Op-Eds Speaking Truth to the Powers-That-Be
If polls are to be believed, perhaps half or more of the people in this country do not consider “health care for all” a collective good, claiming that a “mandate” violates the American ideal of individual liberty. One American physician argues that this Tea Party talking point violates a fundamental, moral mandate of American citizenship.
In last week’s Viewpoint in JAMA, the Journal of the American Medical Association, Dr. Zeke Emmanuel proposed an alternative way of thinking about a citizen’s responsibility to obtain health insurance. He asserted that there is a mandate, a civic duty to buy insurance based on the moral duty each of us has to decrease certain burdens that we pose upon others in society.
A law called the Emergency Medical Treatment and Active Labor Act (EMTALA) states that emergency personnel, including physicians, have a duty to rescue those in need of medical assistance, even when the burdens to the emergency care provider are more than minimal.
A doctor, nurse, or EMT that finds you injured or incapacitated in an emergency has a legal and moral obligation to help you.
This law extends to hospitals that must provide emergency medical care to everyone, regardless of insurance status.
“Indeed, EMTALA can be accurately said to have established universal health care in America—with nary a whimper from conservative activists,” says Forbes contributor Avik Roy.
If physicians and hospitals have this duty, Dr. Emmanuel reasons that “Individuals have a corresponding duty to purchase insurance to cover the costs of this care.”
He interprets this to mean individuals, at minimum, should buy catastrophic policies, not necessarily more comprehensive ones. This requirement, he says, is “consistent with respect for individual liberty.”
In terms of the cost to the individual, catastrophic policies, especially those with some deductibles, should be affordable and would mitigate the burden on the general public who end up paying higher medical costs and insurance premiums because those completely uninsured fail to meet this obligation.
The recent mass shooting in Aurora, Colorado provides a real world demonstration as to what happens when injured individuals without health insurance are taken to hospitals for treatment. The most seriously injured of the 58 people shot continue to require round the clock hospital care that could easily cost hundreds of thousands, if not millions, of dollars per person.
Among them is 23-year-old Caleb Medley who was shot in the eye and is now in an induced coma in the ICU. He has no health insurance. Adding to the burden on society in terms of health care costs is the fact that his 21-year-old wife Katie is also uninsured and has just had a baby. In both Caleb’s case and his wife’s, hospitals cannot turn patients away when they are in need of acute care (i.e. Caleb’s injury and Katie’s delivery).
There is no information as to whether Katie received any prenatal care, but if she did not because of lack of health insurance, there could have been potentially serious risks to her baby’s life as well as her own during and even well after the pregnancy.
According to a 2011 survey by the Colorado Trust, more than 1.5 million people in the state are uninsured; 20 percent of whom are able to pay for health insurance, but said they were not willing to pay. As many as 28 percent of 19 to 34 year olds in Colorado are uninsured, the highest among any age group.
One of the reasons that young people refuse to buy health insurance even when they are employed is that they consider themselves healthy and see little risk of getting sick.
Unfortunately, that assessment is (obviously) not always accurate. Besides specific conditions that are more prevalent in young people, like Hodgkin’s lymphoma and testicular cancer, accidents – the most common cause of death in this age group – are all unforeseen. Then there is the second leading cause of death for ages 15-24 – homicides. Gunshot and knife wounds are the kind of unexpected health emergencies for which all too often young people do not insure themselves.
The media’s response to the Medleys’ uninsured status was to advertise the website where we could all go to donate money for their medical bills. Denver Health set up charity funds to take donations to help defray the cost of all the victims’ care.
Even if enough millions are raised for these particular patients, is online “crowd funding” and hospital charity really the way we, as a country, want to deal with the issue of access to and costs of healthcare in the US today? If they don’t raise enough money, the hospital will pass on the costs of their care to insured people, and insurance costs will rise as a result.
Instead, why not use the Aurora tragedy with the resultant dilemma of the victims’ enormous uninsured medical bills as a teachable moment to finally have a serious discussion about the need for everyone to buy health insurance?
The notion of the “common good”, of pulling together as a society, needs to return to the place of honor it held for so many decades before the Neoconservatives and then the Tea Party demonized it.
In the meantime, for those only motivated by self-interest, Dr. Emmanuel’s argument that there is a moral obligation for everyone to buy health insurance should be persuasive.