Cruel new Fed Law Requires Proof of Citizenship for Medical Care [Archive]

empeake

1st July 2006, 12:44 PM

The problem of this new post-9-11 (hysteria)law is not that it will prevent impoverished non-citizens from getting care, but will corral large numbers of Americans, especially those born in the U.S. w/o birth certificates or access to birth certificates and kick them out of the system as well.

http://www.washingtonpost.com/wp-dyn/content/article/2006/06/30/AR2006063001504.html
I think I can safely assume these guys never did a cost-benefit analysis. I'm no expert on the subject, but it does seem that the negative consequences for people that are entitled to Medicaid are greater than the alleged benefits. Does sound like a egregious case of immigrant bashing for political purposes.

I'm not fully aware of how Medicaid works, so I have the following question: In this scenario, what happens to victims in need of emergency treatment? Are they just jung out to dry?

SteveGrenard

1st July 2006, 01:04 PM

I'm not fully aware of how Medicaid works, so I have the following question: In this scenario, what happens to victims in need of emergency treatment? Are they just jung out to dry?

I think you mean "hung out to die" rather than jung out to dry.

The law conjures up visions of immigrants without money or Medcaid benefits being told to leave the clinic or ER, go out to the curb and wait to die. A garbage truck will be along in the morning to remove your body. Is this a scenario that can happen? Without Medicaid or Medicaid pending and a shortage of non-profit hospitals over wide swaths of the U.S. which are comitted to doing charity care I would say it is definitely a possibility and would be a national disgrace.

After the lawsuits fail, if they fail and and if Congress refuses to reassess the issue there should be action by doctors and other health care workers, well some doctors anyway and an organized resistance by the AMA, the black physicians organizations and the medical student's association, nurses group, well, all of those.

There is something perverse about Warren Buffet and Bill Gates chipping in double digit billions for health care in Africa & Asia if a health care crisis of these proportions occurs right here. Imagine Africans saying they need to go back to Africa to get some Buffet-Gates health care but can't afford the ticket. The billionaires ought to stop smiling for the cameras and start speaking out on this issue.

Tailgater

1st July 2006, 01:10 PM

It's not hard to get these things if you are a citizen already. I have ruined 2 ss cards in the wash and lost my birth certificate moving. Didn't take long to replace them. Hospitals won't turn away people in an emergency as it is. Don't see why it's so hard to ask people to show proof of this. If someone doesn't have some sort of proof (since you need a birth certificate for just about everything else) there is no way they are "in" the system in the first place. Took me forever to get a new liscense plate because of all the proof I needed. I would like to see what these unnecessary, mean spirited, expensive rules are. Funny they cite that people already have to show this proof for other benefits so they shouldn't have to show it again. Uh, doesn't that mean they already have the documentation? I like how they give benefits to people now because they swear that they are citizens. Ya, the honor system is a great idea for the whole welfare system.

RandFan

1st July 2006, 01:12 PM

I'm not fully aware of how Medicaid works, so I have the following question: In this scenario, what happens to victims in need of emergency treatment? Are they just jung out to dry?Absolutely not, the Supreme Court has ruled that no person can be denied Emergency Treatment simply because the lack the means to pay.

Also, The federal Emergency Medical Treatment and Active Labor Act, commonly referred to as "EMTALA," was enacted by Congress in response to a concern over "patient dumping" by hospitals refusing treatment of individuals who could not afford to pay for medical services. EMTALA imposes a duty on the hospital and its physicians to provide medical screening examinations and medical stabilization of all individuals seeking emergency care, regardless of the individual’s ability to pay.

Tailgater

1st July 2006, 01:14 PM

RandFan

1st July 2006, 01:19 PM

ER patients are not turned away even without proof of insurance now. That is one of the problems hospitals are facing. I'm not saying they should, but it is an already existing strain on health care and using people sick on the curb is a bad example.Emergency clinics and trauma centers are closing in ever increasing numbers.

Catastrophe in Care (http://www.tucsonweekly.com/gbase/Currents/Content?oid=oid:69346)
Hospitals are being crippled by the costs of treating migrants--and that could be just the start of an immigrant-related health crisis

You think these coyotes are fools? They don't want some hollow-eyed lunger hacking and coughing blood on them. So it's adios, pal, and now you're America's problem. But they know that already. Every illegal realizes that if he makes it to an emergency room in Southern Arizona, or anywhere around the country for that matter, he can get treatment, free of charge.

It's federal law, and has been for 20 years. In its evolution, the policy has become a kind of federal health insurance program for illegals, and its rising costs are eating up resources that could otherwise go to poor and uninsured American citizens. It has created a financial nightmare for border hospitals and contributed to cutbacks in services at Tucson hospitals.

Is this an outrage? A scandal? Some think it's both. But going back to our active TB sufferer, here's something even worse: The guy can't get treatment anywhere, goes underground and takes a job at a restaurant in Tucson or L.A., and coughs his way to infecting scores of others.

Talk about a Hobson's choice. But as with everything in the ongoing crisis of illegal immigration, the hard choices would largely evaporate if the federal government fulfilled its constitutional duty and took control of our border.

The threat illegal immigration poses to American public health plays out every day at Arizona's hospitals. Until recently, the issue remained only marginally public, a problem medical people batted around among themselves, not with the media. Even today, several hospitals contacted for this story declined comment.

Of course we could always pretend that there is no problem and just ignore it... because, hey, to confront the problem makes one a racist.

empeake

1st July 2006, 01:35 PM

I think you mean "hung out to die" rather than jung out to dry.
Typo. I meant "hung out to dry".

HeavyAaron

1st July 2006, 01:42 PM

Emergency clinics and trauma centers are closing in ever increasing numbers.

Of course we could always pretend that there is no problem and just ignore it... because, hey, to confront the problem makes one a racist.

As a Tucsonian, and in the health care industry, I'll vouge for the article. Tucson has recently closed one of its two level one trama centers. Meaning outside of the Phoenix metropolitan area all of Arizona now has ONE level one trama center. And it's the costs of treating those who cannot pay (which does include, of course, Tucson's very large illegal population) which has done it.

For a while it was being bantered about by Arizona's representatives to try to get Federal dollars to help out border states' hospital obligations as it's a Federal law that puts the burden on us. It didn't go anywhere, however. It still seems like a decent idea to me, though. The US/Mexico border is a NATIONAL border, not just Arizona's border. And the law requiring treatment at any ER is a NATIONAL law. It seems unfair that these national problems are paid for by Arizona and Tucson (as well as New Mexico and Las Cruses, etc.), which are below average economies for the US.

Aaron

RandFan

1st July 2006, 01:52 PM

As a Tucsonian, and in the health care industry, I'll vouge for the article. Tucson has recently closed one of its two level one trama centers. Meaning outside of the Phoenix metropolitan area all of Arizona now has ONE level one trama center. And it's the costs of treating those who cannot pay (which does include, of course, Tucson's very large illegal population) which has done it.

For a while it was being bantered about by Arizona's representatives to try to get Federal dollars to help out border states' hospital obligations as it's a Federal law that puts the burden on us. It didn't go anywhere, however. It still seems like a decent idea to me, though. The US/Mexico border is a NATIONAL border, not just Arizona's border. And the law requiring treatment at any ER is a NATIONAL law. It seems unfair that these national problems are paid for by Arizona and Tucson (as well as New Mexico and Las Cruses, etc.), which are below average economies for the US.

AaronI am in California and the closing of trauma centers started in the south and has been steadily moving north. But not to worry, the money pouring in from illegal immigration will someday cover the shortfall I'm sure. Untill then it would be best to avoid trauma.

skepticdoc

1st July 2006, 01:59 PM

SteveGrenard

1st July 2006, 02:04 PM

I am in California and the closing of trauma centers started in the south and has been steadily moving north. But not to worry, the money pouring in from illegal immigration will someday cover the shortfall I'm sure. Untill then it would be best to avoid trauma.

Also avoid heart disease, stroke, kidney failure, assorted cancers, serious infection of any kind, and any other potentially fatal disorder.

While it is a Federal law to treat an emergency such as life threatening traumas (stop bleeding all over the emergency room) there are many other life threatening conditions as well so I suppose it is alright to not treat them. I don't know any private, investor-owned hospital that will treat these whether you are an immigrant, legal or illegal or a citizen unless you can pay or have insurance.

The gist of the Wash Post editorial is that in spite of what was said above there are many Americans, particularly poor older Americans who were born at home more than 50 or 60 years ago and whose births were never registered. They may not have drivers licenses either and a SS card by itself is not sufficient to establish citizenship or legal immigrant status.

If they use the criteria on the I-9 form, which has two categories of proof, one is passport or birth certificate with a second i.d., or from column B two forms of identity being a SS card and a driver's license or other picture ID. Those who do not have the documentation, even if born in the U.S.A., will now be denied Medicaid benefits. Period. End of story. No exceptions, sorry bud. Got cancer, sorry, go home and die.

I sympathize with the uninsured immigrant situation and those providing such care and this is a separate issue that needs to be dealt with. In NYS it is via charity care where we have many hospitals owned by the church (although St Vincents Health Care in NYC recently had to declare bankruptcy for their efforts) and the community which are non-profit and are required by state law to to give charity care. Rumours of non-proifts shirking this responsibility has triggered an investigation by our illustrious Attorney General, Elliot Spitzer who happens to be running for Governor right now.

But in areas where there are no non-profits and where private investor owned hospitals rule the roost there is no Federal law which compels them to render free care to extremely sick people who just happen not to be in imminent danger of dying at the moment they are being seen.

Closing ERs and trauma centers is one way privates can wiggle out of the business of giving free care. And yes, they can be a liability rather than an asset. They used to be viewed as a place to exploit auto insurance medical policies and a marketing tool to fill beds with insured patients but the scales have tipped away from this so it is understandable why they would close up.

RandFan

1st July 2006, 02:09 PM

I am a liberal, even socialist physician in the U.S.

I think Medical Care should be Universal and transnational.

We should have the courage to ration care, why perform major surgery on demented Alzheimer's patients that are Nursing Home residents? We all will suffer the consequences of communicable diseases like antibiotic resistant TB if we don't help the poor , legal or illegal resident status.

What is the situation in Canada and the UK? If I get sick on vacation, will get the same care as the Nationals?Hey Skepticdoc,

I'm truly torn on the issue. I'm currently without insurance and it has been a real problem for me. Health care is unbelievably expensive. I live in a liberal state that has pretty good benefits and I'm fortunate for that.

The libertarian in me says not to socializing of medicine. My own personal experience would favor it.

RandFan

Anti_Hypeman

1st July 2006, 02:19 PM

HeavyAaron

1st July 2006, 02:24 PM

If preventative care was available to the uninsured emergency rooms would not be so overrun. The uninsured with minor conditions have to wait for it to turn into a life threatining emergency to get it taken care of.

Last I checked you can pay for medical care with cash. You don't need insurance.

And before you tell me they don't have cash, and that I should foot the bill, make sure they don't have cable TV, go to the movies, have sterios, drive cars, etc. Because otherwise it just means that I'd be funding their entertainment.

Aaron

skepticdoc

1st July 2006, 02:28 PM

In the U.S. people should fight to get the same medical care as government employees, congressmen and senators!

skepticdoc

1st July 2006, 02:33 PM

HeavyAaron

1st July 2006, 02:34 PM

And we should ban tobacco and alcohol too!

I thought of putting those on the list. Seems to me that if a person has money for smokes and boose, they don't need my help paying their doctor.

Aaron

articulett

1st July 2006, 02:40 PM

HeavyAaron

1st July 2006, 02:44 PM

I think I'd rather fun their entertainment then spend 1.7 TRILLION dollars on a war based on a lie (not to mention all the dead people, anguish, and so forth)--but then, I've always been a smart shopper--

False dicotomy. As a libertarian I'd rather fund neither, and in reality we fund both.

Aaron

SteveGrenard

1st July 2006, 03:20 PM

Last I checked you can pay for medical care with cash. You don't need insurance.

And before you tell me they don't have cash, and that I should foot the bill, make sure they don't have cable TV, go to the movies, have sterios, drive cars, etc. Because otherwise it just means that I'd be funding their entertainment.

Aaron

Yeah, IF you had the cash, beer money not withstanding, but the people we are talking about are minimum wage part-timers. Many are living in absymal conditions, in houses and apartments shared with ten or more people. Beer money, driving a 20 year old car or fifty bucks a month going on cable is not going to cut it.

Medical care is extremely expensive on the retail level. A single biopsy of a pre-cancerous skin mole generated a $300.00 bill by a patient I know who doesn't make that much money in a week, A single day in an ICU in my area is over $2,000.00. The interesting part about all this is that if you have insurance, Medicare or Medicaid, the prices paid by the third-party payors is set by negotiation, contract or law (Medicare & Medicaid)and is many orders of magnitude cheaper than that paid by someone paying in cash. If you are a cash paying patient you are billed at the highest rate. There is something seriously wrong with this picture. The old attitude was that if you could afford to pay cash you could afford to pay top dollar. Now its because if you pay in cash its because you cannot afford to get insurance or your low paying job doesn't provide it. Some charity hospitals have modified this by charging cash payors on a sliding scale based on proof of income.But other hospitals/doctors don't do this and this is why paying cash is not an option for the poor, uninsured people we are talking about.

HeavyAaron

1st July 2006, 03:28 PM

Yeah, IF you had the cash, beer money not withstanding, but the people we are talking about are minimum wage part-timers. Many are living in absymal conditions, in houses and apartments shared with ten or more people. Beer money, driving a 20 year old car or fifty bucks a month going on cable is not going to cut it.

Medical care is extremely expensive on the retail level. A single biopsy of a pre-cancerous skin mole generated a $300.00 bill by a patient I know who doesn't make that much money in a week, A single day in an ICU in my area is over $2,000.00. The interesting part about all this is that if you have insurance, Medicare or Medicaid, the prices paid by the third-party payors is set by negotiation, contract or law (Medicare & Medicaid)and is many orders of magnitude cheaper than that paid by someone paying in cash. If you are a cash paying patient you are billed at the highest rate. There is something seriously wrong with this picture. The old attitude was that if you could afford to pay cash you could afford to pay top dollar. Now its because if you pay in cash its because you cannot afford to get insurance or your low paying job doesn't provide it. Some charity hospitals have modified this by charging cash payors on a sliding scale based on proof of income.But other hospitals/doctors don't do this and this is why paying cash is not an option for the poor, uninsured people we are talking about.

I was referring to AntiHypeman's call for preventative care. Clearly I'm not suggesting that an impoverished person could pay for ICU. Nor would I ever suggest withholding critical care from a person due to lack of money. But I do believe people need to prioritize their own budgets rather than depending on society to foot the bill for things that they can pay for themselves.

Aaron

articulett

1st July 2006, 07:36 PM

False dicotomy. As a libertarian I'd rather fund neither, and in reality we fund both.

Aaron

Not a fake dichotomy--theoretically, in a democracy the money collected in taxes is supposed to be used for the common good--the people supposedly have a choice via the people they elect to represent them--yet it seems that much of the money that is gathered is spent on things that citizens don't feel is for the common good at the expense of that which truly is for the common good. That's a lot of money--most civilized countries have socialized health care--we wouldn't have to worry about the cost of the uninsured if our money was used for preventative health care rather than combat and the wounds it engenders.

RandFan

1st July 2006, 07:56 PM

we wouldn't have to worry about the cost of the uninsured if our money was used for preventative health care rather than combat and the wounds it engenders. An argument can be made for socialized medicine. An argument can be made against war.

One has nothing to do with the other.

Apollyon

1st July 2006, 08:15 PM

Not a fake dichotomy--theoretically, in a democracy the money collected in taxes is supposed to be used for the common good--the people supposedly have a choice via the people they elect to represent them--yet it seems that much of the money that is gathered is spent on things that citizens don't feel is for the common good at the expense of that which truly is for the common good. That's a lot of money--most civilized countries have socialized health care--we wouldn't have to worry about the cost of the uninsured if our money was used for preventative health care rather than combat and the wounds it engenders.
Who is the "common good" composed of? Is it just taxpayers or everyone? If it's everyone, where is the common good in those who pay no taxes?

Another question. If I waltz into most civilized countries, do I get to partake in their socialized health care for free or little cost with no other qualifications than simply physically being in that country?

articulett

2nd July 2006, 02:11 AM

Who is the "common good" composed of? Is it just taxpayers or everyone? If it's everyone, where is the common good in those who pay no taxes?

Another question. If I waltz into most civilized countries, do I get to partake in their socialized health care for free or little cost with no other qualifications than simply physically being in that country?

It depends on the country and your visa. I house exchange students and they pay a sort of "insurance". But I feel weird getting picky about stupid expenses when trillions is literally wasted--I think we can make huge inroads to many problems domestically with that kind of money--health care is a problem. Frankly, I advocate sterilization as a requirement for citizenship--or at least to get you to the top of the list...Yes, taxes are supposed to be for the common welfare, not the common warfare. Med issues of immigrants would scarcely be a problem if we focused money spent elsewhere on more pressing domestic problems. With that kind of money, you can fix a lot of problems--And I think preventative care, birth control, and sterilization have long term benefits everyone can enjoy. I think it's well recognized that healthcare in this country in chaos--and it's not just the immigrants...other countries seem to manage the issue much better--we can learn from them...

What sort of burden do you think will be added to the taxpayers caring for all the vets with PTSD, brain damage, limbs blown off, etc.? I advocate using money for preventing future medical expenses--

I don't think they are separate issues--I think the separation between the have and have nots is only getting huger, and I think focusing our funds domestically could fill this growing divide. I think there is $30,000 per U.S. citizen spent on the war so far--can you imagine what that could be used for if invested domestically--whether it's education, medicine, preventative care, birth control, or building a wall--or all of the above... When resources get scarce, the "haves" seem ever ready to lord power over the "have nots". I think less divisive means are better.

TragicMonkey

2nd July 2006, 07:09 AM

An argument can be made for socialized medicine. An argument can be made against war.

One has nothing to do with the other.

The US military does have socialized medicine.

BPSCG

2nd July 2006, 07:58 AM

As usual, it falls to me to explain to people the difference between Medicare and Medicaid (this is about the fifth time...). They are not the same; they are not even similar, even though people here appear to be conflating the two.

Medicare is health insurance for people over 65, and for some people who are totally and permanently disabled. You get it by having paid into the Social Security system for years; part of your Social Security withholding is for Medicare (I'm oversimplifying somewhat here). You can also get it by being the dependent spouse/widow of someone who has paid into SS long enough to himself have qualified for Social Security and Medicare - what I call the "June Cleaver model".

The presumption is that you have obtained a Social Security card and worked in the U.S., on the books, for many years. If you worked off the books, you did not pay SS/Medicare taxes, and would not be entitled to Social Security or Medicare, nor would your (surviving) spouse.

Whether you worked here legally or illegally, if you paid those taxes, you are eligible for Medicare. If you are here illegally, and worked off the books so you wouldn't get caught and sent home, you are not eligible for Medicare.

Medicaid is medical welfare. You can't afford to pay your medical bills, and you have no health insurance. You are asking the rest of the taxpayers to pay your medical bills for you.

Why is it wrong to ask someone to prove that he is in the U.S. legally before deciding that he should be entitled to have the rest of us pay his medical bills for him? If it's wrong to require someone to prove he is here legally, why don't we cut out all the red tape and simply put up a sign at the borders: "Free Health Care - All You Can Eat - While Supplies Last"?

SteveGrenard

2nd July 2006, 08:11 AM

There are no presumptions my friend when it comes to this issue.

You can get Medicare if you never paid into the SS system. You can get Medicare by being disabled for one year or more. Children who are born with disabilities qualify for disability a year and a day after they were born. Clearly they have not paid into the system. Which brings up another feature of this "cruel" new law, how it is applied to children who were born overseas to foreign parents who were/are illegals and abandoned these kids to the system here, usually but not necessarily because of a disability. There seems to be no distinction for children when it comes to being an illegal. Do we load up the plane with these wheel chair or bed/crib bound kids and ship them back to their country of birth?

The law is also not clear whether illegal immigrant adults who use/need both Medicaid and Medicare (Yes, I am afraid there are people so poor that they need and qualify for both ... mainly for Medicaid even though they have Medicare already). Medicaid pays for what Medicare doesn't. Medicare is bought and paid for and is an entitlement. I agreeMedicaid is a gift of the taxpayors to those in need.

And yes, I agree there are abuses just like some of the fine folks of New Orleans , as we recently learned, abused their Federal money gift.

But I doubt the young Central American mothers wheeling in their sick kids to our clinics for help are abusing the system. Soon they will be gone.

As an illegal immigrant you may be working and paying into the SS system, even with a made-up SS# or with an illegally obtained SS account. Once they are caught do you think the government will refund all the money (about 14% of their gross pay) by handing them a wad of cash at the departure gate?

But the law fails when it comes to undocumented American born citizens by lumping them together with illegal, undocumented foreign born immigrants. It raises the spectre of "Born in East L.A." - Art Imitates Life. Remember a SS card alone is not sufficient evidence of citizenship (see form I-9).

http://www.uscis.gov/graphics/formsfee/forms/i-9.htm (http://www.uscis.gov/graphics/formsfee/forms/i-9.htm)

What’s more amazing (see above website) is that the government has quietly removed naturalization and citizenship certificates, these are sealed photo-ID documents, issued by the INS, making them no longer acceptable as ID for proving your citizenship.

· The following documents have been removed from the list of acceptable identity and work authorization documents: Certificate of U.S. Citizenship (List A #2), Certificate of Naturalization (List A #3), Unexpired Reentry Permit (List A #8) and Unexpired Refugee Travel Document (List A #9).

HeavyAaron

2nd July 2006, 08:40 AM

I think there is $30,000 per U.S. citizen spent on the war so far

Yeah, umm... you might need to check your facts a little better (or at least have some reasonable idea what that estimate would mean.) US population is just about 300,000,000. http://www.census.gov/main/www/popclock.html $30,000 x 300,000,000 = $9,000,000,000,000. The war in Iraq has cost about $293,000,000,000. http://nationalpriorities.org/index.php?option=com_wrapper&Itemid=182

Don't worry you're only off by a factor of more than 30.

Aaron

SteveGrenard

2nd July 2006, 09:08 AM

A trillion dollars anyone? Try this study:

www2.gsb.columbia.edu/faculty/ jstiglitz/cost_of_war_in_iraq.pdf

Mephisto

2nd July 2006, 09:15 AM

I'm not fully aware of how Medicaid works, so I have the following question: In this scenario, what happens to victims in need of emergency treatment? Are they just jung out to dry?

I worked in a hospital emergency room for nearly 10 years after my discharge from the military, and although I HOPE a case of trauma WOULDN'T be ignored because of this law, I have personally seen Mexican women in mid-labor turned away from a local hospital because of an inability to prove residence. In one instance, I stood aghast (along with several other witnesses, mostly nurses) as a doctor said, "she just wants her kid to be American," as his excuse for refusing treatment.

Being the only Spanish speaking employee available it was very difficult for me to explain to the young girl's father WHY she couldn't be admitted. Although many here (I can already picture who) will scoff at the fact that inequality in America is rampant, it does exist and people (not Mexicans, not Whites, not Blacks, just people) always suffer.

HeavyAaron

2nd July 2006, 09:34 AM

A trillion dollars anyone? Try this study:

www2.gsb.columbia.edu/faculty/ jstiglitz/cost_of_war_in_iraq.pdf

This is clearly a derail, but I'd like to point out that the trillion is the high side of this study's estimates for total costs into the future, and this study has an obvious bias. Ariculett clearly stated he was esitmating COSTS SO FAR, not total costs into the future. And he was claiming, in effect, not 1 trillion dollors, but 9 trillion dollars. And the cost so far is still a long way from a third of a trillion. It's hard to be that wrong with such easy to come by numbers.

Golly guys, I can't believe I'm downplaying the cost of this war. I hate the expense! But it's a big enough cost that we don't need to exaggerate it!

Aaron

SteveGrenard

2nd July 2006, 09:56 AM

I don't think the costs involved or the comparison of the cost of the Iraqui war and the country's health care costs are a derail or irrelevant at all.

Freeing up money to feed the war could be and probably is one of themotivations for this new law along with post-911 xenophobia.

By several measures, health care spending continues to rise at the fastest rate in our history.

In 2004 (the latest year data are available), total national health expenditures rose 7.9 percent -- over three times the rate of inflation

(1). Total spending was $1.9 TRILLION in 2004, or $6,280 per person

(2). Total health care spending represented 16 percent of the gross domestic product (GDP).

(3). U.S. health care spending is expected to increase at similar levels for the next decade reaching $4 TRILLION in 2015, or 20 percent of GDP

(4). In 2005, employer health insurance premiums increased by 9.2 percent - nearly three times the rate of inflation. The annual premium for an employer health plan covering a family of four averaged nearly $11,000. The annual premium for single coverage averaged over $4,000

(5).Experts agree that our health care system is riddled with inefficiencies, excessive administrative expenses, inflated prices, poor management, and inappropriate care, waste and fraud. These problems significantly increase the cost of medical care and health insurance for employers and workers and affect the security of families.

http://www.nchc.org/facts/cost.shtml (http://www.nchc.org/facts/cost.shtml)

Clearly the trillion, even if projected as a cost into the future, would make a significant dent in the health care costs of the U.S. fraud and abuse not withstanding.

The majority of large scale fraud and abuse is comitted by U.S. persons and corporations,(*) not illegal immigrants or poor undocumented American citizens.

Whether throwing undocumented poor people off Medicaid would do the same is doubtful.. In the meantime the country is owned by the oil industry and we all know who answers to them.

------------------------------------------------------------------------------
(*)search HealthSouth and Richard Scrushy ... such as
this:

http://www.chron.com/disp/story.mpl/ap/fn/4013450.html

HeavyAaron

2nd July 2006, 10:07 AM

IIn the meantime the country is owned by the oil industry

:rolleyes:

and we all know who answers to them. [/FONT]

Apparently we all don't know.

Seriously, the Iraqi war, an off-hand remark about oil... come on... this ISN'T a derail?

Aaron

SteveGrenard

2nd July 2006, 10:18 AM

Yeah it was. Costs are not if they are at the cause of this new law. I think what some of us are trying to say is that we will be paying in onerous ways for the excursion into Mesopotamia, an invasion predicated on false pretenses.

HeavyAaron

2nd July 2006, 10:25 AM

... we will be paying in onerous ways for the excursion into Mesopotamia, an invasion predicated on false pretenses.

Absolutely granted.

But the motivations of the politicians are quite irrelevent in evaluating the cost/benifits of a law, wouldn't you say?

Aaron

SteveGrenard

2nd July 2006, 10:41 AM

I worked in a hospital emergency room for nearly 10 years after my discharge from the military, and although I HOPE a case of trauma WOULDN'T be ignored because of this law, I have personally seen Mexican women in mid-labor turned away from a local hospital because of an inability to prove residence. In one instance, I stood aghast (along with several other witnesses, mostly nurses) as a doctor said, "she just wants her kid to be American," as his excuse for refusing treatment.

Being the only Spanish speaking employee available it was very difficult for me to explain to the young girl's father WHY she couldn't be admitted. Although many here (I can already picture who) will scoff at the fact that inequality in America is rampant, it does exist and people (not Mexicans, not Whites, not Blacks, just people) always suffer.

So do you know how she ended up? Did she have her baby out on the curb? In the parking lot? At the local bodega?

SteveGrenard

2nd July 2006, 10:57 AM

Absolutely granted.

But the motivations of the politicians are quite irrelevent in evaluating the cost/benifits of a law, wouldn't you say?

Aaron

Motivations of politicians are important. Without them they wouldn't pass any laws. Why would they want to? In this case the discussion preceding passage centered on cost-savings for the health care industry and the burden of expense of treating undocumented human beings. The law is flawed because American citizens could also be undocumented. The motivation is flawed because individual illegal aliens using the health care system do not directly benefit financially from whatever fraud it is they are comitting or if they are, benefit very little) In fact if you go to the rest of the world they wouldn't be comitting any fraud as medical care is provided without cost to the recipient and is paid for by the country's revenues. There is no such thing as a hospital bill or medical bill in Britain's NHS and your citizenship isn't a requirement for care. The fraud and abuse in the Medicaid system is not due to illegal aliens, it is due to crooked doctors and corporations who are U.S. citizens (or documented immigrants) and are lining their pockets with their fraudulent practices (e.g. double and triple billing or billing for phantom visits and procedures, or performing unnecessary procedures or running prescription drug scams or the multi-billion dollar counterfeit drug scam..) Since Congress has failed to do anything about these crooks legislatively or legally, Congress apparently has decided to shift the blame to illegals or undocumented people and deny them. If you can't win over the real bad guys, ignore them and find a scapegoat you can beat is a policy we have seen time and again.

Also some are suggetsing that post-911 hysteria and xenophobia is the motivation for this law. How undocumented Mexicans, Guatamalans or Salavadorans needing medical care impact on the war on terrorism is one that escapes me.

HeavyAaron

2nd July 2006, 11:06 AM

Motivations of politicians are important. Without them they wouldn't pass any laws. Why would they want to?

I stated nothing to the contrary. I provided a context, namely the context of evaluating the costs and benifits of the law. (Had I been more accurate I would have referred to the costs and benifits of the law's effects, but I take it that was understood.)

In this case the discussion preceding passage centered on cost-savings for the health care industry and the burden of expense of treating undocumented human beings. The law is flawed because American citizens could also be undocumented.

Sure, but this is something the OP addressed. Until now you have not. And this has nothing to do with motivations.

The motivation is flawed because individual illegal aliens using the health care system do not directly benefit financially from whatever fraud it is they are comitting or if they are, benefit very little)

Ummm.... I dare say this is odd. People illegally receiving free medical care do not benifit? Perhaps if it's homeopathic medical care. Would you like to elaborate?

In fact if you go to the rest of the world they wouldn't be comitting any fraud as medical care is provided without cost to the recipient and is paid for by the country's revenues. There is no such thing as a hospital bill or medical bill in Britain's NHS and your citizenship isn't a requirement for care.

Completely irrelavent.

The fraud and abuse in the Medicaid system is not due to illegal aliens, it is due to crooked doctors and corporations who are U.S. citizens (documented immigrants) and are lining their pockets with their fraudulent practices (e.g. double and triple billing or billing for phantom visits and procedures, or performing unnecessary procedures or running prescription drug scams or the multi-billion dollar counterfeit drug scam..)

Okay, well there were already laws covering those problems. Or do you deny this?

Since Congress has failed to do anything about these crooks legislatively or legally,

Okay, you DO deny this. Do you seriously contend that prescription drug scams and counterfeit drug scams are LEGAL?!? And Medicare fraud is LEGAL? Do you really want me to look up those laws before you would believe that they exist?

Congress apparently has decided to shift the blame to illegals or undocumented people and deny them. If you can't win, ignore the them and find a scapegoat you can beat.

You apparently have greater insight into the minds of politicians than I.

Also some are suggetsing that post-911 hysteria and xenophobia is the motivation for this law. How undocumented Mexicans, Guatamalans or Salavadorans needing medical care impact on the war on terrorism is one that escapes me.

So you're saying that an irrational motivation [xenophobia] is irrational? Okay... I have to give you that one.

Aaron

SteveGrenard

2nd July 2006, 11:34 AM

HA: I stated nothing to the contrary. I provided a context, namely the context of evaluating the costs and benifits of the law. (Had I been more accurate I would have referred to the costs and benifits of the law's effects, but I take it that was understood.) Sure, but this is something the OP addressed. Until now you have not. And this has nothing to do with motivations.

Response: Rationale or motivation is a given.

HA: Ummm.... I dare say this is odd. People illegally receiving free medical care do not benifit? Perhaps if it's homeopathic medical care. Would you like to elaborate?

Response: I don't even understand what this means: "People illegally receiving free medical care."There is no law against receiving free medical care, until this one, and that is being litigated right now (see OP).
Anyone receiving anything free, de facto, benefits in some way but not
by being paid. There is also no law against receiving anything free
except maybe controlled subtances without a prescription or alcohol or
cigarettes if one is under a certain age. Matthew Lesko promises me "Free Money"
if I send him money for his book.

I get a free pizza when I buy one at the regular price.

HA: Completely irrelavent.

Response: OK if you say so but it is not irrelevant to the undocumented and probably illiterate undocumented alien where this is the norm in his country and the rest of the world and can't understand why it should be any different only in America. But sure, it's irrelevant.

HA: Okay, well there were already laws covering those problems. Or do you deny this?

Response: I do not deny there are laws against fraud and abuse. You should see the Stark regulations about medical kick-backs. The interesting thing about these laws is that they are filled with so many loopholes they don't work except in rare cases. Stark Regs have loopholes called "safe harbors" which allow doctors to violate these laws if certain conditions are met.
There are openly operating consulting companies that school and design safe harbors for doctors so they can violate anti-kickback regulations.

The fact that fraud and abuse continues to increase the total annual health care tab in the US (without taking into account illegal alien care which is not now fraud ...well up until yesterday) is proof that existing efforts are puny to non-existent and don't work. So as I said, let's pick on some group as a scape goat and show the people we are doing something about it.

HA: Okay, you DO deny this. Do you seriously contend that prescription drug scams and counterfeit drug scams are LEGAL?!? And Medicare fraud is LEGAL? Do you really want me to look up those laws before you would believe that they exist?

Response: They might as well be non-existent since the FDA which has jurisdiction over counterfeting admits defeat, is underfunded and this nefarious trade continues year after year. Rx drug scams are under the purview of state pharmacy and medical boards with little or no subpoena or police powers so rarely result in more than a slap on the wrist or a temporary license suspension and fine ...which is a cost of doing business. You know how an Rx drug scam works? The doctor gives an Rx in the name of a patient to the pharamcy which then bills for the scrip but never dispenses it. In a variation the med is dispensed but then sold back to the pharmacist at a steep discount and then re sold again ..and again..and again.

HA:You apparently have greater insight into the minds of politicians than I.

Response: No. I get my data from reading information provided by those who do and have been for years. In some forty years in hospital and community based health care I also hear a few things now and then.

HeavyAaron

2nd July 2006, 11:52 AM

Response: Rationale or motivation is a given.

Okay, we've lost something. Let's try again... I'm concerned about evaluating the costs and benifits of the consequences of the law. You questioned the motivations behind the law. My point is that the motivations in creating the law have no bearing on the effects of the law. I am currently at a loss as to your position.

Response: I don't even understand what this means: "People illegally receiving free medical care."There is no law against receiving free medical care, until this one, and that is being litigated right now (see OP).
Anyone receiving anything free, de facto, benefits in some way but not
by being paid. There is also no law against receiving anything free
except maybe controlled subtances without a prescription or alcohol or
cigarettes if one is under a certain age. Matthew Lesko promises me "Free Money"
if I send him money for his book.

I get a free pizza when I buy one at the regular price.

I'm hardly saying receiving something for free is defacto illegal. You were claiming that that people fraudulantly receiving medical care were not benifiting. Or did I misread you?

Response: OK if you say so but it is not irrelevant to the undocumented and probably illiterate undocumented alien where this is the norm in his country and the rest of the world and can't understand why it should be any different only in America. But sure, it's irrelevant.

I'm glad we agree! How England chooses its policy has no bearing on our laws.

Response: I do not deny there are laws against fraud and abuse. You should see the Stark regulations about medical kick-backs. The interesting thing about these laws is that they are filled with so many loopholes they don't work except in rare cases. Stark Regs have loopholes called "safe harbors" which allow doctors to violate these laws if certain conditions are met.
There are openly operating consulting companies that school and design safe harbors for doctors so they can violate anti-kickback regulations.

The fact that fraud and abuse continues to increase the total annual health care tab in the US (without taking into account illegal alien care which is not now fraud ...well up until yesterday) is proof that existing efforts are puny to non-existent and don't work. So as I said, let's pick on some group as a scape goat and show the people we are doing something about it.

Ah, but this was not your claim! You claimed CONGRESS hasn't done anything about this. They have! They passed the laws! You're talking about enforcement. That's another branch of government. You knew that, I'm sure... Indeed the executive branch might very well choose not to enforce this new law effectively or at all. But you were specifically talking about Congress.

Response: They might as well be non-existent since the FDA which has jurisdiction over counterfeting admits defeat, is underfunded and this nefarious trade continues year after year. Rx drug scams are under the purview of state pharmacy and medical boards with little or no subpoena or police powers so rarely result in more than a slap on the wrist or a temporary license suspension and fine ...which is a cost of doing business. You know how an Rx drug scam works? The doctor gives an Rx in the name of a patient to the pharamcy which then bills for the scrip but never dispenses it. In a variation the med is dispensed but then sold back to the pharmacist at a steep discount and then re sold again ..and again..and again.

And Congress has made this illegal (which you claimed it had done nothing about, and I rightly disputed.) Once again your complaint has to do with enforcement.

Response: No. I get my data from reading information provided by those who do and have been for years. In some forty years in hospital and community based health care I also hear a few things now and then.

I doubt you have gathered data for forty years on the motivations of legislators writing a brand new law from a hospital. Both a time and space problem there. (Unless you're telepathy does not diminish with distance and involves clarvoiance.)

ETA: I retract that final paragraph based on a more careful rereading of your statement.

Aaron

SteveGrenard

2nd July 2006, 12:23 PM

People receiving free medical care are not benefitting by making money from it. They are saving money. If they are poor they have no money to save so they are not benefitting that way either. It is not their fault they are sick and need medical care or that their children are sick and need medical care. They are not going in for nose jobs on the public dime.

Being sick is hardly a benefit.

I am not interested in the cost/benefit ratio of this new regulation because it eliminates an entire class of person from receiving the benefit: undocumented American citizens who were born here but have no way of proving it to the government's satisfaction and I posted the identity requirements from I-9. This law also wipes out medical treatment of children down to the age of birth through 18 or 21 if you prefer who mayhave no docuementation, have no control over where they are or how they got there and have no birth certificate if they were born at home, in a car or in the parking lot of the hospital the pregnant mom to be was just thrown out of. It also eliminates documented citizens who are naturalized or have a certificate of citizenship,(*) given to children of American citizens who happen to have been born overseas or who are the biological offspring of Americans such as foreign children fathered by Americans, usually but not necessarily in the military. This law disenfranchises a lot of people, is a cruel and feeble attempt to try and contain runaway medical costs which became so infuriatingly high due to medical inflation and the fraud, abuse and the greed of certain elements of the medical establishment which is mostly perpetrated by fully documentedAmericans who manage to escape detection and not go to fully documented American jails even if they are caught. These are the America's Most wanted our police spend their time, effort and money on arresting, prosecuting and jailing while white collar thieves cart off millions from medical insurance scams.

SO the cost of this in human terms far outweighs the benefits anyway you look at it. Some things just never reach a benefits threshold that justifies costs. At the risk of derailment, the dickering in Mess A Po Tamia is an example. I truly fear that those running the government and especially the WH will not stop until they have disenfranchised all save themselves and their inner circle.

If you make laws which cannot be enforced you might as well make no laws at all. NYC is putting people who jump subway turnstiles into Riker's Island prison with murderers, armed robbers and rapists and the Police Comissioner defends this while the Corrections Comissioner says it is ridiculous waste of resources. We cannot enforce the laws that need to be enforced if we spend our resources on victimless crimes such as turnstile jumping; even worse is the lady who went to jail for placing her purse in the seat spot next to her on an empty train, the passenger who fell asleep while riding or the young man who was carrying and drinking from a can of soda through a straw. These terrible crimes will get you time in a real prison!

(*) See unbelievable change in regulation for I-9 making both certificates of U.S. citizenship or naturalization UNACCEPTABLE for proving citizenship or immigration status. Quoted above.

HeavyAaron

2nd July 2006, 12:41 PM

People receiving free medical care are not benefitting by making money from it. They are saving money. If they are poor they have no money to save so they are not benefitting that way either. It is not their fault they are sick and need medical care or that their children are sick and need medical care. They are not going in for nose jobs on the public dime.

Your standard for benifiting is far too high. One does not have to make money from something in order to benifit from it.

You should be comparing the two worlds we actually have available to consider with respect to their condition.

1) Medical care is provided free of charge to this group of people.

2) Medical care is NOT provided free of charge to this group of people.

Condition: sick

Under world 1) person is made well and thus they are better off than they were previously

Under world 2) person is NOT made well and thus is not better off than they were previously

Clearly the result for the person is objectively better under world 2 then world 1. (Were that not the case I hope you wouldn't be advocating this!) Thus they benifit. It ludicris to suggest that we should be comparing their condition before getting sick to after receiving treatment.

They are made better off, which by definition is benifiting. Look, if you don't think they're benifiting, then you should right now be screaming that we should stop treating them. Providing a medical treatment that confers no benifit is a scam.

Being sick is hardly a benefit.

But being made well certainly is. And that's the decision we're making.

I am not interested in the cost/benefit ratio of this new regulation

And THAT ladies and gentlemen is the problem with the government fixes all problems crowd. Doing nothing is better than doing something whenever cost exceed benifits.

because it eliminates an entire class of person from receiving the benefit: undocumented American citizens who were born here but have no way of proving it

That's called a "cost."

to the government's satisfaction and I posted the identity requirements from I-9. This law also wipes out medical treatment of children down to the age of birth through 18 or 21 if you prefer who mayhave no docuementation, have no control over where they are or how they got there and have no birth certificate if they were born at home, in a car or in the parking lot of the hospital the pregnant mom to be was just thrown out of. It also eliminates documented citizens who are naturalized or have a certificate of citizenship,(*) given to children of American citizens who happen to have been born overseas or who are the biological offspring of Americans such as foreign children fathered by Americans, usually but not necessarily in the military. This law disenfranchises a lot of people, is a cruel and feeble attempt to try and contain runaway medical costs which became so infuriatingly high due to medical inflation and the fraud, abuse and the greed of the medical extablishment which is mostly perpetrated by fully documentedAmericans who manage to escape detection and not go to fully documented American jails even if they are caught.

SO the cost of this in human terms far outweighs the benefits anyway you look at it.

Shriek! Did you just perform a cost/benifit analysis? Oh, my! I believe you did! Of course, I may not agree with your analysis, but at least you did perform one. It seems you might be interested in a cost/benifit analysis of this new legislation after all.

Some things just never reach a benefits threshold that justifies costs. At the risk of derailment, the dickering in Mess A Po Tamia is an example.

Yeah, and golly, maybe we shouldn't do things with greater costs then benifits? Hmm?

Aaron

Edited for grammer and clarity.

Beerina

2nd July 2006, 12:44 PM

The libertarian in me says not to socializing of medicine. My own personal experience would favor it.

RandFan

It's one thing to tax to pay for it, it's quite another to dictate what doctors can charge at the point of a gun. Something has to give, and you know it will be the rate of medical care development, costing much more pain and disease in the long run.

SteveGrenard

2nd July 2006, 01:35 PM

HeavyAaron

2nd July 2006, 02:01 PM

There are two separate sets of costs versus benefits ratios at work here.

One is the cost versus benefit of the law itself:

1. Cost of law: disenfranchise many people by denying them medical care
unless they make or have a lot of money which includes enough money to have medical insurance. In short, tell them to go to hell.

2. Benefit of law: eliminate the portion of the country's annual medical
expenditure by X (unknown) number of dollars now going into the pockets of
medical providers, health care workers and institutions from the Medicaid
system.

3. Possible Secondary benefit: reopening of investor and publicly owned ER and trauma centers since they would now be allowed to deny medical care to undocumented aliens and Americans without insurance since Medicaid would be unattainable for both.

-------------------------------------------------------------------
The other is the cost versus benefit of the law on the individuals being
targeted for disenfranchisement. They include:

a. undocumented illegal aliens

b. undocumented legal aliens

c. American citizens born overseas holding either naturalization and
or certificate of citizenship certificates issued by the INS

d. American citizens born in the U.S. outside the medical system
who do not have a birth certificate registration.

1. The cost of the law for the above people ranges anywhere from
the inability to maintain their general health to imminent death.

2. Creation of tiers of medical care based on ability to pay ranging
from none to a private suite with all the amenities.

2. The benefit of the law for the above disenfranchised people is nothing.

I look back and laugh at the government's directive to shut down all "wards" greater than 4 beds because it discriminated against poor people.What hypocrites they turned out to be and won't some poor people wish they could even have a large ward to recover and be treated in.

I guess we will have to wait and see how the litigation pans out, and if it fails, whether or not congress will revisit the law.

Thank you. That's a much more well reasoned argument. I should mention however, that the "go to hell" part is misleading. Treatment for all urgent conditions regardless of ability to pay remains (and hopefully will always remain) the law. (Which you incorrectly listed when you included immenate death as a possible cost of this law.)

For non-urgent matters is where the question is open. If you are unable to pay and unable to demonstrate that you are a US citizen and you have non-urgent medical needs (needs, I'm not talking elective) what should be done? To pretend that it's not a difficult question isn't being fair.

The feasible choices seem to be:

1) No one, deny medical care.

2) The provider, forced by law.

3) Some form of government (Fed, state, and/or local).

4) Charity (which may or may not be the provider).

As a libertarian I lean towards 1) and 4). You clearly lean towards 3). But I also plainly admit that it is a complex question. I also believe it should be addressed as unemotionally as possible (as opposed to using explitives to describe an opposing position. A professional such as yourself should be above that.)

You also list as a cost the fact that this increases the inequity of service provided different people of different means. You imply that that is objectively bad. I should note that it's subjectively bad. Inequity in medical care, housing, diet, transportation, etc. to me is not inharently bad.

If the benificary of any good or service is not the one who bears the cost for that service it is invaribly overused and abused. This is known as "the tragedy of the commons." Liberal minded people love to employ this mechanism when it comes to environmental concerns, but tend to ignore the same effect when the resorce is government services instead of natural elements. If the government will pay for my medical care when I cannot, then if I'm borderline poverty I have a disencentive to save for my own medical needs which are inevitable. Instead I should reallocate that part of my budget elsewhere.

That's inefficient to society as a whole. The market nicely allocates resorces, we should be very careful when intentionally interfering with incentives with the power of law.

Aaron

RandFan

2nd July 2006, 02:42 PM

I worked in a hospital emergency room for nearly 10 years after my discharge from the military, and although I HOPE a case of trauma WOULDN'T be ignored because of this law, I have personally seen Mexican women in mid-labor turned away from a local hospital because of an inability to prove residence. In one instance, I stood aghast (along with several other witnesses, mostly nurses) as a doctor said, "she just wants her kid to be American," as his excuse for refusing treatment.

Being the only Spanish speaking employee available it was very difficult for me to explain to the young girl's father WHY she couldn't be admitted. Although many here (I can already picture who) will scoff at the fact that inequality in America is rampant, it does exist and people (not Mexicans, not Whites, not Blacks, just people) always suffer.One of my closest friends is an addmiting nurse for Kaiser Permanente, she said that is not the norm. For one thing it is against the law. Yes, people break the law but I don't believe that this is rule. You only offer anecdote, do you have any evidence?

SteveGrenard

2nd July 2006, 03:00 PM

There is a Federal law called the Hill-Burton Act .....

Under Hill-Burton if a hospital accepted money from the Federal government for building new income producing buildings or acquiring equipment (I believe) to furnish same, then under Hill-Burton they could turn no one away. After the the statutary period of such service was
complete or the funds repaid or both then I noticed the Hill-Burton regulation signs being removed from ER waiting rooms.

There is an interesting essay on Hill-Burton at:

http://members.tripod.com/american_almanac/hillburt.htm

and I strongly reccomend anyone interested to read this.

This new legislation subverts both the letter and the spirit of Hill-Burton.

I actually go with 3 and 4. Three because I spent my entry years working in healthcare under Hill-Burton and 4 because I have always worked in voluntary, non-profit teaching institutions.
The latter are in dire need of the meager reimbursements Medicaid pays for indigent care
and I believe this new legislation will create a health care crisis for the uninsured indigent
population irrespective of immigration status. Because investor owned hospitals exist which require insurance cards or down payment checks to gain entry #1 on a universal basis will
never happen.

Kaiser-Permanente is an interesting hybrid. Its called an HMO but its a health insurance plan running its own service provider. I always thought they only accepted people with K-P cards.

RandFan

2nd July 2006, 03:07 PM

There is a Federal law called the Hill-Burton Act .....

Under Hill-Burton if a hospital accepted money from the Federal government for building new income producing buildings or acquiring equipment (I believe) to furnish same, then under Hill-Burton they could turn no one away. After the the statutary period of such service was
complete or the funds repaid or both then I noticed the Hill-Burton regulation signs being removed from ER waiting rooms.

There is an interesting essay on Hill-Burton at:

http://members.tripod.com/american_almanac/hillburt.htm

and I strongly read anyone interested to read this.

This new legislation subverts both the letter and the spirit of Hill-Burton. EMTALA prevents them from turning them away.

The federal Emergency Medical Treatment and Active Labor Act, commonly referred to as "EMTALA," was enacted by Congress in response to a concern over "patient dumping" by hospitals refusing treatment of individuals who could not afford to pay for medical services. EMTALA imposes a duty on the hospital and its physicians to provide medical screening examinations and medical stabilization of all individuals seeking emergency care, regardless of the individual’s ability to pay.

SteveGrenard

2nd July 2006, 03:26 PM

EMTALA prevents them from turning them away.

All these regs are fine and dandy but will they apply to the undocumented
who will now be thrown off Medicaid?

It remains to be seen if this applies to undocumented people, and even then, whether it requires a patient seeking and receiving "emergency care"
to receive same and then to go out and find follow-up care elsewhere, or as the case may be, nowhere. People come into ERs with non-specific abdominal pain or other complaints, are worked up and nothing is found. A few hours later they have a cardiac arrest. If they are not admitted and held for observation because they have no insurance ...well ...

Every Prez since Roosevelt has made some sort of effort to fix the health care problems of this country and its so so many uninsureds. Even Bush promised to do this and what does he give us, a fix that is two steps backwards instead of one step forward.

HeavyAaron

2nd July 2006, 03:42 PM

All these regs are fine and dandy but will they apply to the undocumented
who will now be thrown off Medicaid?

It's still the law. Do you have contrary evidense?

It remains to be seen if this applies to undocumented people

No, it doesn't. Courts have already ruled that even non-citizens cannot be turned down for urgent medical care.

, and even then, whether it requires a patient seeking and receiving "emergency care"
to receive same and then to go out and find follow-up care elsewhere, or as the case may be, nowhere. People come into ERs with non-specific abdominal pain or other complaints, are worked up and nothing is found. A few hours later they have a cardiac arrest. If they are not admitted and held for observation because they have no insurance ...well ...

Yep. In fact misdiagnosis occur to people who pay too, you know. Isn't it a bummer?

Every Prez since Roosevelt has made some sort of effort to fix the health care problems of this country and its so so many uninsureds. Even Bush promised to do this and what does he give us, a fix that is two steps backwards instead of one step forward.

Define fix. Also, some uninsured are that way by choice; i.e. they're wealthy. Please don't include the wealthy in your catagory of "problem."

The optimal solution is two dimentional. The first dimention is how much of our finite resources to devote to medical care. The second dimention is how to allocate those resources.

I gather that you want some universal coverage administered by the government to make both of those decisions. Pray tell, how is a buerocrat to make those decisions for an optimal outcome?

Aaron

SteveGrenard

2nd July 2006, 04:41 PM

It's still the law. Do you have contrary evidense?

No, it doesn't. Courts have already ruled that even non-citizens cannot be turned down for urgent medical care.

Yep. In fact misdiagnosis occur to people who pay too, you know. Isn't it a bummer?

Define fix. Also, some uninsured are that way by choice; i.e. they're wealthy. Please don't include the wealthy in your catagory of "problem."

The optimal solution is two dimentional. The first dimention is how much of our finite resources to devote to medical care. The second dimention is how to allocate those resources.

I gather that you want some universal coverage administered by the government to make both of those decisions. Pray tell, how is a buerocrat to make those decisions for an optimal outcome?

Aaron

I asked a ? and you ans. with one.

Do you have info on court decisions you cite?

The tiered system will cause poorer uninsured to be discharged quicker and sicker.

I didn’t mention wealthy people but do you have evidence they are stupid and don’t buy health coverage although they could easily do so?

Yes, I think Medicare should be expanded from cradle to grave. The larger pool will represent a “fix” since now the system is burdened only with covering older and sicker patients. Including younger and healthier members will improve the system by revenues from people who don’t get as sick or sick as often as the group now covered.

The bureaucrats as you call them is CMS. It is in place and they do a fairly good job under difficult circumstances. Basically they will need more computer power and more staff to go from covering over 65s and disabled people to everyone.

http://www.cms.hhs.gov/

RandFan

2nd July 2006, 05:25 PM

I asked a ? and you ans. with one. Yeah, and I think that is appropriate. You're question suggests that the laws don't work. I think you are going to have to demonstrate that they don't. I see no evidence that anyone is being denied health care. The law has been cited now can you demonstrate that it is not being followed?

SteveGrenard

2nd July 2006, 05:50 PM

Yeah, and I think that is appropriate. You're question suggests that the laws don't work. I think you are going to have to demonstrate that they don't. I see no evidence that anyone is being denied health care. The law has been cited now can you demonstrate that it is not being followed?

The law in question went into effect yesterday but enforcement has been postponed until July 17th pending a judges ruling whether to hear a case on its legality. Therefore nobody should be surprised that you see no evidence anyone is being denied healthcare.

Can I demonstrate it is not being followed? you ask. Yes, I just
did. Read link in OP also.

RandFan

2nd July 2006, 11:36 PM

The law in question went into effect yesterday but enforcement has been postponed until July 17th pending a judges ruling whether to hear a case on its legality. Therefore nobody should be surprised that you see no evidence anyone is being denied healthcare.

Can I demonstrate it is not being followed? you ask. Yes, I just
did. Read link in OP also.EMTALA was enacted in 1986. I don't doubt that there are problems. No law is effective 100%. What you have not demonstrated is to what degree EMTALA is not being followed. Clearly this new law was passed to plug loop holes. How big is the problem?

Important: There is a glaring red flag here that you are missing. Clinics and trauma centers are being shut down due to negative cash flow. The trend has started in the South and is moving northward. Doesn't it stand to reason that hospitals are trying to staunch the flow of lost revenue due to mandated expenses. Remember, they can't recoup losses by treating illegals. Is it possible that this is a defensive mesure on their part?

Why we refuse to acknowledge that there is a problem is beyond me.