May 7, 2012
For decades, the attempts at health care reform have aimed to increase access. The United States is one of the few industrialized nations in the world that does not provide universal health care to its citizens. And repeatedly, those who oppose it have been forced to argue that access isn't the problem some make it out to be. Why?
The emergency department, they say. After all, it is a commonly held belief that no one can be denied care there. So -- in essence -- everyone can get free health care if they need it. We have a universal system after all.
That, of course, is not true.
It's not even close. Let's start with the idea that emergency rooms must provide you care.
What's important to remember is that you can't be refused emergency care. That's because the Emergency Medical Treatment and Active Labor Act (EMTALA) requires that any hospital that takes Medicare or Medicaid must check you for emergent conditions and treat them if they exist. Since nearly every hospital in the country takes federal funds from one of these programs, nearly all hospitals are subject to EMTALA.
But "emergency medical condition" has a pretty narrow definition. It includes active labor for women and acute conditions that would cause death, serious bodily organ harm or serious bodily function impairment if they were not treated right away.
If politicians are meaning to say that women have universal access to delivery care, then I suppose there's an element of truth to that. But there's no guarantee of prenatal care in the emergency department. If they are saying that we have universal access if we're acutely having a heart attack, then I suppose there's truth to that as well. But there's no such access for lipid panels, stress tests or prescriptions for cholesterol medications that might help you avoid the heart attack in the first place. If you're acutely obstructed by massively advanced colon cancer, it's likely you can get emergency surgery to end the blockage. But your cancer is likely too far advanced to cure at that point. Moreover, you're not going to get chemotherapy in the emergency department nor could you have gotten the colonoscopy that might have detected the cancer far earlier.
You can't get preventive care in the emergency department. You can't get screened for a host of disorders. You can't get treatment for your depression there or really for any chronic mental disorders. You can't get help with your child's autism, ADHD or developmental delay. And even if you could, it wouldn't be free.