The 1986 Emergency Medical Treatement and Active Labor Act, makes medical care A RIGHT, as it mandates
"hospital Emergency Departments that accept payments from Medicare to provide an appropriate medical screening examination (MSE) to individuals seeking treatment for a medical condition, regardless of citizenship, legal status, or ability to pay. There are no reimbursement provisions. Participating hospitals may not transfer or discharge patients needing emergency treatment except with the informed consent or stabilization of the patient or when their condition requires transfer to a hospital better equipped to administer the treatment."
What does this actually mean? "There are no reimbursement provisions" means the hospitals and/or doctors bear the COST of treatment of an uninsured person requiring emergency care. How do you remedy this?
At the core of ObamaCare is something called the "individual mandate." The Individual Mandate requires every person to purchase health insurance. As with auto insurance, a portion of the coverage is for taking care of the owner of the vehicle; a portion also serves to INDEMNIFY the owner against the financial harm he/she would cause to others. In plain English, it ensures the damage you cause to someone else is covered.
The individual mandate is also at the core of Republican objections to ObamaCare: they claim the government should not "force" people to purchase health insurance. However, the individual mandate is not some socialist construct, dreamed up by a socialist Kenyan.
"The concept of the individual health insurance mandate is considered to have originated in 1989 at the conservative Heritage Foundation. In 1993, Republicans twice introduced health care bills that contained an individual health insurance mandate. Advocates for those bills included prominent Republicans who today oppose the mandate including Orrin Hatch (R-UT), Charles Grassley (R-IA), Robert Bennett (R-UT), and Christopher Bond (R-MO). In 2007, Democrats and Republicans introduced a bi-partisan bill containing the mandate. " ~ The History of the Individual Health Insurance Mandate 1988-2010
The second accomplishment of the individual mandate, is about how insurance functions. Insurance functions by the pooling of premiums to cover the actuarial risks. This means we all pay our premiums to cover the small percentage of us who would have catastrophic losses. While those risks can be mitigated, in the case of drivers, by regulations such has control of driver's licenses, it is not the same for healthcare. The older people get, the more likely they will have one or more catastrophic health and thus financial events.
So with the individual mandate, requiring every person to buy health insurance, THE POOL of younger, healthier people is greatly expanded, and allows for the coverage of the older persons, with greater risks of catastrophic illness.
The Fly in the Ointment
There is however, a fly in the ointment, private insurance companies.
The massive role of the insurance company in health care serves no purpose other than to transfer money from the health care providers to a group of people who provide no services, yet saddle practices with mountains of paperwork and regulations. Yet these are the very same "industry people" who consistently complain about "government regulations."
Private health insurance, is the sweetest business proposition in the history of business. They insure people just up to the actuarial age, where they are most likely to have a catastrophic health event, 65. After which the patient is turned over to "the government" Medicare.
Persons with expensive kidney failure, who have private insurance, are automatically turfed to the government Medicare system.
So this leaves us with a government run medical insurance program, which by definition, insures the sickest people.
The remedy of this is to lower the Medicare eligibility age, to bring healthier people into the pool.
Let me be clear, this is not "socialized medicine," it is a single payer system. The services provided to patients, insured by Medicare, are provided by physicians in private practice.
This contrasts with an actual socialized medicine program like the Veterans Administration, where the government owns and runs the entire system.
There are those who will argue that a government run system is inherently a bad system. My own experience tells me differently. My experience as a practice administrator, informs me Medicare is the most efficiently run insurance plan out there.
The administrative costs of dealing with private insurance can be as high as 14% of annual revenue. As a practice administrator, whose practice saw nearly 70% Medicare patients, and 30% private insured patients, we incurred a cost as high as 7% just to be able to submit our bills to these private insurance companies. Let me repeat, the 30% of our patients who are privately insured are in fact responsible for nearly 90% of our billing related expenses.
One study has shown the average administrative cost to practices to deal with insurance company pre-authorizations, referrals, and drug approvals is $80,000.
Related to the above, every insurance company has its own set of rules. Every insurance company has its own set of tricks to delay and/or avoid payment to a physician for as long as they can. One such trick is the "we need your Tax ID number trick." This usually occurs at least once a year, from a company that has been sending the practice checks for the past 8 months. How is it, all of a sudden, they need the Tax ID before they can send out the next check? Did all the Tax ID's in their computer system get erased by the IT intern? I doubt it. Every doctor in private practice will tell you the same story: there is no greater threat to their existence than the Health Insurance Industry.
This systematic delay of payments is based on something financial people call "float." Imagine purchasing a Visa gift card as a Christmas gift today. The card is not actually used until after New Years. This allows Visa to hold and invest your money on the short term market. Companies can forecast the average number of days it takes a person to use some/all of these types of funds. The same concept it at work here.
Reimbursement to primary care physicians has not increased at all in the past 20 years; at the same time the cost of health insurance is up 131% over the last 10 years.
To get a grasp of the shocking amount of money sucked out of the health care marketplace by insurance companies one only has to look at the retirement package provided to former United Health care CEO "Dollar" Bill McGuire, who was walked away from his health insurance company with more than $2 billion in his retirement package. This same pattern is par for the course in private health insurance companies. The median CEO pay in 2010 was $10 million dollars.
Click to see list of Compensation Leaders for Healthcare
If one places this income inequality in the context of the recent CBO report, it is easy to see the stark contrast in the health care industry when you compare the income gap between the "providers of health care services" to that of the insurance company executives, with the providers being to do more and more for their patients, while the insurance executives compensation continues to escalate.