Thursday, March 25, 2010

Responsibility and Right

Since the passage of the health care reform bill, I've heard lots of talk about personal freedoms and how they're being infringed, often with an admonishment that "This is America, you have to work for what you get!" which distinctly implies personal responsibility, in my opinion.  As the argument goes, the requirement to buy insurance or face financial consequences directly goes against one's personal freedom.  Most states also require the buying of auto insurance in order to legally drive, but no one claims that to be an abridging of personal freedom, at least no one that I know of in their right mind.  Left mind, maybe. 

This is an imperfect analogy, I realize, because driving a vehicle is not required to live.  It is, in itself, a right that is balanced with a responsibility, and that makes sense to most people in the US.  If you don't want to buy auto insurance, then don't drive.  Simple, in theory if not in practice in many parts of our country.  But I'm not writing this to discuss public transit, I'm writing about health care, so I digress.

What seems to be left out in the current discussion is the existence of EMTALA, the Emergency Medical Transportation and Active Labor Act.  This act requires a hospital to provide emergency and stabilizing care regardless of insurance or ability to pay.  If you present with an emergency situation, the hospital must stabilize you (and active labor is considered an emergency under this law) FIRST, then they can worry about how or if you are going to pay. 

What EMTALA does is give you the patient the right to prompt, life saving care, without the wait to check your financial or insurance status.  But this right is balanced by nothing on your part.  In my opinion, the health care reform law balances EMTALA by giving patients the responsibility to attempt to take care of themselves financially by having health insurance.  We do have the option of balancing the equation by taking away EMTALA, but I don't want to be the one to explain to a laboring woman or a man having a heart attack "Please wait here while we check if you have insurance or can otherwise pay for our services". 

Essentially, when faced with the choice between personal responsibility and social responsibility in the United States, we have chosen personal responsibility.  We provide *very* little social support system, on the basis of the Protestant Work Ethic where one works for what they have, and gets what they earn.  However, we require emergency medical care to be provided outside of this framework and without regard to payment ability.  If we put that responsibility onto hospitals, then we need to have patients bear some responsibility as well, and that responsibility on patients is health insurance.  No other profession is required to provide services in this manner. 

Aside from revoking EMTALA, the only other viable option we have is single-payer health care like most other developed nations.  Our choice really comes down to 1) do we want to be a civilized nation that values life, or 2) do we want everything including health care to be based upon the system of desert and assert ourselves finally and irrevocably as a country that values money.

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