Why don’t we throw people out of emergency rooms?

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?

World’s Greatest Healthcare, ctd.

Addendum to my earlier post on US health care. Impressions from a friend’s trip, thankfully not an emergency in the end, to the emergency room of Children’s Hospital in Oakland:

  1. It’s not just the general practitioners in the US who are not very competent. So, a child being examined to exclude appendicitis is given a popsicle — presumably for hydration and glucose — by the intern. A bit later, he wants to give her IV fluids. Why can’t she just drink water? In case it is appendicitis, she shouldn’t take anything orally. Oh yes, I probably shouldn’t have given her that popsicle… I’m sure the microneurosurgeons in the US are first-rate, though. Continue reading “World’s Greatest Healthcare, ctd.”

World’s greatest healthcare (TM)

What does it mean when a US politician like Chris Christie tells the Republican National Convention the US has “the world’s greatest healthcare system”? Is it like when kids buy a “World’s Greatest Dad” mug for Father’s Day: An expression of affection for an ill-favoured thing, but mine own?

One of my formative political experiences was the summer during graduate school, when I listened on the radio to broadcasts of the US Senate debating the Clinton healthcare proposals. What struck me above all was how the senators universally (it seemed) invoked the unmatched excellence of American health care. “The envy of the world”, “best health care in the world”. The only difference of opinion was, of course, that opponents of the reform said that tinkering with this paragon of perfection would inevitably be disastrous, while supporters argued for making this blessing available to more people.*

So, the politicians certainly appear to believe it, and to believe that it should have policy implications; or to believe that a significant portion of the public believes it; or to believe that a significant portion of the public will respond favourably to the assertion, even if they suspect it is untrue. Is it cognitive dissonance? We’re America dammit, and being the sort of people we are, we certainly wouldn’t put up with a ramshackle healthcare system.

Continue reading “World’s greatest healthcare (TM)”