April 2010

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Health Care Reforms and Rights Language


By Jonathan Wallace jw@bway.net



           The major trope the Republicans have used against health care reform is that of “big government” violating individual rights by forcing you to buy a product you don’t want:


Representative Michael Burgess (R-Texas) told CNSNews.com that if the mandate in the health care law requiring individuals to purchase health insurance or be penalized is upheld by the courts, the federal government could mandate anything, such as requiring all Americans to purchase a General Motors car.




           Writing in the Christian Science Monitor (some subtext there, as Christian Scientists don’t believe in medical treatment) Anthony Gregory says, “Nothing in the Constitution authorizes any federal involvement in healthcare”, and invokes the Tenth Amendment (also the ninth, the 13th, the 4th, etc). http://www.csmonitor.com/Commentary/Opinion/2009/0914/p09s01-coop.html


           What is so remarkable about the Republican trope, so plausible on its face as directed to people who loathe government, is that no consideration is given whatever to the inevitable consequences of a “right” to be uninsured.


           What happens when you are critically injured in an automobile accident, or stabbed or shot by an assailant, and transported to the emergency room? How many of the Tea Party types railing against mandated insurance are clear-headed and courageous enough to say, “If I don’t have insurance and can’t pay, don’t treat me”?


           The U.S. health care system is broken in more ways than I can specify in this article. (Just tonight, I got an email saying that the coverage I was barely able to find in my state—I am retired but too young for Medicare—is going up another 20%, for a 40% increase in the last two years.) But we are actively losing hospitals, such as the venerable St. Vincent’s in Greenwich Village, based on a gross conflict between economic realities and laws and protocols which say that everyone must be treated.


And its emergency room volume has been growing faster than the citywide rate, suggesting that it has the worst of both worlds — more emergency room patients and fewer inpatient admissions, which are where the money is….




           Emergency rooms are loss leaders, as most of the really critical patients brought in, suffering from extreme traumas requiring complex surgery and lots of care, have no insurance. Moreover, the uninsured tend to use the ER as their family doctor, coming in for minor problems such as colds which also use up ER time and resources and bring no income. Hospitals hope that enough patients will come to the ER capable of paying for actual admissions that the cost of the ER will be offset, but large urban hospitals rarely are able to accomplish this.


           I worked on ambulances in New York City’s 911 system from 2003-2007, and carried many stabbing and gunshot victims to St. Vincent’s or elsewhere. These people immediately required attention from seven or eight doctors, nurses and technicians, the use of expensive scanning and anesthesia, and difficult surgery, for which they would never be able to pay. After being treated, they would be admitted for weeks or months of post-surgical care (if they survived), all at taxpayer expense.


           During those years and since, a disturbing number of the hospitals to whose emergency rooms I brought people went out of business: Parkway,St. John’s and Mary Immaculate in Queens; St. Clare’s, Beekman Downtown and Cabrini in Manhattan;  St. Mary’s in Brooklyn; among others.


           Obviously, a solution to the gross economic drain on hospitals of having to treat impecunious trauma victims would be a single payer system, like the ones happily maintained in several countries which are close allies and culturally similar to the U.S., notably Canada. Short of that, requiring people to carry health insurance guarantees that hospitals providing services will be paid for crisis treatment.


           The Republican trope, that requiring the purchase of an insurance “product” is a gross violation of personal rights, cannot logically imply a right to be treated at taxpayer expense. Instead, a completely consistent world-view would countenance piles of dying people on the sidewalk outside the ER. The very first thing any doctor would want to know before applying any treatment is, “Can you pay?”


           Of course the logistical problems involved in answering this question are immense. The patient is likely unconscious and unable to answer questions, and may have gone out without a wallet or handbag, or had it stolen in the incident. I suppose we could all bar code our insurance status on our skin somewhere, but an inventive assailant who wanted to make sure you didn’t get treated would deface the bar code—or carve out a microchip implanted in a consistent place, or rip off an “I have insurance” necklace.


           The attorney generals of thirteen (red) states are challenging the constitutionality of the insurance mandate.   Yet in many states, you aren’t allowed to operate a vehicle on the road unless you have insurance for it. It is a well settled moral and legal concept that privileges may be conditioned on obligations. In this case, we either need to condition the other privileges of American citizenship on having health insurance coverage, orgo very far in the other direction, and countenance the corpses on the sidewalk. Because anyone maintaining both a right to be uninsured, and a mandate to be treated at public expense, is selfish and thoughtless.