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.


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.

12 Aug

Florida strips insurance commissioner of power negotiate lower health plan rates

Slick. Refuse to negotiate lower rates or make the health insurance companies compete like in the other exchanges. When ACA exchange rates are announced for Florida, they’ll be crazy high. Prediction: lots of conservatives announcing ‘failure.’


“Florida lawmakers have left the state vulnerable to unreasonably high insurance premiums in an effort to undermine Obamacare, say the state’s U.S. House Democrats.

Gov. Rick Scott and the Legislature cynically stripped Florida of its ability to review rates for the law’s rollout, U.S. Rep. Ted Deutch writes in a letter signed by all 10 of the state’s Democratic representatives.

The letter, which appeals to the federal government to step in on Floridians’ behalf, blames a law Scott signed at the end of May for refusing to allow the state insurance commissioner to ‘negotiate lower rates with companies or refuse rates that are too high.'”

(Via PolitiFact | Democrats say Florida stripped insurance commissioner of power to set health plan rates.)

Dear small business people and freelancers of Florida. You have an honest-to-goodness actually enemy that doesn’t want you to be able to buy healthcare. Just an FYI.

06 Aug

Andrew Sullivan on freeloading

Andrew Sullivan on the encouragement of Freedomworks and other types to get young Americans of a Certain Political Persuasion to refuse healthcare:

“since 1986, hospitals have been legally required to treat anyone seriously ill who presents himself at an emergency room, with clear medical needs. In the most fundamental way, that was the moment the US socialized medicine – and Ronald Reagan signed the bill. Alas, like so many Reagan domestic initiatives, there was no federal money provided to pay for this. And we all know what happened next: all those extra costs for the uninsured drove up premiums for everyone else, drove up hospital costs, giving them a reason to raise prices even further, and played a role in rendering healthcare unaffordable for many others.

What Obamacare does, like Romneycare before it, is end this free-loading.

The law is telling these young adults that if you want to go without insurance, you are not going to make everyone else pay for it if your risk-analysis ends up faulty. You have to exercise a minimum of personal responsibility to pay for your own potential healthcare. In other words, rights come with responsibilities in a liberal democracy. At least that is what I always understood the conservative position to be.

So why is an allegedly conservative organization actively encouraging personal irresponsibility?”

(Via Since When Was Free-Loading A Conservative Value? « The Dish.)

08 May

New data tracks hospital procedure prices openly


“When a patient arrives at Bayonne Hospital Center in New Jersey requiring treatment for the respiratory ailment known as COPD, or chronic obstructive pulmonary disease, she faces an official price tag of $99,690.

Less than 30 miles away in the Bronx, N.Y., the Lincoln Medical and Mental Health Center charges only $7,044 for the same treatment, according to a massive federal database of national health care costs made public on Wednesday.”

(Via Hospital Prices No Longer Secret As New Data Reveals Bewildering System, Staggering Cost Differences.)

I wanted to add, yeah, there was an incredible difference between what I paid for my Canadian ER visit in Montreal versus the bills I got for Allen County, Ohio. Canada was 1/5, and I paid it all in one go at a bursar’s office, versus the 15-20 bills I get in the US for a visit…

12 Apr

David Farland’s lack of insurance due to refusal of insurers to let him sign up for a plan

By 2050 40% or so of the US workforce is expected to be flexible or freelance. Despite the legions of vitriol against health care reform of any kind, right now things like this happen, when freelancers with preexisting conditions can be denied healthcare by companies and thus put their families at risk:

“Through no fault of his own, Farland cannot obtain medical coverage due to pre-existing health conditions. His wife did have a job that allowed them to carry group health insurance, but got laid off during the worst of the recession. When asked how authors survive these kinds of disasters, Farland answered, ‘It’s only through people working together. People are amazingly kind in times like this.'”

(Via Army of Friends Rally Around Best-Selling Author David Farland.)

The current system is due to change next year, due to the reforms that are coming down the pipe. Alas, this happened a year too early for Farland’s family.

This wasn’t a case of someone just not getting health insurance and gambling his family’s life, according to the story above, but a horrible and unique creation of the existing system that conservatives are fighting hard to keep in place, one that forces us to depend on employers and fear being laid off lest things just like this happen.

Consider helping however you can.

By the way, this could have been me. My genetic heart defect means American companies can, until 2014, refuse to even take my offered money if I wanted to get healthcare. Current we’re insured via my wife, but even if I made enough for her to leave her job, I couldn’t get covered due to the same issue.


You should be.