Limit the freebies

As I’ve written about before, one problem with health care in our country is caused by the government mandate to provide emergency services regardless of patient’s ability to pay in the Emergency Medical Treatment Act from 1986.  As the linked Wikipedia article  points out, hospitals that don’t  abide by the act lose out on Medicare and Medicaid payments, which pay for 44% of total medical costs.

The emergency care act is well-intended.  Few people want to see people in dire medical need be denied care.

But, unfortunately, the discussion and thinking usually stops there — are you compassionate or not?

We never seem to proceed to the next step of exploring the real world consequences of this compassionate mandate.  One real world consequence is moral hazard, which leads to an externality.

The moral hazard is that I face less incentive to arrange for cost-effective medical care by doing things like buying insurance and building a relationship with a primary doctor, because if I need medical attention I can get it at an emergency room.

The externality is that my poor planning causes others to have to pick up the cost of my emergency room visit through higher emergency room fees.  According to the emergency care act Wikipedia article, 55% of emergency care goes uncompensated.  No wonder emergency room bills are so high.  Those who do pay have to cover for those who don’t.

Free emergency care is a good deal.  Sometimes businesses run good deals too and they put a limit on them, like “Limit 1 Per Customer.”

Maybe with emergency care we should set a limit on the number of freebies that you get.  Maybe at some point we should expect those who are using the system to pay for it or to find a more cost-effective solution.

I know folks would likely still have a trouble denying care to someone who has run out of freebies, but maybe at that point we start taking a closer look at their lifestyle and see why they can’t afford to buy insurance or pay a $50 doctor’s office visit.

Even the insurance that I pay for has a maximum lifetime benefit.  Why shouldn’t the free stuff have a limit too?

1 thought on “Limit the freebies

  1. Very few voters would support a policy of turning somebody away from an emergency room when treatment is needed. An alternative might be that after the third or fourth unpaid visit to the emergency room, government (not hospital) investigators examine the visitor’s finances, and garnish a small part of the person’s wages (if there are any) or seize and sell “luxury” items such as a TV. The goal is to impose some cost, even quite small, on unpaid visits.


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