My entire medical career has been colored by the reality of governmental regulations.  EMTALA, the Emergency Medical Treatment and Active Labor Act, has been in force throughout the duration of my practice so far.  The law, if you don’t know about it, compels hospital emergency departments (and hospitals in general that take Medicare) to see everyone without payment ‘up front.’  We can bill, but payment is not required for care.

It was a good idea in its infancy.  It kept the poor from suffering undue delays in care.  Now, like the hungry monster in the basement that was ‘so cute and cuddly,’ it has grown huge and it wants to eat all the children in the house.

Nevertheless, we have managed.  Though some hospitals have closed as a result of EMTALA; though some doctors have quit, or retired early; though many specialists elect to no longer take call due to the burden of uncompensated work, most of us trudge on, trying to do the right thing as often as we can, medically, financially and ethically.  And our efforts are often rewarded.
But in light of the gargantuan folly of the economic bailout, I want to ask just one question of everyone in Washington:  ‘Where’s our bailout?’  For years we have done just as you guys told us…’see everyone, do it well, keep smiling, don’t make mistakes, provide the best care in the world and remember that you’re all rich doctors, so quit your whining.’

Well, the banking industry did what government and other private concerns told them; for a while.  They gave loans to people they knew would never pay them back.  Kind of like working really hard to help that sick patient who will never, ever pay a dime.  Fair enough, we all want to help the underdog.  But now, the banks have cried ‘uncle.’  Now, the banks (nominal capitalists all) are holding out their palms for the mother of all socialist interventions.  And so is the auto industry!  Which, as far as I’m aware, was never compelled by anyone to give away a free car.  (If such a program exists, please notify me as I have four children rapidly approaching driving age.)

So the money is flowing from the taxpayers to the industries in order to keep all of them solvent.  Mind you, we in medicine have asked for some crazy things like: increases in reimbursement for actual work on actual people; tax credits for uncompensated care; limits on malpractice awards.  As a result, Medicare payments fluctuate along with Medicaid.  Care is still free.  Malpractice litigation sails along as smoothly as the Love Boat.

So, where’s our bailout?  When will the checks arrive to keep hospitals afloat?  Hopefully, never.
The thing is, I don’t want a bailout.  The banking and auto industries have now, by their surrender and white flag, opened the door to enormous pain.  (I mean, if you’ve ever watched a war movie, you know what usually happens when you put down your rifle in surrender, don’t you?)

They will rue the day, we will all rue the day, when the US Government, arguably one of the most glorious experiments in freedom and most horrific examples of efficiency in history, decided to take over major industries in America.  Especially banking.

So keep your bailout!  I’d rather keep working under EMTALA as it is than have the federal government bail me out with any scheme whatsoever.  In fact, I want the exact opposite.  I want the government to ‘bail out,’ of medicine.  To jump from the great airplane of health-care and pull the ripcord, floating away to distant locales so that we can do what we know how to do…which is take care of sick people.

I want Medicare, Medicaid and even private insurance to go away so that prices are fair and reasonable for everyone, and so that we don’t have what we do now, which is a system of regulations that would probably take all of the four years of medical school to read and comprehend.

We have had, since the 1940’s, a progressively growing experiment in socialized care, since the government is so deeply involved in medical care and reimbursement.  We had, in a sense, our ‘bailout,’ in advance when we were offered money from the government and took it, rather than screaming and running into the night.

It hasn’t worked.  It isn’t going to work.  Bail us out by leaving us alone.  No, let me rephrase that.

To everyone in government, right and left, who has a great idea about how to fix health-care:  ‘Go away!  Leave us alone!  We know what to do and how to do it!  Unless you’ve done rectal exams, over and over, you don’t need to muddle with medicine, because you just don’t understand it.  Get a hobby!  Start campaigning for 2012, or something else useful.’

See, I don’t want any bailout.  I’ll keep paying on my house.  I’ll keep paying property taxes to educate other kids, even as my wife and I home-school our own.  I don’t want vouchers.  I don’t want subsidies for my property.  I just want my job, my family, my faith, my free speech, my firearms and all the other things in the Constitution that God so wisely put into the brilliant minds of the framers…who, by the way, said nothing about funding or controlling health-care.

So, to all of the powerful folks in Detroit, New York, Chicago, all of you big-dogs waiting for the feast about to be dumped on you from my children’s future tables:  I hope you enjoy what you’re about to get.  Salt it heavily, because it isn’t going to taste very good.
And to Washington and all its assorted evil minions:  Please, don’t send medicine a bailout.  Things aren’t perfect, but I for one prefer the current chaos to any future help you might offer.

Unless you want to help us by getting out of the way.

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