Sunday, December 8, 2013

The (real) reason hospital treatment costs so much

The (real) reason hospital treatment costs so much
 by Dr. Ramin Oskoui


 
The pundit class is breathless over a New York Times piece titled: As Hospital Prices Soar, a Single Stitch Tops $500. Health care pricing is indeed significantly driven by hospital costs. But these high costs are of the government’s own making. Imagine an individual using amphetamines to stay awake, then needing to be prescribed a sedative to sleep. That is essentially the cost demands that the Reagan era law EMTALA began and the Affordable Care Act seeks to remedy. It is the government itself that has been mandating cost shifting and led to rising healthcare costs.

The Emergency Medical Treatment and Active Labor Act (EMTALA) enacted by Congress in 1986, under the guise of ‘need’ to provide free health care to indigent people. However, it simply wasn’t true that people couldn’t get health care treatment in hospitals if they couldn’t pay. There were charitable facilities all over the country, not to mention most hospitals reserved plenty of resources to treat people with little to no income. At the time claimed that critically ill or injured people were being turned away from hospitals. This falsehood made great political fodder. The real purpose of EMTALA was to trap hospitals into accepting money from the federal government, which in turn, gives the federal government power over them.

The government made it very impractical for a hospital not to participate. If you didn’t abide by EMTALA, a hospital could lose Medicare and Medicaid funding.. Perversely it has ended up incentivizing spending and wasting of money. Hospital costs rose as “losses” were subtracted from “profits by these “non-profit” operations. While EMTALA was intended to provide all patients the right of medical care in the ED regardless of ability to pay, a cost: benefit analysis performed by Duke University suggests it did just the opposite.

Patients became aware that even without insurance they could access care in Emergency Rooms at seemingly no cost to them. And they did in droves. It also spawned expensive litigation as malpractice attorneys used the law as a springboard for a variety of lawsuits. In order to avoid bankruptcy, hospitals must raise the costs of health care on health insurance companies, who pass these new costs on to the insured through reduced benefits and increased premiums. Public hospitals operated by state and local governments also shift these costs on to taxpayers in the form of increased taxes to pay off the debts incurred. Most hospitals also shift costs to federal taxpayers via uncompensated-care subsidies added onto the reimbursements they receive from Medicare and Medicaid such as the $340 billion program.

Then came the Affordable Care Act. When the case came before the Supreme Court Justice KAGAN stated “No, this is very different, Mr. Clement, and it's different because of the nature of the health care service, that you are entitled to health care when you go to an emergency room, when you go to a doctor, even if you can't pay for it.”

We have come full circle. The entire premise of the ACA is just that argument. The government created the infirmity it now attempts to make us cover by forcing us to purchase health insurance we may not want or need.

Dr. Oskoui, a cardiologist, is the President of the Medical Staff at Sibley Memorial Hospital in Washington, DC.

http://www.lauraingraham.com/b/The-real-reason-hospital-treatment-costs-so-much/149887728682380377.html

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