How to Stop an Outrage

Thursday, April 02, 2009

The Austin American-Statesman, stating that a non-profit task force is looking for ways to "divert non-emergencies away from emergency rooms," reports the following:

In the past six years, eight people from Austin and one from Luling racked up 2,678 emergency room visits in Central Texas, costing hospitals, taxpayers and others $3 million ...

One of the nine spent more than a third of last year in the ER: 145 days. That same patient totaled 554 ER visits from 2003 through 2008.

We looked at frequent users of emergency departments ... and that's the extreme," said Ann Kitchen, executive director of the Integrated Care Collaboration, the group that presented the report last week to the Travis County Healthcare District board. "What we're really trying to do is find out who's using our emergency rooms ... and find solutions."

The health district, one of 26 members of the ICC, has long been concerned about overuse and crowding of ERs, a problem that has hit hospitals around the country. [bold added]
Kitchen later says that each ER visit costs about a thousand dollars.

Although the article does not delve into the types of solutions we might hear about, it does mention one stab at the problem: The health district has expanded hours at its public clinics.

The government is already heavily involved in providing medical care. The ICC is working "with safety-net providers to improve access to and quality of care" [link added]. Current trends are towards ever more government involvement in every aspect of our lives. Given all these things, we can expect, in the very near future, to hear this outrageous waste of money cited as justification for even more government hectoring about our personal habits, intrusion into our daily lives, and pilfering from our wallets.

There are many reasons for this, the primary one being that in our culture, most people wrongly take for granted that we are our bothers' keepers, and that we are obligated to provide care for the more "needy". But there is another reason, of which this article is a prime example.

Notice its treatment of the emergency room crisis as being almost a natural phenomenon: "[O]veruse and crowding of ERs [is] a problem that has hit hospitals around the country." How and why has it "hit" hospitals across the country? You might as well ask why gravity exists to read this article.

In fact, the emergency room crisis is man-made, in large part by a federal mandate that forces emergency rooms to treat all comers. Writing for The Undercurrent, Laura Mazer writes that:
What drives the nation’s hospitals to operate at an obvious deficit, giving away for free a service that is neither cheap nor easy to produce? They do it in part because they are legally required to do so. In 1986, the Emergency Medical Treatment and Active Labor Act made it illegal for a hospital to refuse care in an emergency setting, regardless of ability to pay. The Act essentially transformed emergency rooms into primary care facilities for the uninsured.
If the government is running the hospital, this means that ordinary citizens are robbed at government gunpoint so certain individuals can treat hospital emergency rooms like vacation homes for four months of the year. (If not, the hospital will pay for it, meaning that its owners make less money and its physicians cannot be paid as well. This is also wrong.)

But this never comes up in the article, which is an unforgivable omission, given that some form government intervention is all but certain to be offered as a "solution" to a crisis that government intervention caused in the first place.

The best way to prevent people from camping out in emergency rooms at the expense of other people is to reintroduce the trader principle to the business of medicine, specifically by having patients pay for the medical care they receive on terms the physician finds agreeable. If someone has the resources and the desire to spend 145 days of the year in an emergency room, then the only money he wastes is his own. If not, he wastes no money. And, in either case, others have money that otherwise would have been taken from them, making them better able to afford their own medical care.

Given the widespread acceptance of altruism, that proposal is hardly uncontroversial, but anyone who advocates more freedom as a solution to the myriad government-induced crises in our economy must be alert for situations like this, where government intervention is treated as if it is an immutable law of the universe, which it isn't.

As have indicated before in a different context, a non-problem commonly regarded as a major problem may really be a manifestation of the effect of the welfare state on the economy in disguise. For example, immigrants sucking up social services is not an argument against immigration, but against the welfare state. (How would immigrants cost us anything if the government didn't make it possible for people to freeload in the first place?) Likewise, people abusing emergency rooms is not an argument for further government funding or control of medicine, but against the government paying for medical care at all.

-- CAV

No comments: