Tuesday, July 23, 2013

I Shouldn't Pay for Their Healthcare... But I Do

I doubt we'll see the end of debates about healthcare reform anytime soon. Interestingly, many of the things being tried now were tried a couple of decades ago, too, from my understanding. Yet having worked in a major medical center for the past five years, I can definitely understand that health care needs major reforming.

Last week, I saw a story in my Facebook feed (supposedly) from an ER physician who was treating some young kid with expensive tattoos and piercings, but with Medicaid (public insurance, for those who don't know). The argument was that if he had enough money for the tattoos, piercings, and cigarettes, we shouldn't have to pay for his health care.

There were so many problems and fallacies with this story and argument that I wanted to write a response. I haven't heard a plan I've loved so far, so this isn't a political statement, but rather an opportunity to flesh out some alternative perspectives.

First of all, I've learned in working with a variety of minors, many will actually give themselves or each other the tattoos or piercings. Others get fancy-looking ones free in trade for a variety of favors. So don't be so quick to assume the kid has money. And there's a lot I could say about the addictive nature of cigarettes that would make just about anyone prioritize buying them over health care.

Ultimately, though, the real question comes to whether we should have to pay for other people's health care. Actually, if you pay taxes and have private insurance, you already pay for other people's health care.

Few people know that most hospitals (at least those with an ER or the equivalent) fall under EMTALA, a law requiring the hospital to treat anyone who walks in if they meet admission criteria, regardless of their ability to pay. The admitting staff cannot ask about insurance or payment until they determine if they will admit the individual. The purpose is that anyone can get help in life-threatening situations, which I believe is good.

Now many hospitals treat huge numbers of people who have no insurance or whose insurance doesn't cover costs. The hospitals still have to operate. So who gets the bill? Those of us with private insurance. Our costs get higher, so our insurance premiums get higher. This is just one part of the skyrocketing cost of healthcare.

And it's not just life threatening situations. People use the ER or hospital for things many people would seek in a traditional outpatient appointment. In the psych hospital, for instance, we would regularly have people admitted because they ran out of medications. Why didn't they get them filled outpatient? Either they didn't have insurance, or more commonly, they couldn't get an appointment. So now an issue that could have a sub-$100 visit up to a few times a month turns into a $1000 a day treatment for 3-5 days. And private insurance holders subsidize this treatment.

This also gets us to the issue of not having enough providers if universal health care is passed. I used to be strongly persuaded by this argument. But then I started realizing what it meant: I have money, so I can have health care; someone else doesn't have money, so they can't have health care. Is that really fair? Or godly?

There's also some fallacies with it. Go back to our individual who couldn't get an outpatient appointment for med refills or therapy. Sure, there is a paucity of providers for public insurance (at least in California). But part of the problem is that the public insurance reimburses providers at such a low rate, they often cannot cover costs. If everyone had insurance that could reimburse at a decent rate, more providers would likely be able to be available. Oh, and don't forget that we still subsidize outpatient visits. Many providers have a certain number of low income or pro bono slots. How do they compensate for the financial loss there? By getting more money from those who can pay.

So don't think you'll start paying for someone else. You already do. And it's a completely ineffective use of that money. If we're going to pay for others' healthcare, let's do it in a way that works and really helps everyone.

No comments:

Post a Comment


Got a question, struggle, or doubt you'd like to see addressed here? Contact me, and I'll try to discuss it (and may even help you get an answer).