    That is not the case in other countries. People get the care they need paid for by the government, without the necessity of having health insurance. So, my suggestion would be that another way to approach universal health care other than universal health insurance would be to greatly improve the quality and quantity of health care that one can receive for free paid for by the government

    In other countries where people get the care they need and it is paid for by the government there is a national health care plan that allows this. Those people receive health care that is paid for out of everyone's taxes.  Typically these types of plans are among the type of plan known as single-payer plans.

    I pointed out the difference between single payer plans and health insurance in my post to you above but to save you the time of scrolling up I'll point them out again here.

    Health insurance is designed to make profit and so it tends to exclude people who, for whatever reason, are assumed to be at high risk of actually needing health care.  Money paid in is removed as profit.

    Single-payer plans are designed to provide health care to a population of people and so everyone is covered.  Money paid into the system is used to maintain the system and provide health care.

    There are a couple ways to run a single payer plan.  One, which I don't prefer, is to call it national insurance and charge everyone for it as if it were just like a private plan with the profit motive removed.

    Another, which I do prefer, sounds more like what your're talking about.  This way allows everyone to receive medical care which is billed to the government.  The government pays for the health care out of a fund that is ultimately paid for by taxes.  No person would ever receive a health care bill or a bill for national health insurance.  People would pay more taxes but the burden of paying for health care would be equitably distributed based on income.

    This second method would still have administration costs because the government would still need to negotiate drug/procedure/provider visit costs with providers as well as make sure care was provided everytime a bill was received.  But I think the costs would be less.  The headache for patients would certainly be less.

    Is that answer closer to what you were asking?

    "The time for justice is always right now!" - Samantha Booke, Wiley College debate team, 1935

    by Edgewater on Sun Jan 25, 2009 at 05:40:02 PM PST

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    •  Yes, option number two is what I'm talking about (0+ / 0-)

      My point, however, is that we may be retarding our progress towards it by allowing the discussion to be so focused on universal health "coverage" or "insurance" to the exclusion of the actual real experience that people have of the "universal" health care that does exist. I fully agree that what we have in the way of universal health care in no way meets the definition of "Universal Health Care," but it is how people without health insurance access medical care and I don't see why it should be completely ignored in the discussion.

      In essence, I see two sides to the universal health care discussion. The one side focuses on finding a way for everyone to have health insurance, the other side involves improving the quality of care available for those who don't have insurance. All of the focus has been on the former for the past fifteen-plus years, but it is only the latter has actually provided medical services to those who can't afford it. Can we expect another fifteen of the same?  

      •  Agree that health insurance isn't the way (0+ / 0-)

        that's why in my first post to you I said "no one needs health insurance to live.  At some point or another most people will need health care to live, or at least to have a good quality of life."

        I agree you that the best choice for achieving universal health care in America is one which discards the idea of health insurance altogether.  I disagree with this point you seem to be making though:

        Aren't single payer and Medicare-for-all just more of the same: confusing health care with health insurance?

        The answer to this question is no - and this is what I was trying to communicate to you albeit somewhat incoherently since clearly you didn't understand this is what I was saying ;)

        Here is a good explanation of single-payer plans from Wiki:

        "Single-payer health care is the payment of doctors, hospitals, and other health care providers from a single fund and is one of the systems used with universal health care. The administrator of the fund is usually the government."

        "An approach to health care financing with only one source of money for paying health care providers. The scope may be national (the Canadian System), state-wide, or community-based. The payer may be a governmental unit or other entity such as an insurance company."


        A single-payer plan does not necessitate a national health insurance plan.  All it assumes is a single payer.  How that payment is arranged may differ from plan to plan.  And when I use the word plan I don't mean health insurance plan - I mean health care plan.

        I would disagree that the two sides of the debate on health care are focused on finding a way for everyone to have health insurance and improving quality of care for those who don't have it.  

        If you look in this thread you'll see many instances where people who have insurance are saying they cannot afford the insurance they have and that even though they have insurance they still don't have access to care.  I think people here, at least, are very clear that what they want is good access to good health care for everyone.  Insurance isn't, by necessity, a part of the equation.  This is a third side to the debate.  

        What the diarist has pointed out is a fourth side to the debate. This fourth side is the insurance companies who are fighting any change to the current system at all. I agree with the diarist that they are trying to find a niche in any national plan which is why in the middle of this thread I debated so vehemently against the idea that insurance companies provide health care and against the idea that providing access to health care is equivalent to providing health care.

        Many here already agree that the insurance model doesn't work well, involves too much paperwork, and places too many administrators between a patient and their doctor.

        I don't think the answer is to suggest as you did

        If everyone is going to be covered then why have a "plan" that needs to be administered

        The big problem we have right now is that our national solutions are provided only for the very poor, the elderly, and military veterans.  There is no national plan that takes care of everyone.

        I think the debate needs to be focused to:

        1. Eliminating private insurance companies as a legitimate source for channeling access to health care.
        1. Establishing a governement plan that covers everyone.
        1. Creating a system of payment based on taxation not the formation of a patchwork of health insurance policies that can be purchased from the government.

        I don't think we're going to focus that debate by claiming EMTALA is a form of national health coverage or by suggesting that we don't need a plan that requires administration.  We need to be clear that what we want is open access to health care for everyone that is paid for through taxes.

        Incidentally, the most clear form of single-payer coverage we have right now that is not in the form of health insurance is the Veteran's Administration, not Medicare or EMTALA.

        "The time for justice is always right now!" - Samantha Booke, Wiley College debate team, 1935

        by Edgewater on Mon Jan 26, 2009 at 04:06:13 AM PST

        [ Parent ]

        •  Thanks (0+ / 0-)

          I really appreciate the extended discussion. I think we're pretty much in agreement. I completely agree with your goal:

          We need to be clear that what we want is open access to health care for everyone that is paid for through taxes.

          But I still don't see that you've addressed my question of why not focus on the health care that is available to everyone that is paid for by taxes instead of the insurance that is not. Your VA example is another good one that I hadn't thought of. That's exactly the kind of thing I'm talking about that doesn't get discussed in all of the focus on expanding insurance coverage.

          •  I have addressed your question regarding EMTALA (0+ / 0-)

            if this is what you're referring to when you discuss "health care that is available to everyone that is paid for by taxes."  Perhaps this quote from Wiki will summarize EMTALA in this regard more clearly and show that this is not "free" care that is paid for by federal taxes:

            The cost of emergency care required by EMTALA is not directly covered by the federal government. Because of this, the law has been criticized by some as an unfunded mandate.[4] Similarly, it has attracted controversy for its impacts on hospitals, and in particular, for its possible contributions to an emergency medical system that is "overburdened, underfunded and highly fragmented".[5] More than half of all emergency room care in the U.S. now goes uncompensated. Hospitals write off such care as charity or bad debt for tax purposes. Increasing financial pressures on hospitals in the period since EMTALA's passage have caused consolidations and closures, so the number of emergency rooms is decreasing despite increasing demand for emergency care.[6] There is also debate about the extent to which EMTALA has led to cost-shifting and higher rates for insured or paying hospital patients, thereby contributing to the high overall rate of medical inflation in the U.S.


            If you read that quote you see that what EMTALA really does is force hospitals to provide emergent care, charge the patient for that care, and then write off the debt if the patient cannot pay.  This has resulted in a net decrease in the availability of emergency care which was an unanticipated outcome of EMTALA.  

            EMTALA is not a model for national health care - it is a model for an unfunded mandate that has had serious detrimental effects on the health care system.

            If instead we focus on the VA as a source of care that is available to everyone that is paid for by taxes then we run into a couple of problems IMO:

            1. The VA system, fairly or not, has been badmouthed to the point where many people think of it as a bad thing rather than a good thing.
            1. The VA system itself is a "perk" given for military service that often puts individuals in harm's way and so, philosophically speaking, is not quite the same as providing free care to a larger class of individuals many of whom are not risking their life for their country.  In this sense, the VA can be seen as a reward for being willing to make the ultimate sacrifice for one's country and doesn't serve well as a model for providing care to our weakest, least able citizens.

            I think the best focus is similar to what ncyeve is doing in this diary.  This focus is on how private profit-driven insurance is decimating our health care system, leaving millions without coverage, costing the system enormous amounts of money for ever-increasing paperwork, and taking money paid into the system as profit while providing no care.

            This focus needs to be expanded to address how insurance plans themselves cause needless paperwork, headaches for patients, and extra cost.

            This would be a good start.  

            "The time for justice is always right now!" - Samantha Booke, Wiley College debate team, 1935

            by Edgewater on Mon Jan 26, 2009 at 04:30:38 PM PST

            [ Parent ]

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