View Poll Results: One of our healthcare cost problems appears to be EMTALA mandated care

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  • EMTALA is OK for now but replacement ASAP

    3 37.50%
  • Stop EMTALA, people must pay for their medical care.

    3 37.50%
  • Stop EMTALA, itís not even constitutional.

    2 25.00%
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Thread: What should we do with emergency medical care, EMTALA

  1. #11
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    Re: What should we do with emergency medical care, EMTALA

    The tremendous problem lies in the catch-all standard that really is no longer our "emergency" room. Triage should be used to separate emergency room use and normal treatment. If people who came to the emergency room were rated (not a lot of thought here, just example purposes) as follows:
    Class I Patients who require minor treatment and can be exited in a short period of time.
    Class II Patients whose injuries require immediate life sustaining measures.
    Class III Patients for whom definitive treatment can be delayed without loss of life or limb.
    Class IV Patients requiring such extensive care beyond medical personnel capability and time.

    Then, Class I patients could be helped quickly/cheaply and moved on and out;
    Class II is my definition of who emergency room care is for and why "mandated" care came into existence;
    Class III patients should be turned away or admitted with payment;
    Class IV patients (self-explanatory) - if they're going to die and don't have money to pay for extreme measures, no treatment is necessary. We'll all die eventually.

    I realize that allowing Class III patients to turn into Class II or Class IV patients would be sad, but a percentage of Class III would seek treatment elsewhere or get better. Unless you've spent much time in the waiting room, you wouldn't believe the number of people who are there for colds, hang-overs, drug seeking, and plain old family doctor problems. The emergency room has become the regular doctor for a huge population of people.
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    Re: What should we do with emergency medical care, EMTALA

    Firstly, there is no constitutional grounds for EMTALA as Congress is not empowered to act in such matters. It should be left for states to decide. That in itself would give us a far better range of proposed solutions for cost containment. And I'm guessing when it comes down to it that 99% of people would rather let the odd person who can't pay their way in society kick the bucket in some tragic news story than see their own insurance premiums rise because of the problem of free riders.

    Secondly, at the very least, any such law - federal or otherwise - needs to be limited to treatment to prevent imminent life-threatening emergencies. If someone is suffering loss of life or limb in the absence of being examined, treated or admitted, then that's someone the hospital may admit. And this should be limited only to American citizens and legal residents of the United States; people who are here illegally should not be guaranteed access to treatment. Treatment itself should be limited only to what is necessary for the immediate address of fatality prevention. Every hypochondriac single mom out there doesn't need to be humored every time her kid runs a fever.

    Health care providers should be given (a) reasonable leeway to exercise their best judgment in such matters, (b) liability protection for denial of non-essential care and (c) tax incentives to offset the cost. Hospitals and doctors can always volunteer their services free of charge. We just need a mechanism in place to ensure they eat the cost if they choose to do so rather than pass it on to paying customers.

    I would look for states to affect something along the lines of the following principles:
    (1) Mandatory treatment only for imminent threat of loss of life
    (2) No treatment for illegals
    (3) Cost containment mechanism to prevent passing the costs onto paying customers
    (4) Substantial tax incentives or minor grants or subsidies to help pay for "free" care
    (5) Legal protection for hospitals to exercise best judgment
    (6) Leeway for hospital to elect voluntarily to provide services over and above to those not mandated to received it

    These are just some ideas off the top of my head. Obviously we could end up with fifty different versions of EMTALA at the state level and states would be able to watch their neighbors and pick-and-choose from what they believe works best and what doesn't. So long as we have another top-down, one-size-fits-all approach from Washington, however, there's not likely to be much innovation or freedom of choice in this matter.

  3. #13
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    Re: What should we do with emergency medical care, EMTALA

    Quote Originally Posted by Morality Games View Post
    I get kind of tired of this response. Quite of a few conservatives think most of these issue can be reduced to a question of abuses reducing efficiency, when they can't be.

    The majority of people who go to the emergency room, and the most expensive to care for, need to be there to live and/or be functional in society. There's no easy way out of that. Similarly, the longevity of most appliers continuing reliance on unemployment benefits derive from the general lack of opportunities and the need to take a serious loss in assets and long term investments in order to pursue the remaining ones, not from laziness.

    Seriously, if reducing abuses could solve these problems, we would have done it already.

    Agree with Samsmart in spirit, but I would have to hear his reasoning on the sales tax first.
    First of all, I do disagree with minimizing the fiscal impact of "abuses" and suggesting that those abuses are not a major problem. I'm in the field and I can tell you that it absolutely is a signifiant problem, but it is obviously not the only problem. Secondly, the EMTA is not a bad law- although the problem it addresses is not widespread: The problem that a medical provider would refuse to render emergent care in a life threatening situation due to monetary concerns. According to their licensure and oaths, physicians would ordinarily be required to do this anyway, in the absence of any federal law. This law exists to reaffirm the necessity of rendering life saving treatment first, and asking questions about insurance and finances later.

    I think the entire system could be reformed in a way to render this law unnecessary- but not by means of cirumventing the capitalistic system of healthcare we have with Obamacare, a single payer system, or an individual mandate.

    Quote Originally Posted by samsmart View Post
    Well, no, conservatives are right in that using the emergency room for such things are inefficient which leads to increase costs.

    But where conservatives are wrong, I think, is that they don't advocate an individual mandate system or a single-payer system in order to decrease costs by ensuring everyone pays into a health care system.
    Have you been to health clinics Cananda and Australia and the UK? I have. And yes, I have read the surveys of people- the slanted ones that make it look like, based on patient survey, the quality in those countries is better. It is not better. Is state of the are equipment and medicine available there? Yes. Are the hospital emergency rooms less burdened with indigent/non life threatening? Yes. The problem with their models (again, all single payer systems) are A) The patient is not the customer; the government is the customer- and the government has a monopoly, so things like customer service and bedside manner- even ensuring the speediest treatment time for non life threatening office visits (especially with regard to healthcare professionals who are not doctors) does not affect the bottom line for those providers because there is no patient choice. What I saw, especially in Australia, was a doctor's office that was OBVIOUSLY influenced by government. (Ever been to the tag office or the DMV?) and B) the standards of treatment leave nothing to the discretion of the doctor- other than determining a patient's clinical criteria and whether he/she meets or does not meet the established standard for a particular treatment. In this country, if you say your neck hurts, and nothing shows up on an x-ray, the doctor can presribe MRI. Not in Australia. Part of the criteria for MRI is that the doctor has to consider how the pain is affecting your function. If you are functional enough, you get PT and painkillers without a diagnosis (because the doctor can't diagnose without the MRI). Without a diagnosis, PT is not going to be effective. How is the PT supposed to know which interventions are appropriate for you a patient?

    The government needs to, at a bare minimum, keep their noses out of the clinical aspects of healthcare. This would not be possible under a single payer system.
    Last edited by kamikaze483; 12-03-11 at 10:29 AM.

  4. #14
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    Re: What should we do with emergency medical care, EMTALA

    Quote Originally Posted by tessaesque View Post
    I think a bigger issue is the use of ERs as diagnostic tools for non-fatal illnesses. Going to the ER because the kid has a 99.7 temp and a sniffle, especially if you don't plan to pay, is abusive and wasteful. It clogs waiting rooms and wastes resources. Let's fix that, because true emergent care for life-threatening circumstances is a much smaller issue.
    On this subject:

    This morning (Saturday) my son woke up with his left eye swollen shut and oozing - obviously an infection that came on overnight.

    Where to take him? It's not an emergency but it isn't something I want to put off 'til his DR's office opens on Monday. . . I called around - couldn't find out where any such after-hours or walk-in clinic is. The only walk-in clinic is at Children's - in Little Rock which is 45 minuts away.

    You know: there are towns and even an Airforce base between here and there - not a single one has a clinic of this nature? If they do I can't find it listed, no one knows about them via phone calls.

    Not having clinics readily available or at least listed and advertised forces people to go to the Emergency Room whenever anything comes up.

    And based on my past experiences - when it comes to people who aren't going to pay or who forget to pay - there are collection agencies.

    But - I think insurance companies should roll unpaid copays (etc) into the client's premiums that they pay every month if they go unpaid for too long - or something like that which puts the weight of pay back on the individual.
    Last edited by Aunt Spiker; 12-03-11 at 10:42 AM.
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  5. #15
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    Re: What should we do with emergency medical care, EMTALA

    Quote Originally Posted by Morality Games View Post
    I get kind of tired of this response. Quite of a few conservatives think most of these issue can be reduced to a question of abuses reducing efficiency, when they can't be.

    The majority of people who go to the emergency room, and the most expensive to care for, need to be there to live and/or be functional in society. There's no easy way out of that. Similarly, the longevity of most appliers continuing reliance on unemployment benefits derive from the general lack of opportunities and the need to take a serious loss in assets and long term investments in order to pursue the remaining ones, not from laziness.

    Seriously, if reducing abuses could solve these problems, we would have done it already.

    Agree with Samsmart in spirit, but I would have to hear his reasoning on the sales tax first.
    I didn't say that reducing abuse would solve every problem, but it would certainly be the beginning to solving some of them. People who misuse available resources drive up the cost of those resources in the process. That's true in every single industry, whether it's government run or not. Curtailing abuses would most certainly help, and the safest, most efficient way to start in the ER-world would be a campaign to eliminate the use of ERs as diagnostic tools for a damned head cold.

    Did you know that many local pharmacies now offer on-site, free-of-charge diagnostics for flu, ear infections, strep, kidney infections, bladder infections, yeast infections, common cold, and several other non-fatal illnesses? You might not have, because a lot of people don't. Did you know that you can buy relatively cheap (under $20) diagnostic kits for most of those illnesses at said pharmacy, and that those kits are up to 99% accurate? You might not have, because a lot of people don't. If more people were made aware of and utilized those tools I'll bet we could significantly cut down on ER misuse.

    You act as those abuses should just be ignored because nothing can be done to stop them. That's ignorant and lazy.
    Last edited by tessaesque; 12-03-11 at 10:49 AM.
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    Re: What should we do with emergency medical care, EMTALA

    Quote Originally Posted by Blackstone View Post
    Firstly, there is no constitutional grounds for EMTALA as Congress is not empowered to act in such matters. It should be left for states to decide.
    I agree that it is prohibited.

    The rest of your post is interesting but relevant only to discussions about any particular state's legislation.

  7. #17
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    Re: What should we do with emergency medical care, EMTALA

    Quote Originally Posted by kamikaze483 View Post
    ....
    The government needs to, at a bare minimum, keep their noses out of the clinical aspects of healthcare. This would not be possible under a single payer system
    .
    Wow, your post was informed and clear. Iím only quoting your major issue to offer an idea for a solution.
    I was enlisted Air Force, and therefore I received a lower level of medical care than officers. (I had several personal experiences and several observations that clearly demonstrated this; and it appears to be true currently.) In the military this can be considered just in a system where people are not equal. In fact most of the world is like this. So, if we had a basic government regulated system for emergency health care (or health care in general) where the government had their noses in it to minimize cost but provide some fairly good care; then allowed private companies to sell insurance policies for expenses above what the government system provided, would we have an architecture for a solution? This would be a mutiple payor system if the patient wanted it and could afford it.

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    Re: What should we do with emergency medical care, EMTALA

    So, if we had a basic government regulated system for emergency health care (or health care in general) where the government had their noses in it to minimize cost but provide some fairly good care; then allowed private companies to sell insurance policies for expenses above what the government system provided, would we have an architecture for a solution? This would be a mutiple payor system if the patient wanted it and could afford it.
    I think those types of reforms would be BETTER than what is currently proposed in Obamacare. My main concern with Obamacare is that I believe the best quality healthcare will be obtained in the private marketplace- and I think the provisions in the Obamacare bill hinder that market and will eventually result in a single payer system even though there are no provisions for that in the bill. The way that will play out is that the legislation is so burdensome (with requirements to insure people with pre-existing conditions, etc) that the current, market based health insurance system will collapse under the pressure... and then what do you think the governmental response to that crisis will be? To implement a federal single payer health care insurance program, which I still believe was always the end goal. I think there can be some federal intervention to close the equity gap- but I think that aid needs to supplement monies paid by the insured to a PRIVATE insurer. I think the goal should be to get everyone privately insured via incentive, rather than mandate. I posted a proposed plan in anothter thread that I believe would do exactly that, and at the same time halve taxpayers' healthcare spending and decrease the influence of the federal government (by means of repeal of exisiting legislation) rather than expand it. I linked below to that thread.

    http://www.debatepolitics.com/health...post1059970523

  9. #19
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    Re: What should we do with emergency medical care, EMTALA

    My answer isn't on the poll. Implement universal healthcare so those who cannot afford care will have the option of not using ERs for primary care. ERs are absolutely the most costly way to render primary care, but the current US system leaves this as the only option for millions of people who make too much to qualify for medicaid, but don't make enough to afford health insurance.

  10. #20
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    Re: What should we do with emergency medical care, EMTALA

    Quote Originally Posted by Frolicking Dinosaurs View Post
    My answer isn't on the poll. Implement universal healthcare so those who cannot afford care will have the option of not using ERs for primary care. ERs are absolutely the most costly way to render primary care, but the current US system leaves this as the only option for millions of people who make too much to qualify for medicaid, but don't make enough to afford health insurance.
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