I've had it with the looney-Right and their standard bearers repeating a LIE endlessly, in person, on radio, on TV... anywhere they can flap their lips and repeat it is just one more place too many.
What is the Big Lie about Healthcare?
You've heard it from all the major players, including the Clown Car boobies who are still in the GOP Primary, like Mitt Romney (still holding on to his 'likely nominee' title).
The lie: If you are sick, you can go to a hospital and receive healthcare, even if you have no money.
Now, there are lies and damned lies. This is most definitely the latter.
Below the Fleur-de-Kos for the skinny on the Big Lie...
So, before 1986 there was a big problem in These United States when it came to Healthcare in hospitals.
Turns out, sick people - even dying people - were arriving at hospitals across the land, and being turned away or even dumped on another facility.
Why? Because hospitals were not required to treat anyone who showed up sick, just the patients who could or would pay them. This is, after all, America the land of Free Market Capitalism, right?
So the United States Congress decided, in 1986, to put a stop to this inhumane treatment of sick and dying poor Americans who managed to get themselves to any hospital Emergency Room which accepts and treats Medicare patients.
Signed into law by none other than President Ronald Reagan, the EMTALA (Emergency Medical Treatment and Active Labor Act) was part and parcel of the 1986 Omnibus bill known as COBRA.
And in direct opposition to what Republicans of all stripes claim to be true about hospitals and sick people with no money - this bill does not require that a hospital treat you if you show up at their door sick.
What are the facts about this much ballyhooed and completely false claim by the Right?
Wikipedia has a great entry on this, but I'll link to the CMS (Centers for Medicare and Medicaid Services) and the American College of Emergency Physicians, mostly, in this post.
Here is the CMS short version:
In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual's ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented.
Here's the one from Wikipedia:
It requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions. Participating hospitals may only transfer or discharge patients needing emergency treatment under their own informed consent, after stabilization, or when their condition requires transfer to a hospital better equipped to administer the treatment.[1]
Congress passed EMTALA to combat the practice of "patient dumping," i.e., refusal to treat people because of inability to pay or insufficient insurance, or transferring or discharging emergency patients on the basis of high anticipated diagnosis and treatment costs. The law applies when an individual with a medical emergency "and a request is made on the individual's behalf for examination or treatment for a medical condition."
From the American College of Emergency Physicians:
EMTALA requires Medicare-participating hospitals with emergency departments to screen and treat the emergency medical conditions of patients in a non-discriminatory manner to anyone, regardless of their ability to pay, insurance status, national origin, race, creed or color.
Now, there is a muchness to the three short versions of what EMTALA is, but there is something in the Wikipedia entry which you won't really find in the other two (unless you open and read through a bunch of links at the CMS, which does, in the end tell the same tale).
The Wiki entry also has this:
An emergency medical condition is defined as "a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual's health [or the health of an unborn child] in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs."
That right there is the key to the Big Lie.
Just being "sick" is not enough to receive treatment - although every person who presents at a hospital ER which accepts and treats Medicare patients, under EMTALA, is required to be "evaluated" as to whether or not their condition is an Emergency Medical Condition. If it is determined to be an EMC, the hospital MUST treat the person - but only until they are stabilized or able to be discharged for self-care.
What happens if the person's condition does NOT meet the EMC requirements?
Depends upon the hospital.
Some will still treat the patient, even if they only have the flu or a minor injury not requiring sutures. But under the Law, the patient is responsible for the bill - I highly advise NOT going to an ER for flu symptoms, the bill will give you a stroke when it shows up a couple of weeks after you've recovered from the flu! Go to an Urgent Care clinic or your local Public Health office (many counties have at least one doctor or PA (physician assistant) working at this office who sees those with no other healthcare options).
Some will advise the patient to seek care at an Urgent Care or at the office of their Primary Care Physician (PCP). Hah. Like poor people going to an ER for treatment for the flu have a PCP or can afford an Urgent Care clinic visit (last time I went to one was over six years ago, and the 15 min visit cost $75 back then, I haven't a clue what they cost currently).
Nevertheless, it is clear that the Republicans are LYING each and every time one of them says:
"The United States already has healthcare for the poor, we don't need to fix this system. If you are sick, you go to the hospital and you get free care. They have to treat you. But it costs the rest of us, because they charge us more to make up for that free care."
The ONLY thing true there? Yeah, the hospitals charge everybody else more for the uncompensated care they are mandated to provide to those in dire need of assistance. But the poor patients who receive this care? For them, it is not free, unless the hospital in question has a "charity" fund and screens uninsured patients and pays their bill (or part of it) out of the fund. The poor, uninsured patient, who in all likelihood works at a shitty minimum wage job? That patient will probably make too much to qualify for a reduction in the charges - and eventually, the debt collectors will be hounding the patient until hell freezes over to pay the bill and all of the added interest and fees which have accumulated in the meantime.
The takeaways?
1. Republicans are liars (but Al Franken told us that back in 2003, and most of us already know it).
2. Hospitals have to EVALUATE everyone who shows up and asks be seen for treatment.
3. Unless you are having an officially recognized "Emergency Medical Condition", they can tell you to go somewhere else for care (and generally do so).
4. ERs are also sick of Republicans saying this, because they just end up with more and more poor folks looking for that "free care" for their kid's flu or their twisted ankle or their migraine headache - all of which seem pretty "emergency condition" to the patient and their families, but don't meet the standards the hospital uses to determine if they have to treat them or if they can send them elsewhere for care.
5. Please, every time you hear this Big Lie, tell whomever is near you the truth about EMTALA.
6. Republicans are liars. *(yes, I know it's a repeat, but some things need repeating and this is one of them)
From the comments, by LI Mike:
I am a former hosp administrator and worked with EMTALA for years.
Yes, the Republicans are full of it.
I worked at a safety net hospital, but we still billed uninsured patients for their ER visit. We did have a sliding fee-scale program. So, if the patient returned with proof of income we'd match it to our sliding fee chart and discount the bill accordingly. Not every hospital does this.
More often than not, however, indigent patients just don't follow up with billing notices. In NYS these unreimbursed expenses are made almost whole by a mechanism known as the bad debt and charity care pool. I.e., a % of revenue from every hospital in the state is pooled and then sent to hospitals based on a need formula.
Sort of a Karl Marxian set up -- from each according to ability to each according to need.
Just one of many mechanisms throughout the USA to keep health care provider doors open for the bad debt and charity care incurred.
The major problem though, is that patients w/o insurance use the system haphazardly so you have situations described by Dr Teeth above. ERs are geared for emergencies and cost a lot.
Many ER patients don't follow up with post discharge med advice, their conditions worsen and they wind up back in the ER, or worse, are admitted.
A system with everyone covered lends itself to some rational provision of services. If you have a chronic condition you can get it stabilized by routine visits to a clinic, or by faithfully following a care regiment outside the hospital.
That is why we see those health stats from other industrial countries with per capita costs 1/2 of our costs and outcomes so much better. With everyone in the system, the system works much better.
FROM THE COMMENTS:
Please see this post by sbwoodside for examples of what is NOT treated under the EMTALA at Emergency Rooms
