Boiling It Down

King of Malaysia

Image by wazari via Flickr

With confirmation bias rampant, sometimes it makes sense to me to try to boil problems down to basics, so I have tried to do that here.  A writer in the Globe thinks he is the only one who can see through the Emperor’s new clothes, but he fails to look beyond his own prejudices for the real problem.  Below is the piece I offered in rebuttal this morning.  If Mr. Eberhardt is typical, the subject of medical care is still confusing people.

On the Globe’s opinion page (3/17/2011) Duane Eberhardt had some fun slamming Democrats for their foolishness in passing the Affordable Care Act, a.k.a., ObamaCare, in

1989 Corvette C4 Coupe - Wrecked. Dec 21, 2008.

Image by TexasDarkHorse via Flickr

that it requires insurance companies to cover preexisting conditions.  He likens it to waiting until after an accident to buy auto insurance or until after a fire to buy house insurance.  Well, it does sound pretty silly.  But suppose there were a law on the books that forced repair shops and builders to fix the cars and rebuild the burnt-down houses regardless of the ability of the owners to pay? Who then would want to buy insurance?

That is exactly the situation we have had in the healthcare industry for the last 35 years.  From Wikipedia:  “The Emergency Medical Treatment and Active Labor Act . . . passed in 1986 . . . .  requires hospitals and ambulance services to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions. As a result . . . , patients needing emergency treatment can be discharged only under their own informed consent or when their condition requires transfer to a hospital better equipped to administer the treatment.”

As a society we Americans are unwilling to see anyone want for needed medical care and

Barack Obama signing the Patient Protection an...

The President Signs the ACA, via Wikipedia

we also like to live in the moment.  We save little for the future and we indulge ourselves in unhealthy lifestyles.  Medical care is expensive and science keeps coming up with expensive equipment and medicines to offset those lifestyles, but we don’t want to pay for insurance until we need it.  EMTALA allows people to do that and that’s why the system is broken.

The ACA is an attempt to make the best of a bad situation, but Mr. Eberhardt is right that it invalidates the basic concept of insurance.  But he is wrong to slam the Democrats for it.  Why?  Because just like the GOP he offers no solution to the dilemma of EMTALA.

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About Jim Wheeler

U. S. Naval Academy, BS, Engineering, 1959; Naval line officer and submariner, 1959 -1981, Commander, USN; The George Washington U., MSA, Management Eng.; Aerospace Engineer, 1981-1999; Resident Gadfly, 1999 - present. Political affiliation: Independent, tending progressive as the GOP recedes from its Eisenhower roots.
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4 Responses to Boiling It Down

  1. jwhester says:

    Your point is well taken. However, there is a bit of comparing apples to oranges also going on in this discussion of pre-existing conditions.

    When insurance companies refuse to cover people with pre-existing conditions, it is NOT like car insurance companies refusing to insure past accidents. It is more like them refusing to insure anyone who has EVER had an accident. They figure that their chances of having a second accident is more than someone who has never had an accident, so it improves their bottom line, and it leaves many people uninsured.

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  2. Jim Wheeler says:

    Hmm. I think the comparison is valid.

    The person who comes bare of financial means or insurance to the ER with a stroke or heart attack is, in effect, asking the system to repair him after the accident, whereas had he been insured, seen the doc regularly and taken her meds, she would likely not be in such broken condition. Now, there she is in ICU and somewhere in the maze of equipment is a metaphorical machine going, ka-ching, ka-ching on the taxpayers’ dime.

    BTW, auto insurance companies do that which improves their bottom line because that is the way insurance is supposed to work. Risky behavior should be penalized with higher premiums because that encourages good behavior. Greed has nothing to do with it. If that discourages people from buying collision insurance, then such people need to look inward for the blame, not towards the insurance company. Too bad medicine can’t work that way.

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  3. My only question about this is what was the rate of medical inflation before 1986? My sense is it was pretty high even before the federal mandate to serve. My sense is that hospitals have always ultimately served even those with out an apparent means to pay in a medical emergency even before the federal mandate to do so. Interesting that this federal mandate dates to the days of Reagan. Is that Ironic?

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  4. ansonburlingame says:

    Jim,

    I agree that the GOP has failed to solve the problem as defined by you and most Americans. The premise is that everyone MUST have access to the best medical care available. And no one has solved that problem and NEVER will do so in my view.

    Either side comes up with new ideas to attack parts of the problem, such as Obamacare “attacking” preexisting conditions. It solved THAT problem, at least to a greater degree than ever before. But it forgot to figure out how to pay for it!! Even if Obamacare is deemed constitutional with the mandate to purchase health insurance we STILL won’t be able to affort such care, in my view.

    100 years ago people would have “Mom” set a broken arm and put a splint, homemade, on it. Today……?

    I am watching “The Tudors” an interesting “saga” now on Netflick about Henry VIII. He was injured in a joust and all of England, including the doctor by his bedside, simply prayed for him. The doctor reluctantly decided not to “bleed” him and said Henry was simply “in the hands of God” shortly after the injury. Henry survived and soon thereafter cut off Ann’s head! He humanely decided not to burn her at the stake.

    But back to the premise, the unachievable premise, of the best healthcare available for all. It is a great “end”, like world peace forever. But the means to achieve such “ends” are not achievable.

    We have made a “little” progress to prevent really big wars, of late. They are called nuclear weapons, like ’em or not. I sometimes believe those weapons are a good solution to traffic problems in Dallas and Atlanta when I get “stuck” in such traffic. And then of course there is world population waiting to be solved.

    Imagine any government of 100 years ago deciding to pay for the setting of every broken leg in America as well as providing all the splints at government expense. Well such is reality today, like it or not.

    I don’t disagree with “everyone” having access to the best possible medical care. And everyone in fact does have such access today, except in massive emergencies when doctors and facilities are overwhelmed by sheer numbers. What we have tried to do but not done however is relived the burden of the COST of such care from “everyone”.

    Ultimately government now tries to carry that cost burden and it is NOT working, here, Europe or former communist countries.

    After writing about healthcare for two years now, I am convinced solutions are not available given the opening statement of the problem or goal.

    How about “health care must be available to all Americans but each American must pay for it themselves”. We did exactly that until 1965.

    America CAN afford the solution to that problem because each American will then have to decide what and how to pay for medical care, or automobiles, or steak dinners, or …… “fritos”, etc.

    Now I can already hear you and liberals think I am crazy to suggest such an inhuman approach. OK, it is a tough approach for sure, like triage in emergencies. But before you challenge the impossiblity of such a solution on humanitarian grounds, show me ANY socialized medical system anywhere in the world that has ever worked over the long haul. I don’t know of any such successful system giving the best to all, all the time (of anything) without factoring cost, sustainable cost into the system.

    Many have tried, but none have yet to succeed, in terms of medical care for all.

    Anson

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