# No health insurance = left to die? **URL:** \ **Category:** Factual Questions\ **Created:** [February 24, 2004, 8:39pm UTC](https://boards.straightdope.com/t/no-health-insurance-left-to-die/230973 "2004-02-24T20:39:24Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![Capt.Ridley\_s\_Shooting\_Party](https://avatars.discourse-cdn.com/v4/letter/c/cc9497/32.png) [@Capt.Ridley\_s\_Shooting\_Party](https://boards.straightdope.com/u/Capt.Ridley_s_Shooting_Party)\ **Post date:** [February 24, 2004, 8:39pm UTC](https://boards.straightdope.com/t/no-health-insurance-left-to-die/230973/1 "2004-02-24T20:39:24Z")
What happens if you are unable to pay for vital health care in the USA? I am aware of Medicare and Medicaid, however Medicaid apparently is not eligible to everyone who cannot pay (that’s the impression I got from the official site, anyway). Are people really left to die if they cannot pay, like proponents of socialised health care claim (I’m having a really hard time trying to find a report of anyone being left to die)? What’s the straight dope? ---
**Author:** ![seaworthy](https://avatars.discourse-cdn.com/v4/letter/s/a8b319/32.png) [@seaworthy](https://boards.straightdope.com/u/seaworthy)\ **Post date:** [February 24, 2004, 8:43pm UTC](https://boards.straightdope.com/t/no-health-insurance-left-to-die/230973/2 "2004-02-24T20:43:38Z")
I don’t know about scheduled surgeries, but I know (from several visits to ERs with people who couldn’t pay, and times when I myself had to go) that every ER (in Florida anyway) has a big sign in English and Spanish that says the hospital has to provide emergency care, even if the patient cannot pay for it. So if you get shot and someone calls an ambulance, they’re not going to throw you in the alley if you can’t pay. But if you need a transplant or something, and can’t afford the surgery, then I think you’re SOL. ---
**Author:** ![conczepts](https://avatars.discourse-cdn.com/v4/letter/c/8e7dd6/32.png) [@conczepts](https://boards.straightdope.com/u/conczepts)\ **Post date:** [February 24, 2004, 8:49pm UTC](https://boards.straightdope.com/t/no-health-insurance-left-to-die/230973/3 "2004-02-24T20:49:42Z")
IANAD, but I beleive doctors take the hippocratic oath which states something about protecting all human life. At the emergency room they have to treat you if you’re dying no matter what, and if you can’t pay, you can’t pay. Think about all the sick homeless people who would die at hospitals if they didn’t treat people who couldn’t afford it. ---
**Author:** ![St.Urho](https://avatars.discourse-cdn.com/v4/letter/s/8e7dd6/32.png) [@St.Urho](https://boards.straightdope.com/u/St.Urho)\ **Post date:** [February 24, 2004, 8:54pm UTC](https://boards.straightdope.com/t/no-health-insurance-left-to-die/230973/4 "2004-02-24T20:54:22Z")
People are certainly not left to die. The [Emergency Medical Treatment and Active Labor Act](http://www.emtala.com/)(aka EMTALA) requires all hospitals to provide life-saving, stabilizing treatments to anyone who needs them, regardless of their ability to pay. I’m not sure if it’s covered under the same statute, or another one, but ambulances are not allowed to refuse treatment/transport to anyone, either. > [@](#): > > Q. What are the provisions of EMTALA? > > A. Hospitals have three basic obligations under EMTALA. First, they must provide all patients with a medical screening examination to determine whether an emergency medical condition exists. Second, where an emergency medical condition exists, they must either provide treatment until the patient is stabilized, or if they do not have the capability, transfer the patient to another hospital. Third, hospitals with specialized capabilities are obligated to accept transfers if they have the capabilities to treat them. Medical care cannot be delayed by questions about methods of payment or insurance coverage. Emergency departments must post signs that notify patients and visitors of their rights to a medical examination and to receive treatment. ``` So while people do receive life-saving treatments and EMS transport, there is no guarantee that they can or will receive important follow-up treatments. The uninsured may also not receive preventive care that could prevent their conditions from becoming an emergency. Treating the uninsured can result in either financial hardships for the patient, or losses for health care providers. The American College of Emergency Physicians estimates that ER docs lose on average $138,000 per year from EMTALA-related care. Lastly, it's been my experience in EMS that people without insurance sometimes wait until it is too late to seek emergency care. ``` St. Urho NREMT-P ---
**Author:** ![Eva\_Luna](https://avatars.discourse-cdn.com/v4/letter/e/e495f1/32.png) [@Eva\_Luna](https://boards.straightdope.com/u/Eva_Luna)\ **Post date:** [February 24, 2004, 8:57pm UTC](https://boards.straightdope.com/t/no-health-insurance-left-to-die/230973/5 "2004-02-24T20:57:13Z")
I can attest firsthand that uninsured people are not generally left to suffer if they have an urgent medical need. I was uninsured when I broke my leg in 6 places, and got immediate and excellent care in the E.R. I just had to spend the coming years paying it off myself. I wouldn’t have died if they hadn’t repaired my leg, but I definitely would have been left with severe and permanent damage and possibly been permanently crippled. (I’m not back to 100% anyway, even with the best available care.) ---
**Author:** ![RealityChuck](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/realitychuck/32/195_2.png) [@RealityChuck](https://boards.straightdope.com/u/RealityChuck)\ **Post date:** [February 24, 2004, 9:09pm UTC](https://boards.straightdope.com/t/no-health-insurance-left-to-die/230973/6 "2004-02-24T21:09:14Z")
There are government grants and hospital funds to cover emergency care; hospitals are not allowed to turn away patients due to inability to pay (though some do, and can sometimes get away with it for a time if there are multiple hospitals in the area). ---
**Author:** ![tdn](https://avatars.discourse-cdn.com/v4/letter/t/94ad74/32.png) [@tdn](https://boards.straightdope.com/u/tdn)\ **Post date:** [February 24, 2004, 9:42pm UTC](https://boards.straightdope.com/t/no-health-insurance-left-to-die/230973/7 "2004-02-24T21:42:02Z")
> [@seaworthy](#): > > But if you need a transplant or something, and can’t afford the surgery, then I think you’re SOL. Think again. If you need a transplant, your life is most certainly in immediate danger. They will provide care. As a cite, I offer my ex-girlfriend (rest her soul) was in exactly that situation. She received excellent care, and got a new kidney. Twice. ---
**Author:** ![Scarlett67](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/scarlett67/32/7387_2.png) [@Scarlett67](https://boards.straightdope.com/u/Scarlett67)\ **Post date:** [February 24, 2004, 9:45pm UTC](https://boards.straightdope.com/t/no-health-insurance-left-to-die/230973/8 "2004-02-24T21:45:26Z")
I have a friend who is a single mom with two kids and a low income. She has been eligible for public funding for emergency surgery for one of her children, and recently for diagnostic medical examinations for herself from some kind of “women’s care” fund. I also know that she has been in the position of paying a small amount every month for medical bills. ---
**Author:** ![seaworthy](https://avatars.discourse-cdn.com/v4/letter/s/a8b319/32.png) [@seaworthy](https://boards.straightdope.com/u/seaworthy)\ **Post date:** [February 24, 2004, 9:49pm UTC](https://boards.straightdope.com/t/no-health-insurance-left-to-die/230973/9 "2004-02-24T21:49:21Z")
> [@tdn](#): > > Think again. If you need a transplant, your life is most certainly in immediate danger. They will provide care. I’m not disputing this, but the reason I said if you need a transplant or some other scheduled surgery, you’re SOL, was I was thinking about that movie John Q (I think that’s what it’s called- Denzel Washington takes a hospital hostage or something). I didn’t actually see the movie, but I thought it was about how his health insurance wouldn’t pay for some surgery that his son needed to live, and the hospital wouldn’t do it either, so he held the hospital hostage to make them do it. Of course, like I said I haven’t seen the movie, I could be way off. And I thought the waiting list was so long for most organ transplants that even the people that can afford to pay for it often die waiting for the organ. But that’s a little off topic. I was just making the point that in my experience, it applied to ERs only, not scheduled surgeries. ---
**Author:** ![tdn](https://avatars.discourse-cdn.com/v4/letter/t/94ad74/32.png) [@tdn](https://boards.straightdope.com/u/tdn)\ **Post date:** [February 24, 2004, 10:23pm UTC](https://boards.straightdope.com/t/no-health-insurance-left-to-die/230973/10 "2004-02-24T22:23:03Z")
> [@seaworthy](#): > > I’m not disputing this, but the reason I said if you need a transplant or some other scheduled surgery, you’re SOL, was I was thinking about that movie John Q (I think that’s what it’s called- Denzel Washington takes a hospital hostage or something). I didn’t actually see the movie, but I thought it was about how his health insurance wouldn’t pay for some surgery that his son needed to live, and the hospital wouldn’t do it either, so he held the hospital hostage to make them do it. Of course, like I said I haven’t seen the movie, I could be way off. May I save you the price of the rental? That movie sucked big time (IMnsHO). The first flaw in the plot was that very premise. Pretty much the same reason I hated Double Jeopardy. If you are convicted of murder, but the victim turns up alive, you do not have a free pass to kill that person. Call me a curmudgeon, but any movie where the entire plot is based on a false notion is one that I will entirely fail to enjoy. Anyway, yeah, you got the plot close, you just can’t expect a flawed plot to reflect reality. > [@](#): > > And I thought the waiting list was so long for most organ transplants that even the people that can afford to pay for it often die waiting for the organ. But that’s a little off topic. True enough. And as you seem to guess, organ availability is not based on ability to pay. > [@](#): > > I was just making the point that in my experience, it applied to ERs only, not scheduled surgeries. I think free care applies to either. But I’m guessing that is available for elective surgery only for certain procedures. Free care might get you a new liver, but not a breast enhancement. ---
**Author:** ![elfkin477](https://avatars.discourse-cdn.com/v4/letter/e/a9a28c/32.png) [@elfkin477](https://boards.straightdope.com/u/elfkin477)\ **Post date:** [February 24, 2004, 10:29pm UTC](https://boards.straightdope.com/t/no-health-insurance-left-to-die/230973/11 "2004-02-24T22:29:15Z")
> [@RealityChuck](#): > > There are government grants and hospital funds to cover emergency care; hospitals are not allowed to turn away patients due to inability to pay (though some do, and can sometimes get away with it for a time if there are multiple hospitals in the area). The ones that can turn you away are private hospitals, aren’t they? They forgo government funding, but in turn have the right to decline care for those who can’t afford it. I think. ---
**Author:** ![St.Urho](https://avatars.discourse-cdn.com/v4/letter/s/8e7dd6/32.png) [@St.Urho](https://boards.straightdope.com/u/St.Urho)\ **Post date:** [February 24, 2004, 10:52pm UTC](https://boards.straightdope.com/t/no-health-insurance-left-to-die/230973/12 "2004-02-24T22:52:22Z")
> [@elfkin477](#): > > The ones that can turn you away are private hospitals, aren’t they? They forgo government funding, but in turn have the right to decline care for those who can’t afford it. I think. My understanding is that EMTALA makes no distinctions between public and private hospitals. > [@](#): > > _from [url=“[http://www.emtala.com/](http://www.emtala.com/)”]the ACEP fact sheet_ > Q.What is EMTALA’s scope? > > A.The law applies when an individual “comes to the emergency department.” The Centers for Medicare & Medicaid Services (CMS) has defined a dedicated emergency department as “a specially equipped and staffed area of the hospital used a significant portion of the time for initial evaluation and treatment of outpatients for emergency medical conditions.” This means that outpatient clinics not equipped to handle medical emergencies are not obligated to provide care on-site. They will be allowed to refer patients to a nearby emergency department for care. ---
**Author:** ![5cents](https://avatars.discourse-cdn.com/v4/letter/5/46a35a/32.png) [@5cents](https://boards.straightdope.com/u/5cents)\ **Post date:** [February 25, 2004, 12:09am UTC](https://boards.straightdope.com/t/no-health-insurance-left-to-die/230973/13 "2004-02-25T00:09:34Z")
> [@St. Urho](#): > > My understanding is that EMTALA makes no distinctions between public and private hospitals. Yes, but there’s no regulation saying that a hospital must provide a high-quality emergency room. In many places I’ve been in the US, quite often the big-name private hospitals have tiny under-equipped emergency rooms, and county (i.e. public, or private with public funding) hospitals have huge, well equipped emergency rooms. If I was in a bad car wreck, I’d be happy to hear (if I was in a condition to hear, that is) that the ambulance/helicopter was taking me to the county medical center. Also note that the law states that the hospital must stabilize the patient. That means what it means, i.e. put in a condition where they are not getting worse. ---
**Author:** ![St.Urho](https://avatars.discourse-cdn.com/v4/letter/s/8e7dd6/32.png) [@St.Urho](https://boards.straightdope.com/u/St.Urho)\ **Post date:** [February 25, 2004, 12:33am UTC](https://boards.straightdope.com/t/no-health-insurance-left-to-die/230973/14 "2004-02-25T00:33:20Z")
> [@5cents](#): > > Yes, but there’s no regulation saying that a hospital must provide a high-quality emergency room. In many places I’ve been in the US, quite often the big-name private hospitals have tiny under-equipped emergency rooms, and county (i.e. public, or private with public funding) hospitals have huge, well equipped emergency rooms. If I was in a bad car wreck, I’d be happy to hear (if I was in a condition to hear, that is) that the ambulance/helicopter was taking me to the county medical center. > > Also note that the law states that the hospital must stabilize the patient. That means what it means, i.e. put in a condition where they are not getting worse. That’s certainly true. For example, if I got shot in Kansas City, I’d want to go to Truman Medical Center right off the bat. I was just disputing **elfkin** ’s statement that private hospitals can turn away patients because they don’t accept government money. ---
**Author:** ![JRDelirious](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jrdelirious/32/9531_2.png) [@JRDelirious](https://boards.straightdope.com/u/JRDelirious)\ **Post date:** [February 25, 2004, 1:24am UTC](https://boards.straightdope.com/t/no-health-insurance-left-to-die/230973/15 "2004-02-25T01:24:56Z")
> [@5cents](#): > > In many places I’ve been in the US, quite often the big-name private hospitals have tiny under-equipped emergency rooms, and county (i.e. public, or private with public funding) hospitals have huge, well equipped emergency rooms. > […] > Also note that the law states that the hospital must stabilize the patient. That means what it means, i.e. put in a condition where they are not getting worse. And if the hospital you walk into does not have the capability to provide the care a life-threatening condition requires, it is obligated to arrange for transfer to a facility that does once the patient’s stable enough to transfer. The Trauma Centers are usually at public-funded hospitals (county or university) precisely because a trauma center = large expense, little return on it. The kind of things governments do. This is of course for cases of _emergencies_, that is, _imminent_ danger. Necessary-but-not-imminent cases will ideally be handed over to caseworkers who would coordinate with the various social-welfare entities, employers, families, doctors, etc. to see what can be worked out. The big problem in the USA is that a lot of people in the grey zone “in-between” comprehensive insurance coverage and full Medicaid coverage do not have the money to cover out-of-pocket for “normal” major medical procedures and drugs. This is the big worry of laid-off or retired middle-class workers – not that they’ll die waiting for a rare transplant, but that they will have to liquidate their possessions to cover the cost of a major crisis, or have their pension check swallowed whole by the enormous cost of maintenance drugs prescribed for a chronic condition. The “John Q” situation has a smidgen of truth in cases in which you require some procedure or drug that is _experimental_, or that is extremely specialized and available only by prior referral from specific providers, or that is otherwise an _extraordinary_ procedure in terms of rarity and risk. But guess what, you get the same problem under socialized medicine. Resources are finite. ---
**Author:** ![5cents](https://avatars.discourse-cdn.com/v4/letter/5/46a35a/32.png) [@5cents](https://boards.straightdope.com/u/5cents)\ **Post date:** [February 25, 2004, 2:29am UTC](https://boards.straightdope.com/t/no-health-insurance-left-to-die/230973/16 "2004-02-25T02:29:25Z")
> [@JRDelirious](#): > > But guess what, you get the same problem under socialized medicine. Resources are finite. You could argue that US medicine is socialized, although through the back door. There is of course medicare and medicaid, but there is also obscenely expensive emergency room care, which helps defray the cost of treating those who can’t pay. Insurance companies get smart and started pushing their clients to go to urgent care clinics (which are essentially doctor’s offices with extended hours), which skews the ratio of uninsured to insured in hospitals even more. Two cases, to make the case: I twisted my knee (playing hockey). Went to the local urgent care (where my own doctor sometimes works). Got an xray and a visit with the doctor (get crutches!). Cost: $175, negotiated to $100 by insurance, I paid $10. I stubbed my toe really hard. Looked like I dislocated something. Too late for urgent care, so I went to the emergency room. Got an xray and a visit with the doctor (tape them piggies together!). Cost: $585, negotiated to $430 by insurance, I paid $40 (I’ve got good insurance). A few things to note about these two incidents. First, although we are talking about different body parts, the services were essentially the same, so you’d expect the costs to be in line, all things being equal. However, the cost at the emergency room was 4x the cost at the urgent care, so it appears that my emergency room bill will pay for 3 folks with stubbed toes or twisted knees that can’t pay (or maybe one poor slob with a stab wound). That’s were the “socialized” part comes in. Its not direct, but it is hard to argue that it doesn’t exist. Second, being an emergency room doc absolutely sucks. In the first case, my doc got about $70 of that $100, in the second, the emergency room doc got $25 of the $430. I’m sure emergency room docs are hurting (if they have to treat 3 other patients that can’t pay, and only get my $25), but the hospital probably isn’t (they took in $390, the other $15 was for reading the xray). ---
**Author:** ![Mr.Blue\_Sky](https://avatars.discourse-cdn.com/v4/letter/m/d26b3c/32.png) [@Mr.Blue\_Sky](https://boards.straightdope.com/u/Mr.Blue_Sky)\ **Post date:** [February 25, 2004, 2:38am UTC](https://boards.straightdope.com/t/no-health-insurance-left-to-die/230973/17 "2004-02-25T02:38:27Z")
In the hospital where I work, we have a large in-house fund set aside for indigent care (even if you AREN’T indigent). If you are in dire medical need, we will not turn you away. We are reimbursed by the state for a certain percentage of this care. It is not unusual for someone to come in and get $50,000+ in care and not have to pay a single cent. OTOH, if you are capable of paying, but don’t have insurance, we can usually cut you a deal. ---
**Author:** ![drachillix](https://avatars.discourse-cdn.com/v4/letter/d/48db29/32.png) [@drachillix](https://boards.straightdope.com/u/drachillix)\ **Post date:** [February 25, 2004, 3:48am UTC](https://boards.straightdope.com/t/no-health-insurance-left-to-die/230973/18 "2004-02-25T03:48:49Z")
> [@+MDI](#): > > Are people really left to die if they cannot pay, like proponents of socialised health care claim (I’m having a really hard time trying to find a report of anyone being left to die)? Not only are they not left to die you need to realize something about EMS and ER staff. They do not have a financial agenda. You do what you can to fix the problem dropped in front of you, there is a whole department of administrative types who will sort out the financial angles later. Not only do they usually not care about your ability to pay, its pretty much the last thing on their minds. ---
**Author:** ![nancyflute](https://avatars.discourse-cdn.com/v4/letter/n/f17d59/32.png) [@nancyflute](https://boards.straightdope.com/u/nancyflute)\ **Post date:** [August 21, 2004, 6:13pm UTC](https://boards.straightdope.com/t/no-health-insurance-left-to-die/230973/19 "2004-08-21T18:13:54Z")
> [@JRDelirious](#): > > And if the hospital you walk into does not have the capability to provide the care a life-threatening condition requires, it is obligated to arrange for transfer to a facility that does once the patient’s stable enough to transfer. The Trauma Centers are usually at public-funded hospitals (county or university) precisely because a trauma center = large expense, little return on it. The kind of things governments do. > > This is of course for cases of _emergencies_, that is, _imminent_ danger. Necessary-but-not-imminent cases will ideally be handed over to caseworkers who would coordinate with the various social-welfare entities, employers, families, doctors, etc. to see what can be worked out. > > The big problem in the USA is that a lot of people in the grey zone “in-between” comprehensive insurance coverage and full Medicaid coverage do not have the money to cover out-of-pocket for “normal” major medical procedures and drugs. This is the big worry of laid-off or retired middle-class workers – not that they’ll die waiting for a rare transplant, but that they will have to liquidate their possessions to cover the cost of a major crisis, or have their pension check swallowed whole by the enormous cost of maintenance drugs prescribed for a chronic condition. > > The “John Q” situation has a smidgen of truth in cases in which you require some procedure or drug that is _experimental_, or that is extremely specialized and available only by prior referral from specific providers, or that is otherwise an _extraordinary_ procedure in terms of rarity and risk. But guess what, you get the same problem under socialized medicine. Resources are finite. Boy, did you ever hit a nerve when you mentioned drugs! I am in the unfortunate position of being on permanent disability. After 24 moths of temporary disability, this happens automatically. Another thing that happens automatically is that you receive Medicare, parts A and B . . . and they deduct $67 from each monthly check! Since Medicare covers such a small fraction of the cost of prescription drugs, I must retain my regular health coverage, too . . . but I have $67 less per month to achieve my saving up necessary for each quarterly premium payment. What the pharmaceutical companies have done to this country is criminal. They need money for R & D? Boo-hoo, and kiss my [your choice], too. :mad: ---
**Author:** ![nancyflute](https://avatars.discourse-cdn.com/v4/letter/n/f17d59/32.png) [@nancyflute](https://boards.straightdope.com/u/nancyflute)\ **Post date:** [August 21, 2004, 6:16pm UTC](https://boards.straightdope.com/t/no-health-insurance-left-to-die/230973/20 "2004-08-21T18:16:02Z")
> [@JRDelirious](#): > > And if the hospital you walk into does not have the capability to provide the care a life-threatening condition requires, it is obligated to arrange for transfer to a facility that does once the patient’s stable enough to transfer. The Trauma Centers are usually at public-funded hospitals (county or university) precisely because a trauma center = large expense, little return on it. The kind of things governments do. > > This is of course for cases of _emergencies_, that is, _imminent_ danger. Necessary-but-not-imminent cases will ideally be handed over to caseworkers who would coordinate with the various social-welfare entities, employers, families, doctors, etc. to see what can be worked out. > > The big problem in the USA is that a lot of people in the grey zone “in-between” comprehensive insurance coverage and full Medicaid coverage do not have the money to cover out-of-pocket for “normal” major medical procedures and drugs. This is the big worry of laid-off or retired middle-class workers – not that they’ll die waiting for a rare transplant, but that they will have to liquidate their possessions to cover the cost of a major crisis, or have their pension check swallowed whole by the enormous cost of maintenance drugs prescribed for a chronic condition. > > The “John Q” situation has a smidgen of truth in cases in which you require some procedure or drug that is _experimental_, or that is extremely specialized and available only by prior referral from specific providers, or that is otherwise an _extraordinary_ procedure in terms of rarity and risk. But guess what, you get the same problem under socialized medicine. Resources are finite. Boy, did you ever hit a nerve when you mentioned drugs! I am in the unfortunate position of being on permanent disability. After 24 moths of temporary disability, this happens automatically. Another thing that happens automatically is that you receive Medicare, parts A and B . . . and they deduct $67 from each monthly disability check! Since Medicare covers such a small fraction of the cost of prescription drugs, I must retain my regular health coverage, too . . . but I have $67 less per month to achieve my saving up necessary for each quarterly premium payment. What the pharmaceutical companies have done to this country is criminal. They need money for R & D? Boo-hoo, and kiss my [your choice], too. :mad: [Next page](https://boards.straightdope.com/t/no-health-insurance-left-to-die/230973.md?page=2)