Thursday, March 29, 2007

Notional Health Service

Here's a weird sentence from Andrew Sullivan, in the context of his disputing elements of David Brooks' NYT column today --

I'm a small government Goldwater conservative, but I think compulsory high school education is worth the trade-off of freedom. I think universal healthcare insurance is an infringement of liberty, but since we have committed to providing emergency healthcare for all, it's a trade-off worth making for fiscal and moral reasons.

Which sounds like he's saying: since the government is paying for emergency room care anyway, it makes more sense to provide full health insurance for everyone.

Now somehere in there is a valid point, but more prominently in there is an old canard that circulated back around the time that Hillary Clinton was proposing universal health insurance. In 1993, current Fox News all-star Fred Barnes wrote

Federal law (Sec. 9121 of the Consolidated Omnibus Budget Reconciliation Act of 1985) requires medical screening of everyone requesting care at a hospital emergency room. If treatment is needed, it must be provided. What this adds up to is 'universal access' to health care in America.

This faux chapter-and-verse statement quickly entered the discourse and helped undercut the case for Hillary's plan. The problem is that it's wrong. Emergency rooms are only required to stabilize anyone presenting, not cure them, and even more, the emergency room still charges. They send a bill. A very large bill, even if they only sent you back on the street with painkillers when you actually might have cancer. And the bill doesn't get paid. And then some combination of the hospital, other patients, charities, and taxpayers end up paying the bill -- while the uncured patient retains all the uncertainty of wondering how they'll manage the next time they get sick.

Now that is one good argument amongst many for universal health insurance, but read Sully's sentence and it's not clear that's what he means. In particular, his use of the word "provide" puts him in Fred Barnes territory, territory that in 1993 Barnes shared, in helping bring down the Clinton plan, with the New Republic -- edited by Andrew Sullivan.

UPDATE 3 APRIL: Not clear from this new post by Sully which version of "we already have universal health insurance" he means --

Yes, I'm fine with universal health insurance - but mainly because we currently effectively have it anyway, in the most inefficient manner possible, and only if the health system remains in private hands.

FINAL UPDATE 11 JULY: Joining the club of those who believe that emergency rooms already provide universal health care -- George W. Bush (caught by Dan Froomkin):

The immediate goal is to make sure there are more people on private insurance plans. I mean, people have access to health care in America. After all, you just go to an emergency room.

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