So, You Think You Can Get Health Care If You Need It?

In the raging discussion about the need (or lack thereof) for health care reform, one of the arguments that comes up frequently is that there are already laws in place guaranteeing medical treatment for those who are sick, irrespective of their ability to pay.

Not true.

The majority of indigent care is provided by charity hospitals. They may be funded by their local government or have various private benefactors. In order to be designated a 501(c)3 non-profit facility eligible for federal tax-exempt status, the IRS requires that they provide a "community benefit" (as stated in the Internal Revenue Code). As such, charitable hospitals are judged on whether they provide sufficient health benefits to the community.

The key word here is "sufficient".

Much of what is considered sufficient is dictated just as much by local governments and benefactors as the regulating agencies. The facility doles out care as described in its charter and as required to keep its non-profit status. That generally involves treating those at or below the poverty line. So if you're super poor, you'll most likely be able to get the treatment you need. It may take awhile to get, and it may not be as good as the care your neighbor got when he had the same thing, but you'll get treated.

But who is treating the guy making $70,000 per year, providing for a family of four, who doesn't have health insurance? He won't meet the charter of the community hospital. What if he gets sick? At the end of the day, real world practice is much different than any ideal penned in a lofty mission statement.

The Emergency Medical Treatment and Active Labor Act (EMTALA) was created in 1986 to prevent hospitals from rejecting patients, refusing to treat them, or transferring them to "charity or county hospitals" because of inability to pay or Medicare or Medicaid coverage. EMTALA makes sure you or I get care no matter what if it's a life or death situation. It provides for women in active labor or those requiring emergency treatment to avoid long-term consequences (i.e. broken bone, etc.). But the reality is that many private facilities consider EMTALA a bad word and do everything they can to minimally stablize patients and boot them out the door as fast as possible.

When I worked in the emergency room of a large, for-profit hospital, I can't tell you how many times we had to turn patients away because they didn't have insurance. Or how many times the E.R. docs claimed it wasn't safe to let a patient leave but the hospital administrator refused to allow them to be admitted. The rule of thumb was do to as little as possible in the least expensive way to be able to transfer them somewhere else.

During my time there I saw three patients die after E.R. docs were forced by hospital administrators to discharge them. One of them died not 10 feet away from the E.R. doors, another died in the hospital lobby, and another died in the car as her husband was taking her to the county hospital. And at the end of the day, what did the hospital gain? They had to pay huge legal fees to represent them in court.

The only ones who have the "right" to care now are those with insurance who show up at the right provider's door (the one in their network), the independently wealthy, and the super poor. It's the middle class that's having the problem - and they represent the largest group of citizens in America.

Sources:
1. EMTALA: http://www.emtala.com/faq.htm
2. IRS Regulations for Non-Profit Facilities: http://www.irs.gov/publications/p557/ch03.html
3. Portrait of the Middle Class:http://www.commerce.gov/s/groups/public/@doc/@os/@opa/documents/content/prod01_008833.pdf
4. How the Middle Class Struggles: http://www.usatoday.com/money/perfi/general/2003-09-14-middle-cover_x.htm