What to do about/how to pay for emergency health care?

[GeorgiaDon 407]

Several current and recent posts regarding health care have made me wonder what people what people think about the current American policy towards emergency health care. (Obviously this poll is directed towards Americans, but others are welcome to add their comments of course). At present, if someone shows up at or is brought to an emergency or trauma center, they must be treated to save their lives. Some proportion of these patients cannot or do not pay for this treatment. As a result, others are forced to pay more, either in taxes or through higher insurance premiums (as insurance plans are billed more than they otherwise would have to be to make up the loss the hospital takes on the non-payers). Poll option (1) is to continue this policy as is. Poll option (2) is to require proof of ability to pay before treatment, and patients unable to prove this would not be treated, even if that means that they die. This would of necessity also include patients who are incapacitated and for one reason or another don't have their wallet/insurance cards on them when they are brought in. Perhaps prudent people would have their policy information tattooed on conspicuous locations on their body; several tattoos would be advisable as some locations would be subject to road rash or other obscuring injuries. Option (3) would be to treat everybody, but make it harder to get out of paying, or perhaps allow taking of a kidney or cornea or something (presumably not a heart) in exchange.

It seems to me that the current approach isn't working very well. Some people are being tapped to pay for care for others, who in some cases can get away without paying anything. That creates an incentive for people to not buy insurance. Emergency wards and trauma centers are stretched thin, and many are closing. Here in Georgia the state legislature just passed a law imposing "superspeeder" fines to raise money for trauma centers; if you're stopped for doing over 85 mph on an interstate or 75 mph on a 2-lane state highway, you get an additional $200 fine. This is supposed to bring in $25-30 million/yr, but it seems to me if people do slow down a bit the revenue could be less, and not very predictable or dependable. Anyway I think the issue is important, and even more so for skydivers, as we can all think of situations where it would suck to have no trauma centers to go to, or to have to be transported an excessively long distance to get life-saving care. So how do we put life-saving care on a sound financial footing? One way would be to deny care to those who can't pay, but personally I don't like that option. Some people who could pay will arrive unconcious and without a wallet, and then would be left to die (hence my facious comment about tattooing). Also I don't think medical professionals would be happy about having dead/dying people piling up outside the hospital doors. However I suspect some SC posters wouldn' have a problem with exactly that.

If you vote for option (1) or even (3), I'm curious if anyone has a constructive suggestion about what could be done. My suggestion, which I know is not without problems, would be to fund the centers on a state-by-state basis with a sales tax on all goods/services. The tax would likely be small (<1%), and would be applied entirely to life-saving emergency and trauma care. The logic is that everybody, including illegal immigrants and those too poor to pay income tax, still buy goods and services, so they would contribute. Hopefully, since health insurance plans would no longer have to pay for that level of care, premiums could go down, so people who already have insurance might not see much of a net change in income (although I don't know the numbers well enough to be sure of that). Anyway that seems to me to be one way to assure that everyone is covered and everyone pays something. Of course, health insurance would still be needed for anything more, such as reconstructive surgery and physiotherapy to restore optimal function, so there would still be pretty much the same incentive to pay for insurance as there has always been.

What's your suggestion?

Don

_____________________________________
Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996)
“Education is not filling a bucket, but lighting a fire.” (Yeats)

[billvon 3,176]

>It seems to me that the current approach isn't working very well.

Agreed. So cover basic emergency care for everyone. That way no one is turned away. At the same time, do not cover anything beyond that. Break your femur? You get X-rayed, evaluated for complications and put in traction. Want an IM rod? Well, you'll need insurance (or some cash) for that. Heart attack? Emergent treatment is covered, but that quadruple bypass isn't.

>would be to fund the centers on a state-by-state basis with a sales tax on all
>goods/services.

Not a bad idea, provided it was administered well.

[georgerussia 0]

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It seems to me that the current approach isn't working very well. Some people are being tapped to pay for care for others, who in some cases can get away without paying anything.

There is also another related problem - people who do not have medical emergency, but still are coming to the emergency room because they do not have insurance and cannot afford or don't want to pay for the office visit. This may or may not fit the discussion, as this is not "emergency health care", but it still takes significant resources from emergency room stuff, so it has to be addressed too.

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My suggestion, which I know is not without problems, would be to fund the centers on a state-by-state basis with a sales tax on all goods/services. The tax would likely be small (<1%), and would be applied entirely to life-saving emergency and trauma care. The logic is that everybody, including illegal immigrants and those too poor to pay income tax, still buy goods and services, so they would contribute.

I like this approach. The only issue I see is that 1% might not enough. We pay more for Medicare, which provides coverage to less people. And hospital visits could be really expensive. So the real tax might easily end up like 7-10%, which would be a significant change.

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