For those not in emergency care, EMTALA stands for Emergency Medical Treatment and Active Labor Act.  It is a law that says that everyone in our emergency departments must be treated without hospitals or doctors asking for money.  We can send bills, but can’t collect before seeing them.  This was, in its inception, a good idea.  Doctors and hospitals were turning away seriously ill patients and women in active labor, and sending them to indigent hospitals across towns, or further.  People died.

So, EMTALA was a good thing.  For a while. Now, it has become a huge unfunded mandate, and everyone knows it.  Doctors in offices send patients to ER’s when they owe too much money for office visits. And patients know, despite their nice cars and trucks, nice cell-phones, jewelry and expensive drug habits, that they won’t have to pony up any cash to be seen.  So, our volumes are huge, our waits are long, and we collect about 25% of what we bill (or less).

For a long time, I’ve been muttering to my friends and family that if we could just let doctors write off uncollected debt from their taxes, it would help a great deal.  Not only ER docs, but everyone in medicine!

Apparently, someone in California has been listening to my thoughts and conversations.  Because Rep. Mary Bono (R. California), Sonny’s widow, has introduced legislation that would do exactly this; provide tax relief for bad debt accrued by physicians working under EMTALA.  We all need to work to make this happen, and support Rep. Bono.  I haven’t seen the bill, so I don’t know the specifics.  But it’s a brilliant idea.  Not only would it help offset the huge mandate that is EMTALA, it could encourage physicians to see the uninsured.  And in the end, the government would get more health care for the uninsured than they lost in tax revenues.  (Of course now they get both, but it’s inherently unfair).  Furthermore, it wouldn’t require that any new funding pathway or agency be developed!
Attorneys understand our difficulty on this topic, as they have to do ‘pro-bono’ (no pun intended to Sonny’s dear wife) care.  That is, courts appoint them to give free legal counsel to those who can’t afford it.  Furthemore, that’s a constitutional right.  But they aren’t getting paid what they consider fair market value.  (Of course, they’re getting something, which beats the EMTALA reimbursement of zero!)

But physicians and attorneys need to be behind this legislation together, because it makes a statement.  The government can’t just have what it wants for free.  There is a cost.  And a right can’t be a right if someone else has to pay for it.  Life, liberty, the pursuit of happiness, these don’t require that I write a check, a physician work for free, or an attorney spend valuable hours counseling a murderer on how to stay out of the electric chair.  They are rights, not entitlements.  Pro-Bono care and EMTALA have become perverse mixtures of rights and entitlements.  They’re ‘entitlerights’.

Let’s all work together on this to have a more equitable, and sustainable system.  I want to see everyone.  I don’t want to repeal EMTALA.  But there has to be a balance.  In the end, it may even reduce the cost of healthcare across the board; even to the already insured.

Call your congressman/congresswoman and senator.  Let’s help Mary Bono make this a reality!

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