Health Care Reform #1

Unfortunately, there hasn't been anything truly blog worthy to report lately. Eric is busy studying for the CPA exam and looking for a new accounting position. I have been working the crazy hours as usual at LTCG. I was reassigned to a new set of responsibilities overseeing all of the executive complaints, Dept of Insurance and legal complaints for care management. I can't say it's a promotion as I was not given a new title, nor a raise in exchange for this added responsibility and the inherent stress. But no risk of lay off at present. For this, we are grateful!

So the health care reform/debate has been on my mind lately and I've been wanting to post my thoughts about it. In my career as a medical social worker to date, I have worked for an HMO, a long term care insurance TPA (third party administrator) and for two hospitals (psych and med/surg), so no one can tell me that my opinions are uninformed. I have a lot to say on the subject as it is so complex. With that said, anyone who believes that the debate ultimately boils down to issues of economic cost has no idea what they're talking about.

Following are my thoughts on the subject, organized by the fallacy/topic being perpetuated by the media/politicians I feel most passionately eager to write about!

#1 Fallacy: Uninsured Americans can't/don't get quality healthcare because they can't afford it.

My in-laws did not believe me when I told them that it is against the law for a hospital to deny treatment to anyone who needs it or asks for it regardless of their ability in pay. They also did not me believe me when I explained to them that a hospital is legally prohibited from pursuing reimbursement for care and services from those who do not have insurance and cannot afford to pay. I don't blame them. The fact that the US government already mandates access and delivery of emergent and inpatient medical care to anyone (legal or illegal) regardless of insurance and financial status is not advertised or discussed by the media. The media and politicians want to perpetuate the myth that uninsured Americans are denied healthcare services, or forced into bankruptcy to pay the bills.

In every Medicaid/Medicare participating hospital (more than 9 out of 10 hospitals other than VA hospitals fall into this criteria) there are signs which are printed by the government and in multiple languages posted on the doors and walls which advise patrons that services will be provided to them regardless of the ability to pay.

Have you ever heard of the Emergency Medical Treatment and Active Labor Act? I would encourage you to learn more about it. You will feel better knowing that anyone -- and I mean ANYONE -- can walk into virtually any ER and ask for services and are guaranteed to get them at no cost if they do not have the ability to pay. ERs are overcrowded with long wait times... EMTALA is one of the reasons why because EMTALA only applies to ERs/hospitals.

I worked at UCLA Medical Center in the ER for three years. UCLA is ranked among the top 10 hospitals in the country on almost every measure of quality for patient care and medical practice standards. I can assure you that the homeless population in West LA have the best deal going when it comes to healthcare services -- much better than most of you who have insurance. They walk in or are brought in via ambulance for an illness or emergency to one of the greatest state of the art ERs in the world, they receive the greatest medical care from the top doctors in the world for free, and walk away, back to the streets. No deductibles, co-pays, or insurance precerts for them. You, oh "privileged" insured person, are not so lucky.

But the government and the media will continue to tell us all that unless we have "universal coverage", the poorest among us will continue to suffer and be denied care when they most desperately need it.

http://en.wikipedia.org/wiki/EMTALA

Pay special attention to the section entitled "Hospital Obligations Under EMTALA". Of note, one of the obligations is that "individuals requesting emergency care... must receive a medical screening examination to determine whether an emergency condition exists." This is important because this means that if a patient comes to the ER for an ear infection or strep throat, they qualify for services under EMTALA as they have requested emergency care and are thus entitled for their medical exam. Regardless of the ability to pay.

Among other requirements enacted with EMTALA:

• Patients cannot face criminal prosecution for failure to pay, even if the patient came to the hospital aware of inability to pay. Hospitals and third-party agents may not threaten patients with prosecution as a means of scaring the patient into making payment. Patient can be prosecuted under existing federal, state, or local laws for providing false name, address, or other information to avoid payment, receiving bills, or to hide fugitive status.
• A hospital may not perform a credit check on a patient either before, during, or after stay. The patient cannot receive a negative credit mark for failure to pay the hospital or any related services, or any third-party agent collecting on their behalf. Such services may not threaten patient with credit reporting to scare them into paying.