Tuesday, October 9, 2012

Adalja on Repealing EMTALA

Dr. Amesh Adalja, a Clinical Assistant Professor at University of Pittsburgh School of Medicine, discusses why we should repeal the EMTALA law that forces ER's to provide emergency care to all individuals seeking care irrespective of ability to pay.

Here is an excerpt from his 10/8/2012 Forbes piece, "Universal Health Insurance Mandates, And The Emergency Care Myth":
To concretize what EMTALA does to a healthcare facility, transpose the law to the restaurant setting. If a hungry person goes to a restaurant and orders a cheeseburger and is unable to pay, restaurant personnel are completely free to withhold the sandwich and, if this is a frequent occurrence, to refuse entry of the person into the building. These actions are a clear exercise of the individual rights of the restaurant owner to do commerce with whom she wishes on a voluntary basis with terms mutually agreeable to both parties. This common sense, market-based approach in which one is expected to pay for the things one needs is forbidden from occurring in the healthcare realm, and those who violate EMTALA are subject to heavy fines.

One other consequence of EMTALA, also not often mentioned, is that it creates a moral hazard. If a person knows that, because of EMTALA, they will not be refused emergency care despite being unable to afford it, what is their incentive for obtaining insurance? While a person is still legally liable for the hospital charges, many hospitals eventually “forgive” the unpaid debt with minimal repercussions for the individual.

What EMTALA has predictably created is a situation in which emergency care has become viewed as a right to be provided by healthcare facilities irrespective of the fact that to do so nullifies the rights of providers. In creating this false right, EMTALA also fuels the animus of certain individuals against purchasing their own health insurance because the law created an emergency care safety net that is always available.
Basically, government mandates create moral hazard and "cost shifting" which is then used to justify yet more government mandates (such as the individual mandate to purchase insurance).  As always, controls breed controls.

Instead of piling on more government controls, we need to repeal and unwind them.  I'm glad that Dr. Adalja is putting EMTALA on the table for discussion.  Let's hope policymakers listen to him.

(Read the full text of "Universal Health Insurance Mandates, And The Emergency Care Myth".)