The Emergency Medical Treatment and Active Labor Act (EMTALA)[1] is a U.S. Act of Congress passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA).

Fate, whether or not health care is a right, this law exists and is enforced. Which means that for all intents and purposes, people cannot be turned away from an emergency department....
They have the legal right, if not the "constitutional right".
You are correct that it is easier to end this "legal right"
Do you suppose that there is any likelihood that the law will be over turned so that Ed's can start turning away people who have no insurance?
I doubt it.
So, your hair splitting on whether its a right or not is meaningless.... As long as the law exists people cannot be denied treatment at an ED....

Explain how this isn't socializing the cost of their medical care......

Doctor Fate wrote:

danivon wrote:

Doctor Fate wrote:More correctly, there are limits to our rights, or they come with obligations.

And yet the Declaration of Independence declares certain rights to be 'inalienable'. Not that I disagree, as the DoI is an aspirational document (containing a shopping list of alleged iniquities performed in the name of a long-dead King).

". . . among these are Life, Liberty and the pursuit of Happiness."

No healthcare.

I do wish you would not simply hit 'reply' and start inline responses before reading the whole post. Had you done so, you would have realised the redudancy of your response - I already addressed that very line somewehere else....

Well, dictatorship is not economically free either. I think this is a pretty weak argument, with all respect. It's still the same people who are/are not paying for the election who are/are not paying taxes.

The point is not necessarily who pays for it, but that it is not free.

But hey, here it is - people who pay taxes pay for the government to do stuff is pretty much a tautology. Big whoop. Those who pay do so in order that everyone can have the right to vote.

But, free speech has little to do with expense. It has to do with the right to say what you want with only minimal restraint.

But it is also about (as per recent legal precedents) allowing money to speak loudly. We all know that as much as access to post a blog is cheap, access to shower the nation with advertising or political messages is not.

Where is healthcare guaranteed as a right?

It is not explicitly guaranteed, but that does not mean it is not guaranteeable, or that it should not be considered a right.

Well, actually, it does.

If the Constitution does not define the limits of government by defining our fundamental rights and the government's legitimate role, then it does nothing at all.

Oh dear. Further on, I do oultine what I believe the purpose of the Constitution to be. The fact is that the 9th Amendment means that just because a right is not listed in the Constitution explicitly does not mean it is not a right.

Yes, but by no means would they have imagined that some sort of socialized medicine could be guaranteed as a "right" without amending the Constitution.

I can quite imagine that they would not have foreseen all kinds of things 200+ years ago. The founders of the USA were fairly wise and forward looking, but they were not prescient, and by no means perfect. After all, they didn't even sort out some basic stuff like people being owned by other people.

Secondly, the purpose of the Consitution is not to confer rights on the people, but to impose a structure and limits to the Federal Government. It has also later been interpreted and amended to apply limits to State governments as well, and to add new rights (or, rather, to remove the ability of governments to deny people rights, such as not being a slave or being a woman who can vote etc).

This does nothing to advance the notion that healthcare is a right.

It was not intended to. The intent was to destroy the notion that just because the Constitution doesn't explicitly say something does not mean it cannot be true. In other words, it was an argument to push back the notion that healthcare cannot be a right, or is not a right.

Not so. A right, like free speech, can only be revoked by amending the Constitution. That bill can be reversed on any given day by a Congress and President desiring to do so.

It is not a "right," but an unfunded mandate by the Federal government--exactly the sort of thing the Founders sought to stop.

If you are going to define a 'right' solely as being one explicitly enumerated by the Constitution, go ahead. But the Constitution does not even do that, so I don't see why I should follow your 'logic'.

This is frustrating. When I mention taxes, you jump to assuming that we are only talking about Federal taxes (and then further seek to limit the scope to a single Federal Tax), and when we talk about rights, you are blinkered to everything except that which is clearly Constitutionally guaranteed. The problem is that 'taxes' as a word does not mean 'Federal Income Tax', and 'rights' does not mean 'Rights specified in the US Constitution'. If I wanted to restrict the debate to the latter terms, I would use them. As I do not, I use the former, more general words.

If one has a right to life, and the pursuit of happiness, then it follows that one has the right to health, as poor health is a threat to both.

Patent nonsense.

1. Your explication is nothing remotely like authorial intent.

I am not applying 'authorial intent'. I am applying logic. Please explain to me how health is not linked to 'Life' or 'the pursuit of happiness' before declaring that this makes no sense.

2. If healthcare is a "right," then surely food, clothing, and shelter are MORE necessary for "life," yet we don't have the "right" to them. Are there subsistence programs? Yes. Do they grant me the right to show up at a restaurant and get food for nothing? No. Can I go to the mall and get whatever clothing I like for free? Can I move into any house I'd like?

No.

Healthcare is not a "right." Food is not a "right." Clothing is not a "right." Housing is not a "right."

I would argue that sustenance is a right. If a child is not being fed by it's parents, would we just shrug and say "well, the kid has no rights to food"? Of course not. Similarly with shelter and clothing.

Of course, the United Nations Declaration of Human Rights enumerates these rights:

Article 25(i) "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control."

The USA is a signatory to that Declaration. While they may not recognise the UNDHR, it is out there.

Of course, food, clothing and shelter being rights does not mean that one can get whatever food or clothes or shelter for free at all times. It does, however, imply that those who have no means to buy those things should still have access to them, and they should not be denied such by the State.

Frankly, I'd rather not be like Britain.

And thank you for the utterly pointless jibe.

Does EMTALA say that the hospitals have to not charge the patients?

I read the EMTALA.

Prior to 2003, some knowledgeable commentators had suggested that no discussion of any payment issues should take place before the medical screening examination and any needed stabilizing treatment are provided. CMS has even recommended that hospital personnel not answer any questions initiated by the patient, apparently on the theory that some patients may be dissuaded from staying if they learn that they will be financially responsible for the treatment, even if they are assured that they will be seen without consideration of payment issues.

http://www.emtala.com/faq.html
Click #13

bbauska

Does EMTALA say that the hospitals have to not charge the patients?

No. .
So what?
Indigent people, with no ability to pay can and are billed. But, as posted before, fully 16% of ED patients don't pay the bill. Because they can't.
ED's are forced to treat patients they know have no ability to pay.
You've already agreed that patients shouldn't left to die...so i'll assume you support the objective of the law.
Now, explain how, once the government starts forcing hospitals to accept patients who cannot pay how that isn't essentially socialism? (Signed into law by Ron Reagan ironically)

Just because something is a right does not mean the government will provide it. It just means government cannot restrict access to it.

I have a Constitutional right to a firearm as a civilian. Under the argument that healthcare is a right so government must provide it, then the government should be providing civilians with firearms.

I guess I have a right to free electricity then? The government requires the electric company to send warning after warning after warning before they can shut off my service. They must provide service not knowing if I can pay or not. Based on your emergency room example, that is aright, then I guess so is free electricity?

rickyp wrote:bbauska

Does EMTALA say that the hospitals have to not charge the patients?

No. .
So what?
Indigent people, with no ability to pay can and are billed. But, as posted before, fully 16% of ED patients don't pay the bill. Because they can't.
ED's are forced to treat patients they know have no ability to pay.
You've already agreed that patients shouldn't left to die...so i'll assume you support the objective of the law.
Now, explain how, once the government starts forcing hospitals to accept patients who cannot pay how that isn't essentially socialism? (Signed into law by Ron Reagan ironically)

I agree that the emergency treatment of ANYONE should occur. That is humanity.

Since the hospitals have to treat them it is a form of charity from the hospital. If the government does not reimburse a hospital it is not socialism. Since we are dealing in the hypothetical realm, why not think a government does not have to reimburse a hospital, and the hospital can bill a patient. Is the government reimbursing the hospital?

Suppose homeless guy goes to the hospital and racks up 100K in bills over a period of time. Homeless guy is run into by city bus and gets a settlement of 1 million. Hospital gets 100K plus interest. No government, right?

Bbauska, you do not need to have the government pay for a system to be socialism. A co-op is a socialist institution, for example. If a hospital has to, by law, provide healthcare to everyone regardless of ability to pay, then this means they are being required to provide it for free to some. If something is required, it is not 'charity'.

Under EMTALA, any hospital that accepts Medicare payments is affected (so even though it is not direct funding, there is government involvement). As the vast majority of hospitals which have Emergency departments rely on Medicare funding for a substantial part of income, they are pretty much forced to accede to EMTALA.

Prior to EMTALA, you had 'patient dumping' - refusal to treat due to inability to pay or chucking people out when costs looked like they may go up. So it was not passed on a whim or simply to aggrandise the government. And while you would agree that it is simple humanity to treat someone in an emergency, clearly not all hospitals felt it was something they should do.

The constitutional arguments are very interesting, but I wanted to return to the premise of Ricky's comment about ERs. It is true that the cost of an ER visit is more expensive than urgent care or a routine hospital visit, but I think we are missing the larger point. Namely, high US health costs are not primarily attributable to the ER, and in particular the indigent over using ER services. Therefore, since the ER requirements are not the cornerstone of the problem, it is a red herring to assume that this issue is the main problem here.

Perhaps we can establish that everyone has a right to a certain level of health care, but there is no way to establish that everyone has a complete right to an infinite amount of health care no matter what the cost.

archduke

Just because something is a right does not mean the government will provide it. It just means government cannot restrict access to it

In this case the law is guaranteeing access (eliminating the ED's ability to restrict access) ... The inverse of your statement.
And the government is enforcing the ability to access ED health services, without regard to how the ED's are to be compensated in the event that patients can't pay their bills.

bbauska

Since the hospitals have to treat them it is a form of charity from the hospital. If the government does not reimburse a hospital it is not socialism.They've socialized the cost of the ED service to people who can't pay

.....
Those unpaid bills don't magically disappear, and by placing the label "charity" on them you don't magically make the consequences of an unfunded liability go away.
Taxpayers or other patients at the hospital end up paying these costs.... (Those with the ability to pay, cover the costs for those unable to pay).
You may want to pretend this isn't effectively socialism.... But pretending doesn't magically change reality either ...

bbauska

Suppose homeless guy goes to the hospital and racks up 100K in bills over a period of time. Homeless guy is run into by city bus and gets a settlement of 1 million. Hospital gets 100K plus interest. No government, right

This happens with great frequency I'm sure.
And space aliens could land and offer to pick up the tab too.
But we live in the real world. And whats really happened is a de facto socailization of medical care for indigents through the ED....

ray

Namely, high US health costs are not primarily attributable to the ER, and in particular the indigent over using ER services. Therefore, since the ER requirements are not the cornerstone of the problem, it is a red herring to assume that this issue is the main problem here.

Perhaps we can establish that everyone has a right to a certain level of health care, but there is no way to establish that everyone has a complete right to an infinite amount of health care no matter what the cost

No, the absolute cost of US health care is not solely caused by EMTALA. But, EMTALA has lead to the use of ED's as health care by indigents. Period.
And since there is no magical way to ignore the 16% of ED costs that are (according to the earlier link which was dated in the late 90s..) incurred as a result of EMTALA one has to admit that socialized medicine has been established for the indigent.
My point has been that the US has been unable to square its moral position (We won't allow hospitals to turn away those who need care, regardless of their ability to pay), with the responsibilities that come with the moral position. The costs.
Its simply; "We want the benefits of socialism" without paying for the costs of socialism. In a typically complex American solution, hospitals have taken the role of spreading the cost of the unfunded liability and acting as the social agent rather than the government. So people like Bbauska could pretend it isn't so...
Which has lead to inefficient delivery of services. At the ED rather than clinics or doctors offices.

Your last paragraph may be correct, but its again a deflection. Its a fact that systems of health care that are openly socialist also deal with .... The ability to provide versus the ability to supply.
The only difference is that in the US, the fee for service system and the profit motive drive decisions to use more and more services ...rather than making rationale judgements based upon what's best for the patient.
I've mentioned the Mayo clinic. It has the best outcomes, and best cost effectiveness of any American hospital. Mostly it has removed the doctor from the profit equation. There a re a myriad of things that could be done that would improve cost effectiveness and efficiency of the US health care system. That would probably be number one.
But recognizing that providing insurance for everyone, regardless of ability to pay, would mean the very poor would find better ways to get their health needs met, other than ED is also one...
The ACA goes a step in that direction, by increasing the numbers covered by insurance.... But only a step.

In this case the law is guaranteeing access (eliminating the ED's ability to restrict access) ... The inverse of your statement.
And the government is enforcing the ability to access ED health services, without regard to how the ED's are to be compensated in the event that patients can't pay their bills.

Access is enforced, payment is not. Patients are liable for the bills they rack up.
How is this different from the electric company example? You must be given access to the electricity and when you fail to pay,. they must continue supplying the electricity for some time before shutting you off. We also have similar laws for landlords who can't kick people out of their homes after they fail to pay for months at a time. Because the government demands a patient must be seen while not absolving them of their debt, it is in no way any sort of right in the least.

Taken further, I had jury duty a week or two ago. I was part of a group to be selected for a triple murder case expected to last 3-4 weeks. The government demanded I must serve if selected, since the government made a demand without regard to what i could afford to do because of this demand, what if I couldn't pay my mortgage, couldn't pay my phone bill? etc. Does that let me off the hook because the government demanded me to forgo my usual pay? (luckily I got off for reasons other than "can't afford it" I did mention that and they could care less, I told them I was biased and I mentioned crap I had remembered from news reports and nonsense I knew would not be admitted as evidence ...THAT they didn't like and I was sent home ...yippee)

Just because the government demands something does not absolve other things, they demand a patient be seen, that does not absolve them of payment nor does it now become some sort of right.

tom

Just because the government demands something does not absolve other things, they demand a patient be seen, that does not absolve them of payment nor does it now become some sort of right.

So what?
Please explain what happens to the unpaid medical bills and the costs for the EDs associated with those unpaid bills.
And please explain what would happen if someone with $65,000 in unpaid bills showed up at an ED, the same Ed he carries the debt with, with a life threatening illness.
Hint. The doctors treat the patient. Because its the law. (They have a legal right to treatment.)
Disagree? If so why?

Archduke Russell John wrote:Just because something is a right does not mean the government will provide it. It just means government cannot restrict access to it.

I have a Constitutional right to a firearm as a civilian. Under the argument that healthcare is a right so government must provide it, then the government should be providing civilians with firearms.

QFT!

rickyp wrote:archduke

Just because something is a right does not mean the government will provide it. It just means government cannot restrict access to it

In this case the law is guaranteeing access (eliminating the ED's ability to restrict access) ... The inverse of your statement.
And the government is enforcing the ability to access ED health services, without regard to how the ED's are to be compensated in the event that patients can't pay their bills..

The problem, dear rickyp, is that you don't go far enough.

If it's all about "access" as a right, then every American should be able to show up to any doctor for any reason without the ability to pay.

So, we should all drop insurance, go to whatever doctor we want, refuse to pay, and sue if a doctor refuses treatment.

After all, healthcare is "a right." You can't define a "right" by "life-threatening" or many ER visits would be turned away. Who are you to decide what is/is not necessary? Furthermore, what right does a doctor have to limit my "rights?"