Posted by: notdeaddinosaur | January 5, 2011

A Modest Proposal to End Starvation

Letter to the editor in yesterday’s Philly Inquirer:

…In 1986, Congress passed and President Ronald Reagan signed the Emergency Medical Treatment and Active Labor law, which requires hospitals to admit all who arrive at the emergency room and treat them without regard for their ability to pay.

In essence, we had federally mandated national health care – signed into law under a Republican administration. What we did not have is a rational way to pay for the mandated health care.

Those who seek to repeal the federally mandated insurance requirements in the health-care law should also seek to repeal EMTAL[A], a deeply immoral proposition if I ever heard one….

Hear, hear! Riddle me this, Batpersons: how come no one ever challenged the constitutionality of EMTALA? Is it some kind of truism in American politics that Ronald Reagan could do no wrong? I suppose it would be pretty difficult politically to try arguing a position where you’re basically advocating throwing laboring women out onto the streets if they can’t pay. No one, not even a politician, wants to appear that heartless. So they went and essentially enslaved hospital emergency departments, forcing them to provide services without any guarantee of payment. Immoral indeed!

That’s just the tip of the iceberg. Most Americans seem to feel that the Hippocratic oath — few, if any, of whom have actually read it — somehow compels the rest of us doctors to do the same thing. You wouldn’t believe how indignant some people get when they discover that I expect to be paid cash money for my time and expertise.

But medical care is important, especially in emergency situations. We as a society refuse to condone the heartlessness of letting the seriously ill and injured suffer without care just because they happen to be without financial resources.

Oh yeah?

Hunger is rampant in this country as well. It should be morally unacceptable for anyone in this great nation of plenty to starve to death. So why hasn’t anyone proposed the Emergency Feeding and Maintenance of Adequate Libations (EFMAL, pronounced “Eff ’em all”) Act, which compels restaurants to serve anyone who walks in the door regardless of their ability to pay? What’s that, you say? Restaurants are in business to make money? It’s unconstitutional to make them give stuff away?

Makes about as much sense as forcing emergency departments to provide uncompensated (that means “free”) care. It’s no way to run a business, unless by “running a business” you really mean running it into the ground. Could that really happen? Look around: plenty of recent ER closings in the news.

So to all those politicians looking to repeal the new health insurance reform legislation, how about a little moral consistency. Dump EMTALA while you’re at it. Then again…what am I saying? “Politicians,” “morality,” and “consistency” all in the same sentence? Forgive me. I think we may have more luck with my restaurant proposal. After all, this Republican congress sure seems poised truly to “EFMAL”.



  1. The same thought had occurred to me. I just have not been following healthcare politics to know if the constitutionality of EMTALA has already been thouroughly debated or not.

  2. Once again, wisdom from Dino’s corner. 🙂

  3. Ah man. I was kinda hoping to see some Jonathan Swift refrence in here. Oh well. Got “eff ’em all” out of it, not so disappointed anymore.

  4. […] Zombie Horse: a few thoughts on health insurance reform. And Immaculate […]

  5. EFMAL. I like it.
    Now we just need to create legislation for free housing, legal services, and XBoxes.

  6. “Hear, hear! Riddle me this, Batpersons: how come no one ever challenged the constitutionality of EMTALA? ”

    Took a quick look at the statutory language and, on its face, although inartfully worded, it seems to apply only to “participating hospitals.” So, the compliance requirement is a condition arising upon the hospital’s decision to take government money to treat old folks. Ergo, no basis for challenging the constitutionality of the statute.

  7. Probably the largest unfunded mandate to date (remember, Obamacare is not yet fully implemented) that has forced closure of multiple hospitals.

  8. AMEN!

  9. […] via […]

  10. I agree. EMTALA ends up being lots of free care for the ER and hospitals, not to mention the on call docs. The ER ends up being a free clinic for the self paying patients and a Medicaid clinic. Most of the area docs won’t accept new self paying patients, as self pay becomes no pay. Medicaid patients are seen for the one time follow up visit from the ER and then discharged back to the ER for the required free care. No business could exist if EMTALA was applied to it.

  11. One major problem is that ER’s–most healthcare facilities and providers, for that matter–charge uninsured patients, who are much less likely to have a primary care physician, way more than insured patients. So those least likely to be able to afford the treatment are charged the most. When they see the bill, they don’t pay either because it’s so daunting or because they feel angry at the cost. My sister had a panic attack, and we thought she might be having a heart attack given our family history, so we called the ambulance. She was charged $32 for a single dose of Xanax. The total bill was over $1000.

    However, it does bother me a lot to see people abuse the ER for non-urgent conditions. Something needs to be done about this such as legal fines (imposed by the government) for blatant misuse of the ER.

    Ideally, there would also be more non-emergency clinics for people who have medical problems that need to be addressed immediately but that are not serious enough for ER treatment. Conditions like gastroenteritis, for instance. That would require more primary care physicians, of course.

    It’s amazing how many cost problems could be alleviated if there were more family physicians. But as long Medicare and insurance companies grossly underpay certain specialties like family medicine, relative to some other specialties, things won’t improve.

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