Dr. Tom: How did you answer? …

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By Thomas R. Kluzak, M.D.

So, how did you answer the question, “Should everyone in the United States be entitled to health care?”

Sorry, that was a trick question. It doesn’t really matter because the question has already been answered for all of us, and the answer is “yes.” The Emergency Medical Treatment and Active Labor Act of 1986 requires treatment of anyone who shows up in an emergency room, regardless of citizenship, legal status or ability to pay.

The impetus behind this law was the common practice of dumping, sending patients, especially those who had no insurance, across town to another hospital. It only applies to emergency rooms that accept Medicare and does not include any provision for payments.

Under what is known as an unfunded mandate, it should have been easy to predict what would happen. A person goes to the emergency room with a minor complaint, found, after a CT scan or two, to be straightforward and easily treated. Months later, a bill for $2,000 or more, arrives. Unable to pay it, bankruptcy ensues.

Therefore, we all end up paying for such uncompensated care, which is a very significant part of the overall health-care budget. It was recently estimated that hospitals, on average, cannot collect 6 percent of what they are owed.

I personally have little sympathy for most hospitals since I have seen how poorly they treat employees, especially as mergers increase, creating large systems that offer corporate health care. Nevertheless, none of us would want to run a business that starts in a 6-percent hole.

Maybe a better question would be: What do we owe our fellow human beings? As individuals? As a society? Those should keep a plethora of philosophers busy for a millennium or so, with so many positive and negative consequences surrounding the act of giving, but I would suggest that an initial consideration would have to include cost.

If a person were dying of thirst, who would deny that person a glass of water? But, what if that glass of water had a price tag of $1,000? Or $100,000? It becomes a different question, doesn’t it?

So, I am going to go out on a philosophical limb here and suggest that we can afford basic health care for everyone in this country, relying not on EMTALA, but rather a more rational approach to financing and cost control, and will discuss how in the next columns.

For next time, imagine the horror of socialized medicine.

Dr. Kluzak, an Idyllwild resident, is board certified in  Anatomic Pathology, Obstetrics and Gynecology. He also is a freelance photographer for the Town Crier.

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