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Friday, March 22, 2019

Columns

Can’t afford not to care


Yo Ho Haul Together by David Haydon

 

 

Even after the second anniversary of its passing, the Patient Protection and Affordable Care Act remains a magnet for controversy.

Much of the act has yet to go into effect, but as provisions become effective, they enter the cross hairs of pundits and politicians across the nation.

The Supreme Court is deliberating on the constitutionality of the individual mandate provision of the act — which requires individuals not covered by employer or public health insurance plans to purchase private health insurance policies.

Before that, the 24-hour news cycle erupted over hormonal birth control being considered as preventative care and covered at 100 percent. In the mire of all of these debates, it’s easy to forget what we are already paying for.

According to the Census Bureau, almost 50 million Americans were uninsured last year, including 19 percent of 18- through 24-year-olds. While some of these individuals might be able to afford general care like primary physician visits and, if they are lucky, possibly simple outpatient surgery, emergencies are a whole other story.

An uninsured, seemingly healthy college student can be bankrupted in an instant by a single car accident or an unexpected cancer diagnosis. While those who oppose government regulation of any kind, including health care, might be able to say “let him die,” hospitals are fortunately, legally bound to provide care to those who need it.

In 1986, Congress passed the Consolidated Omnibus Budget Reconciliation Act, which allows individuals who have lost their jobs to maintain their health insurance coverage at a significantly higher price for a certain period of time.

The bill also included the Emergency Medical Treatment and Active Labor Act, which requires hospitals and emergency facilities to treat any patient experiencing an emergency, regardless of insurance or ability to pay. The Centers for Medicare and Medicaid Services reports that currently, up to 55 percent of US emergency care is entirely uncompensated.

The EMTALA makes no mention of reimbursement for these services. So, how can hospitals afford to treat these patients? Property taxes. A percentage of state property tax revenue goes directly to the support of hospitals, schools and other local organizations. As American taxpayers, we are already paying for the health care of the nation’s uninsured, and we are doing it in the most financially inefficient manner possible.

The scale of this financial inefficiency is easily illustrated by the fact that those without insurance are far more likely to procrastinate treatment. Without the money to see a doctor, a simple and treatable condition such as tonsillitis can become a life-threatening emergency in the form of an airway-blocking abscess.

Now instead of the patient’s care costing no more than an office visit and an antibiotic, the patient must turn to a hospital emergency room for surgery, which must be performed by a specialist.

This is why the Affordable Care Act not only mandates that non-covered individuals purchase their own insurance, but also covers preventative care at 100 percent to incent individuals to seek out care early, when it is less expensive and more effective.

The mandate was originally a conservative idea designed by Bush advisors and conservative Mark Pauly when he was tasked to come up with a free market solution to the problems in our health care system. His solution was a conservative one, rooted in personal responsibility.

GOP presidential nominee Mitt Romney was, until recently, so proud of the effectiveness and success of the health care program he implemented in Massachusetts precisely because he felt the backbone of the system was a conservative solution — the individual mandate. Successful state health care programs — such as Romney’s in Massachusetts — laid the Affordable Care Act’s foundation.

As a society, Americans have always taken care of one another. As a matter of policy, we do not deny needed health care to those that cannot afford it, and we are not about to start now. The Affordable Care Act, while flawed, at least makes it possible for more US citizens to have access to cost-effective health care and reduces the number of uninsured burdening the system with the costs of delayed care.

No bill is perfect, and it may not be the exact program we wanted to see, but it’s a step in the right direction for patients and taxpayers alike.

Emily Brooks is an economics senior and may be reached at [email protected]

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