Sunday, September 27, 2009
We will treat them
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Steve Huff
Huff lives in Patrick County and practices family medicine.
Entrenched in anti-tax, anti-immigration and anti-entitlement ideologies, conservatives have a simple answer to health care reform: No. There's one question, however, that stymies even the most fanatical ditto-head.
What will you do, doctor, when a man who speaks poor English shows up in your emergency room clutching his chest? What about the panicky uninsured woman holding a listless baby? What about your deadbeat neighbor who has simply run out of his diabetes pills?
It's a dilemma unique to America, both unfortunate and unnecessary. Other developed countries promote primary care (family doctor, internist, pediatrician) as the portal of entry into the system. In this way problems can be more easily prevented or minimized.
Uninsured Americans rarely can afford a primary care provider. The going estimate of 46 million uninsured Americans ignores the 25 million underinsured whose co-pays are too high, deductibles are prohibitive or coverage too weak. One in five American citizens goes without regular, reliable health care.
If it weren't for the Emergency Medical Treatment & Labor Act of 1986 those patients might be out of luck. That law forces most emergency rooms to at least take a look at anyone who comes in the door, regardless of ability to pay. (The sad thing is that someone had to write a law like that in the first place.)
Aside from the ER, there are free clinics bursting at the seams, a smattering of government-subsidized clinics, alternative medicine providers, prayer trees, half-empty bottles of antibiotics from your grandma's cabinet, natural supplements from the Internet -- or just toughing it out. When these options fail, the medically underprivileged head to the ER.
The visits are not free. The privileged majority -- those of us with jobs and insurance -- pay for them indirectly through premiums, deductibles, co-pays and taxes.
In the Democrats' new health care proposals, who will pay for the uninsured? The same privileged folks cited above.
That is why one conservative ideology -- that responsible taxpayers should not foot the bill for deadbeats and illegals -- is ludicrous. Responsible taxpayers and policyholders are going to pay in one form or another whether they know it and whether they like it.
The only way conservatives can get past this ideological quandary is to repeal EMTALA and replace it with what I'll call the Medical Bouncer Act: Someone will have to stand in the parking lot of every ER in America and require each patient to show proof of citizenship and ability to pay.
Undesirables will be removed from the premises irrespective of their ability to walk, breathe or tolerate pain. This will be done quickly and out of sight of the health care staff, because no one in the health care profession, I hope, will knowingly refuse care to a needy individual.
The day medical bouncers return to America is the day I yank down my shingle and head for the border. In all my years and travels, I have seen no other country where an ill or injured citizen must sell his assets and set up pocket change collections at local businesses to stay out of bankruptcy. All developed countries in the world except the United States cover all their citizens, at lower cost and with better outcomes.
This year we could join them. It will require a choice: Should we continue to pay top ER dollar for everything from common colds to avoidable medical catastrophes, or can we begin to pay primary care prices at the beginning of illness, or better yet, before illness occurs?
Even cold-blooded economists agree that massive change must occur. Along all these lines President Obama has done his homework. His ideas are solid, vital and urgent. If Senate Democrats must take drastic parliamentary measures to avert a Republican filibuster, so be it.
It boils down to this: When the last Barack O'Hitler poster comes down and the final unruly congressman dabs the spittle from his chin, we still will have sick and needy human beings: citizens, illegals, insured, underinsured, uninsured. One way or another, we will treat them. One way or another, someone will pay.
