A crucial issue in the debate about the health insurance mandate is the cost incurred in providing life-saving medical care to people unable to pay for it. If not for this cost, there would be no case for the mandate.
My question: what are the details of the laws requiring such care to be provided? Are they state? Federal?
Who do they apply to: doctors and nurses? Hospitals?
Also important, when were such laws passed? And what was the status of such laws at the time the Constitution was drafted? Would, say, a Philadelphia surgeon have been required to perform whatever life-saving procedures there were at the time on an indigent person who showed up at his doorstep?
Finally, what are the legal issues regarding a person’s ability to “opt out” of such a law. IANAL, but I understand that a person cannot simply declare such things in other arenas. E.g., a suicidal person can’t make his homicide legal by signing a document saying he wants to die.
You can see the debate this leads to on the constitutionality of the PPACA, but I ask that this thread be kept in the realm of GQ. TIA.
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.
Specifically, Emtala as I quoted above is a requirement of medicare/medicaid participating hospitals. Virtually any hospital in the US needs to accept medicare payments to survive financially except a VA hospital or a hospital like Shiners Hospitals for Children.
Well National Minimum Drinking Age Act tried to force states to not lower their drinking age. There’s no attempt to coerce states under emtala. It’s simply a requirement of private hospitals wishing to participate in the Medicare program. The Department of Health and Human Services runs Medicare - it only follows that the government, through HHS, will impose rules on participating hospitals.
Medicare spending in 2009 was over $500 billion or 20% of the national expenditure on healthcare. There aren’t realistically any hospitals that could even consider surviving without medicare simply to avoid providing emergency care to the uninsured.
But technically yes it’s a requirement only of medicare participating hospitals.
That’s correct but note that F. U. Shakespeare specifically asked about requiring** life-saving care** regardless of ability to pay, so it’s directly on point to what he asked about.
Fuzzy is correct - I’m interested in anything life-saving, although svd678 is also correct that this includes both emergency and ongoing care (and the cited law only requires the former).
My gut feeling is that these kinds of laws probably existed before 1986. I know that comment doesn’t really belong in GQ, but a bump is a bump.
I’ll just chime in by saying that at common law, you don’t owe a duty to anyone to whom you didn’t harm. That’s still true today. A regular citizen can walk by another citizen lying on the ground with blood gushing from him beginning for help, and Mr. Regular Citizen can just keep walking without suffering criminal or civil penalties. (I believe a couple of states added laws a few years ago saying that you must at least call someone).
But in addition to that, I’m sure that doctors, nurses, and the like have duties to their licensing boards that would get their licenses yanked if they did such a thing.
I would just WAG that before the middle part of this century, there were no such laws and none were needed. In the 1980s, there were probably a few horror stories of renegade doctors that turn away patients at the door who went home and died. Then Congress, (checks forum) responded with the law.
General observation: Every doctor I know says that he is required to stop and give aid if he sees a traffic accident or someone in trouble. If that is true, then why could that same doctor, without the law, toss someone out of an emergency room door?
IANAD, or a lawyer either. But might the distinction hinge on what a doctor can provide with his/her own abilities and resources, and what a hospital or other facility can do? E.g., a doctor happening upon a stroke victim can help some, but shouldn’t be expected to have a respirator handy.
I actually don’t think this is true (that doctors must stop and give aid). I may be wrong, but could some one provide a cite if it is correct?
ETA: I realize this could be part of a contract for a particular type of medical work, but I have never heard about it as a general rule for health care providers off duty.
Ok, here is a scenario. I will state what I think is the case, but I am open to correction if wrong. Suppose you go to the emergency room of a hospital with a heart attack. You will get immediate treatment and be told that you need an immediate bypass operation. They will then discharge you and you are on your own.
You can’t be discharged until you are medically stable. If you are having a heart attack you are not medically stable.
Say you walk into my ED with a heart attack. For the sake of simplifying the scenario lets say it’s a STEMI so it’s immediately obvious that you’re having a heart attack. My hospital happens to be a heart center so I write orders for the medications you need now and call cardiology who will take you for a cardiac catheterization to try and open up the blocked artery in your heart. After than you go to the Cardiac Care Unit where they monitor you to make sure that there are no complications from the cath, you don’t have another heart attack, etc. While you are in the hospital the social worker comes and starts you getting signed up for charity care and any government programs or whatever that you are eligible for. Assuming you have no complications during your stay you are discharged after a few days with prescriptions for any medications you need and follow-up instructions.
In the specific case of stomach cancer, most instances where you would have abdominal pain severe enough to send you to the ED, you would already have a very advanced cancer with little chance of long-term survival, even with treatment. So, typically you would require some type of stabilizing treatment (perhaps chemotherapy), which EMTALA would cover, but only to the point of getting you to a stable medical condition where they could discharge you.
If surgery were required in order to stabilize, they would perform it.
Rather than postulating vague scenarios and "what if"s, it might be easier to just look at any of several websites that break down EMTALA and elaborate on the types of treatment that are required to be given.
The basic premise is emergency treatment and stabilization, so I would be incredibly surprised to find chemotherapy covered under EMTALA, but emergency surgery to treat any number of complications from cancer certainly would be.
From personal experience, what I can say is that, while you may get emergency care in a hospital under these laws, in California at least, there will be an effort made by the hospital to recoup their expenses from you. You will be asked to provide information such as SSN, full name and address - once they have that, they have you over a barrel. You will be billed and if you fail to pay, or to honor a payment arrangement, they will turn the matter over to a credit agency, etc, etc. So you will pay in the end.
By the way, this emergency care in no way is a substitute for regular preventative medical attention and checkups. No one except the rare local free clinic will give you that. Even the ones that do, check your assets and bill you accordingly.
So - if you are totally without income and resources, there are means to look after most of your medical needs. If you are, like me, receiving the benefit of a pension but without health insurance, you are going to pay and pay for your medical care until you have nothing left and are without income and resources. And remember - you can only declare bankruptcy once every seven years, so incurring a big medical bill and then writing it off in bankruptcy is not a “plan” that works only once…and as you get older your medical needs are unlikely to work on a 7-year schedule.
So for those who are claiming that there is really no need for universal medical insurance, I beg to differ, because “Obamacare” would have done nicely for me until I am eligible for Medicare; and would have been even more useful to my wife, who cannot afford medical insurance either, and won’t be eligible for Medicare for almost 10 years.
Just my two bits, I welcome your own comments.