01 Oct

American healthcare was already socialized by Reagan, we’re just fighting about how to pay for it

Today the US government shut down. Ostensibly by Tea Party Republicans to try and stop socialized medicine from becoming a reality. In fact, false equivalence reporting has lent an air of respectability to the effort (they might be fighting a losing battle, and the polls are low for congress and Republicans, but they’re fighting for their minority opinion).

By the way, false equivalency is when you’re a news organization and someone says ‘our party believes the world is round’ and you have someone on saying ‘the world is flat’ and the reporter says ‘opinions differ’ and offers you poll results about what people believe after the two talking heads hash out why the world may or may not be flat.

So here we are.

But the fact is, US medicine has been socialized since the year 1986.

1986.

In 1986, President Ronald Reagan passed a bill called the Emergency Medical Treatment and Active Labor Act, or EMTALA.

See, up until 1986, hospitals and doctors could turn people away if they didn’t have the money. So could emergency rooms.

Let’s repeat that.

Up until 1986, in the USA, hospitals could turn a dying person away at the door if they didn’t have money, or refuse to treat.

As you can imagine, costs were kept down.

In 1986, Republicans passed EMTALA. What did EMTALA do? It socialized healthcare and made emergency rooms just like police, or firemen, or roads. It said people showing up on a door step of an ER dying *could not be refused* treatment.

Why did this happen. Because patients were being, literally dumped, by hospitals to prevent having to assume the expense of treating them:

Congress passed EMTALA to combat the practice of “patient dumping,” i.e., refusal to treat people because of inability to pay or insufficient insurance, or transferring or discharging emergency patients on the basis of high anticipated diagnosis and treatment costs. The law applies when an individual has a medical emergency “and a request is made on the individual’s behalf for examination or treatment for a medical condition.”

Here’s what that looked like on the ground:

Ron Anderson, M.D., president and CEO of Parkland Memorial Health and Hospital System in Dallas, was the medical director of the emergency department at Parkland in the early 1980s, and he knew all about dumping. “I would see patients transferred with knives still in their backs, or women giving birth at the door of the hospital, simply because they were uninsured.”

These, and many other shocking incidents, caught the attention of the CBS investigative show 60 Minutes, which, on March 17, 1985, broadcast an episode titled “The Billfold Biopsy,” about the dumping of unstabilized patients at Parkland.

So basically, Ronald Reagan set up hospital emergency rooms as socialized healthcare, and then…

…didn’t fund them.

It’s an unfunded mandate.

So it’s illegal to let patients die on your doorstep. A step forward in society (Reagan at the time said it allied with American’s Christian principles and his own). But the Republicans of the time never paid for it. They kicked that particular can down the road.

As a result, hospitals saw emergency room visits drastically increase. Insurance companies, because many of the uninsured used emergency rooms as care (to which they’re legally allowed, it’s how to collect the payment later that’s in issue), try to refuse to pay for the increase. Hospitals got clever at burying costs into healthy patient’s procedures, or anywhere else.

The system gets distorted.

So we already have socialized healthcare, it’s just that the hospitals, the government, and the insurance companies are all putting their fingers on their noses and saying ‘not it!’ due to that single fact: the 1986 bill was an unfunded mandate.

The thing is, one way or another, we do pay for it. Via taxes. Via higher costs of procedures. Via too much red tape caused by this giant game of ‘not it.’

Because of EMTALA.

Hillary Clinton tried to create a way to pay for it, so that all citizens chipped in. It looked too socialized. The Heritage Foundation suggested that all citizens just be forced to carry health insurance, and that if it cost too much for poor people the government chip in a little. Much like using the road (only, because the road is ‘being alive’ everyone has to have car/health insurance because you can’t get off the road, except for by dying), everyone has to have insurance. Massachusetts adopted this model, and it’s not perfect, but it’s way better than the current situation.

Obamacare imitates the Heritage and Massachusetts model. But it’s being fought by anti-Obama Tea Party folk because it’s socialism.

No son. Socialized medicine arrived in 1986.

What is being fought out is a case of ‘will we now be fiscally responsible about the socialized medicine that Ronald Reagan signed into law or will we continue using the expensive, unfunded mandate via emergency room payment system that has been a mess since 1986?’

The current House Republicans claim to be fighting socialized healthcare. If they were, I’d respect their ideological position. But none of them are filibustering or trying to repeal EMTALA. I haven’t seen a single attempt to repeal EMTALA by any of them.

So stopping the government, all the fits thrown this week, all this misery and the high, high cost of this shutdown to the economy, will come merely because Republicans refused to pay for a mandate their party created in 1986. (also, if you’re a Republican or Tea Party and not campaigning against EMTALA, I don’t take you seriously if you say you’re fighting socialized medicine, because you’re not, you’re just fighting to not have to pay for it).

Right now, ACA lets freelancers and people in between jobs get healthcare. It lets people outside of large corporations get healthcare. It lets small businessmen get healthcare.

It makes the practice of insurers dumping people with preexisting conditions illegal.

It makes it easy to find a healthcare package.

It has already been shown to be slowing down the rising cost of healthcare in studies.

And people want to try to stop it. Because it might help people not have to wait until they’re hurting in front of the emergency room to get the benefit of that 1986 law, it’ll let people start taking care of themselves ahead of time.

It’s been working in one state very well for a long time. It works well in other countries. We know how the ground game goes.

One group is doing everything they can to stop it, because this refinement of how the 1986 law is handled society-wide is coming from someone they didn’t vote for. That’s not a reason to hurt millions. It’s the biggest, saddest, childish thing I’ve seen.

Remember it come the next round of elections.

Remember well.

Here is Healthcare.Gov.