MEMO TO MICHAEL GRAHAM: WHY CAN’T WE BE ALLOWED TO LET YOU DIE?

So far as I know, those who want to repeal and replace the Affordable Care Act have never been asked anything like the above question.

On NPR’s weekend edition last Saturday, Scott Simon put another question to the conservative talk show host Michael Graham. “Do you believe,” Simon asked, “that every American has the right to health care?” Graham said “no.”

In the present rhetorical climate of obfuscation, equivocation, and circumlocutory evasion, Graham’s “no” was refreshing. But when Simon went on to ask Graham if he would let people die, he quickly said that nobody was talking about that and then veered off into the topic of Meals on Wheels.

But it’s high time we did talk about letting people die.

If you believe, as Graham does, that everyone should be responsible for his or her own health care, why should all the rest of us have to pay for emergency room care? Suppose you get hit by a truck as you’re crossing an intersection. If you have freely chosen to be uninsured as well as to save no money and have thus exercised a right that is dear to all conservatives, why can’t all the rest of us just as freely choose to let you bleed to death right out there on the street? Why can’t we be allowed to let you die?

The simple answer to this question is that letting you die in this way is against the law—specifically against the Emergency Medical Treatment and Active Labor Act (1986), which was signed into law by that well-known bleeding-heart lefty known as Ronald Reagan. According to this law, any Emergency Department that accepts payment from Medicare—and virtually all of them do—must treat anyone who needs emergency care, including women in active labor, regardless of his or her ability to pay. Since the law provides no federal money to compensate Emergency Departments for this care, it is precisely what all good conservatives loathe: an unfunded mandate. As such, it levies a hidden tax on hospitals and everyone who pays for their services in any way. One way or another, all of us who can afford to do so have to subsidize emergency room care for those who can’t afford it for themselves. And the cost in not small. According to the American College of Emergency Physicians (http://www.acep.org/content.aspx?id=25936), hospitals furnished over 50 billion dollars’ worth of uncompensated care in 2013.

So how can this hidden tax be justified? Only by stating a principle that largely contradicts what Michael Graham told Scott Simon. And the principle is this: every American has the right to life-saving health care. That is what the Reagan-signed Emergency Medical Treatment Act affirms. So anyone who believes, as Graham does, that no American has the right to health care, that each of us is responsible for our own health care, should be asking Congress to repeal Reagan’s EMT as well as Obama’s ACA. Call it the “let them die” amendment to the bill for repeal. If anyone freely chooses to be uninsured and broke, emergency room doctors may freely choose not to treat them. Let them go on bleeding. Let them die. Let women in labor have their babies on the street.

I doubt, of course, that even the most rabidly conservative legislator would have the guts to propose such an amendment. But if I’m right in believing that all sides in this debate accept the principle that every American has the right to life-saving care, consider what this principle entails.

It doesn’t just apply to the short-term care that Emergency docs provide. It also applies to the long-term effect of health maintenance, particularly preventive services such as cancer screenings that are now fully covered under the ACA. To deny such services by making health insurance unaffordable for some 24 million Americans, which is what the repeal of the ACA would do, is to let a significant number of them die every year. In 2010, according to Families USA (http://familiesusa.org/product/dying-coverage-deadly-consequences-being-uninsured), over 26,000 people between the ages of 25 and 64 died prematurely because they lacked health insurance.

Is it any less heartless to let them die than to let anyone bleed to death at the door of an Emergency Room?

When are we going to affirm the principle embraced by virtually every other developed nation in the world—that for the good of us all, every American has the right to health care--which means affordable health insurance for all.

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