Occasional reflections on Life, the World, and Mathematics


In discussions of market forces in health care, someone always points out that we don’t allow people to just die in the streets. Anyone who shows up in an emergency room must be treated (in the US this has been true since the Emergency Medical Treatment and Active Labor Act of 1986, I believe). Among the many other reasons why medical care does not respond to free market incentives, then, is the fact that the providers are not able to turn away customers who are unwilling or unable to pay.

But here’s what I’m wondering: This is always presented as an issue of basic humanity, or altruism. We can’t let the poor die of treatable injuries or illnesses because that seems too brutal. But is that the whole story, or even most of the story? My suspicion — and I’d have to go back to the debates on EMTALA to develop any clarity on this — is that the real reason we have a no-exceptions requirement that hospitals provide urgent care to the poor is that there’s a significant danger that the non-poor might be confused with the poor, particularly in times of medical emergency. Someone who has been hit by a car or has suffered a stroke and is disoriented is likely incapable of quickly identifying herself as an upstanding creditworthy citizen with health insurance. So the hospital is required to try to keep them alive long enough to allow them (or their relatives) to demonstrate that they are worth saving.

Which leads to a question: Supposing biometric databases become universal, and the hospitals are able to immediately ID anyone who comes through the door. Will we then relax the rules, and allow them to turn away the indigent, perhaps sending them off to some primitive alternative hospital for the poor?

Comments on: "Why don’t we throw people out of emergency rooms?" (4)

  1. I’m not sure what your point is, but here’s a thought. Even the guru of the free marketers, Adam Smith, was clear about how the mercantilism of his day worked: it required that people feel that they are being treated equitably by society (economic and social justice) and that their government was responsive (even if only in theory) to their needs. At no time did Smith assume or assert that the marketplace was the be-all and end-all of the social compact. Without regulation, the marketplace is a tyranny; it is anarchy unbound. The banks, insurers, Wall Street, and corporate American in general have instantiated this claim time and again. Looking at U. S. history, it’s reasonable to say that the free-market economy has failed us more than it has supported us. Without reasonable safeguards, it cannot work.

    • No disagreement here.

      My point is just that I don’t know if our rules requiring emergency treatment reflect a moral recognition of common humanity with the underprivileged, or just the self interest of the privileged in situations where they might be mistaken for the underprivileged.

      • Sorry if I misunderstood. Still, here’s a great opportunity for me to paraphrase the famous and witty physicist Richard Feynman. It doesn’t matter how brilliant your theory is, if it isn’t supported by experience, it’s wrong. This is by way of saying that economic theory is the least scientific of the “soft” sciences and is often out of touch with reality.

      • Again, no real disagreement, though I think I’ve developed more sympathy for the difficulties of economists in recent years. I don’t think they’re all arrogant and out of touch with reality. It’s just that the market fundamentalists, like all fundamentalists, speak the loudest for having the fewest doubts.

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