Since President Obama has called for health care reform in this coming year and has selected Kansas Governor Kathleen Sebelius as Secretary of the Health and Human Services Department, the perennial debate about universal health care will soon be roaring fast and furious. What the opponents of universal health care apparently fail to appreciate is that the United States already has universal health care - emergency rooms.
In 1986, President Reagan signed the Emergency Medical Treatment and Active Labor Act into law, which requires virtually all hospitals to provide emergency care regardless of the patient's ability to pay, citizenship or immigration status. The Act imposes significant penalties on hospitals for noncompliance but provides no funding to finance emergency room care. This causes hospitals to increase the price of emergency room care so that it can recoup some of its costs from insured patients who access emergency room care. It also causes hospitals to increase the cost of non-emergency medical care provided to insured/paying patients.
While the Act was enacted for the noble purpose of insuring that poor patients received the same care that more wealthy and insured patients can receive, the emergency room system of universal health care has proven to be extremely costly. According to the National Coalition on Health Care (www.nchc.org), nearly 46 million Americans, or 18% of the population under age 65, lacked medical insurance in 2007. About 20% of the uninsured stated that their usual source of care is the emergency room compared to only 3% of those covered by insurance. The US spends nearly $100 billion per year to provide health services to the uninsured, often for preventable diseases that could be treated more efficiently if diagnosed at an earlier stage. The uninsured are 30% to 50% more likely to be hospitalized for an avoidable condition, with the average cost being about $3,300. The National Coalition on Health Care also found that hospitals pay about $34 billion worth of uncompensated care per year; another $37 billion is paid by private and public payors for health services for the uninsured and $26 billion is paid out-of-pocket for those who lack coverage.
When the health care debate begins, Republican politicians will inevitably pontificate about the need to let the free market reign and the danger to our economic system of universal health care. While higher emergency room medical costs may not be the primary culprit of our runaway medical costs, it is time to remind them that we already have universal health care under a system enacted by a Republican president-the emergency room and the Federal mandate that emergency rooms provide all patients receive care regardless of ability to pay. Proponents of universal health care simply want to supplement it with a system that is less costly, more effective, and more humane.