Healthcare Reform In America

Health Care Reform in American

What is Necessary Now

Amit Thaker

Millions of Americans and over 11 million illegal entrants working in the United States have no form of health care coverage and rarely an ability to pay for services provided to them when they choose to utilize the U.S. health care system. Typically these patients practice poor preventative health and wellness practices and often present with very acute and very serious medical and surgical illnesses. By law (EMTALA) hospitals and providers have no right to refuse the non-payer treatment and in turn, billions of health care dollars are "spent" annually on care for which hospitals and providers will never be compensated. Each and every one of us pays directly and indirectly for the billions in uncompensated care. That care is paid for in taxes, in medical costs, and in insurance premiums and we will continue to pay unless we do something today about the rising uninsured population and a government that appears confused and lost in how to deal definitively with this issue. If we all look to the greater good, we can begin to buck a national trend that is swelling the ranks of the uninsured and wreaking havoc in the health care system to the tune of millions and millions of dollars Ð'- money that is extracted from the coffers of the insured payer.

My interests in this discussion are therefore two topics:

1. The problem with the uninsured and how provision of that health care affects the overall delivery of care to general population in economic and non-economic means.

2. The problem with rising medical liability premiums and how this rise is not proportional to the rates of awards or case prevalence.

The following is a case example of the inequity in how the uninsured patient taxes the health care system in a financial fashion that exceeds the system's ability to subsidize that care. Physicians and hospitals are bound to follow the Emergency Medical Treatment and Active Labor Act (EMTALA) that mandates that all emergency services be provided to any patient who presents to an emergency department, regardless of their ability to pay. Any patient with an emergency medical condition is evaluated, treated and admitted and provided sub specialist medical/surgical care based on medical/surgical necessity. In an emergency situation, financial and demographic information will be obtained only after the immediate needs of the patient are met. Patients are admitted or discharged based on their physical health and not based on the patient's ability to pay their bill. Patients can only be transferred from the admitting facility to a level of equal or higher level of care only if their medical or surgical needs cannot be met the present facility. Hospitals are required to provide coverage for the facilities hey routinely perform and as of present, mandate their professional staff to provide that call service, while taking that provider away from his/her practice, placing them at medical legal risk in the process of mandating that call, with no promise of compensation or security from litigation from the patient for whom the free service is provided. Those services, even at an uncollected loss, cannot be written off when preparing taxes for the medical professional's business practice, as the government refuses to recognize that practice as having any value.

Some years ago, as the trauma surgeon on call for the hospital, an illegal entrant was shot by the police while in the act of committing a robbery. In the course of committing that crime, he shot and killed a convenience store worker. By law that patient comes to my emergency room's trauma suite and is resuscitated per ATLS protocol, taken to the operating room where life-threatening injuries are repaired and his life saved. He was given the same care and provided the same surgical expertise that the Pope would have been provided had he been our patient that evening. Interestingly, after surgery the patient is not arrested, but a police officer is posted outside his room 24/7. Pima County within the state of Arizona and thereafter all of his medical bills would be honored by the state. The instant this patient is discharged from the hospital, he is taken into custody and the legal system side-steps the responsibility to pay any of the bills accumulated during the admission, which exceeded $200,000 dollars after a nearly 6 week hospital admission. The city-appointed attorneys representing my patient thereafter were compensated, yet the hospital and the providers who rendered services never received compensation. That same patient, who never paid a penny for the great medical and surgical care provided, maintains the right to sue both hospital and provider if he ever were to believe that his care was substandard. The effects of this inequity over time, in certain geographic areas, have significant implications on the delivery of health care in those areas. To protect themselves from EMTALA regulations smaller hospitals stop performing certain services, such as infant deliveries, as they are often high risk and complicated. These patients are then transferred out of area, to a higher level of care, funneling patients at rates beyond the receiving hospital's ability to accommodate, still without any means to compensate. The end result is the financial destruction of the higher level of care, because the law requires that those increases in uncompensated services be provided. Also, providers will leave the area to open a practice in more provider-friendly regions, or will restrict their practices and the region therefore loses the ability to provide that service, or the provider will retire from practice early. In Tucson, as the population grows, we are losing physicians per capita of the general population, while rural areas restrict