EMERGENCY CARE OR HEALTH CARE?
Louise Annarino
March 27,2012
What is health care? it is more than curing the sick or saving the dying.It is also preventing disease and enhancing wellness. In fact, Medicare has 3 parts: hospitalization, in office medical treatment and preventive care, and pharmaceutical coverage. The oral arguments both sides made today, and the questions of the Supreme Court Justices pivoted about a conception of saving lives through emergency treatment. it is easy to see how this happened. In arguing for the ACA (Affordable Care Act) one might think it best to stress the harm the ACA seeks to prevent in the strongest fashion, i.e. preventing the deaths of Americans. The opposition arguing against would argue that hospitals do not refuse treatment, and no one will die from lack of treatment even if they are uninsured since emergency rooms don’t refuse treatment. Focusing on emergency care is shortsighted.
Justice Scalia engaged in a conversation with General Verrilli who argued in support of ACA,each falling into the trap of distilling health care down to ER care:
GENERAL VERRILLI: No. It’s because you’re going — in the health care market, you’re going into the market without the ability to pay for what you get, getting the health care service anyway as a result of the social norms that allow — that — to which we’ve obligated ourselves so that people get health care.
JUSTICE SCALIA: Well, don’t obligate yourself to that. Why — you know?
GENERAL VERRILLI: Well, I can’t imagine that that — that the Commerce Clause would –would forbid Congress from taking into account this deeply embedded social norm.
JUSTICE SCALIA: You — you could do it.
It is time for a history lesson. “In 1946, Congress passed a law that gave hospitals, nursing homes and other health facilities grants and loans for construction and modernization. In return, they agreed to provide a reasonable volume of services to persons unable to pay and to make their services available to all persons residing in the facility’s area. The program stopped providing funds in 1997, but about 200 health care facilities nationwide are still obligated to provide free or reduced-cost care.” – http://www.hrsa.gov/gethealthcare/affordable/hillburton/
I am familiar with this case, having assisted in enforcing its provisions while a Columbus Legal Aid Society Lawyer,1978-83, when local hospitals were failing to notify eligible patients of the program; denying care to those unable to afford treatment and/or suing them for unpaid charges which should have been covered under Hill-Burton. Is there a societal norm to treat those in need of medical care? Perhaps, but it is not consistently applied; and in the case of hospitals, did not exist under the law until hospitals needed the latest technology and machinery but could not afford it without help from the federal government. The competition between hospitals to have the latest and best drove this bill. Hospitals improved their competitive edge. To get the federal money to do so, they agreed to not turn away those seeking emergency room treatment. They agreed to stop the bleeding, restart breathing, sew up or put in a cast those in need of emergency care. What happens after the emergency is over, i.e. the person will not soon die is not part of the pact. Once one survives the emergency, further treatment is not assured. If one has no insurance, he must pay out-of-pocket. I am concerned the next step will be to repeal Hill-Burton requirements. Justice Scalia would have no problem doing so.
Justice Scalia spoke correctly. Not only could we imagine a system where hospitals and doctors are not obligated to provide health care; we were operating that way until 1946. We still are except for emergency care in the ER, and a percentage of reduced-cost hospital services for income eligible patients. Hill-Burton applies only to participating hospitals (not every hospital participates), and only to hospital costs. It does not apply to doctor’s services.
To focus on emergency care, a saving lives paradigm, and hospitalization needs is too limited a discussion. Health care is so much more.
Justice Kennedy expressed his concern that healthy young persons are mandated to pay for care they don’t need. He assumes more old persons than young persons die. Of course! But health care is about more than saving persons from death. Justice Scalia expressed a belief persons could buy health insurance when they go to the hospital, no need to mandate it beforehand. Again, he focuses on emergency care, hospital care; not health care.
I wonder if the arguments would be better presented by women. After all, we need health care no matter our age. We bear the babies while young, and we take the kids to the pediatricians. We also push the men we love to go to the doctor they strenuously avoid admitting they need to see. We understand health care as much more than emergency care.
annarino writes 