On the Individual Mandate…

In staking out their position, many conservatives and most libertarians convey health care as a privilege, not a right. Fair enough.

EMTALA, a federal law, is explicit, and rightfully gives every individual (including non-citizens) the ability to get emergency and acute care until stable. Individuals will barter, negotiate (sometimes at 10 cents on the dollar) or walk away from their bills. Again, this is a right federal law guarantees.

Has any state governor, policy figure of import, or academic reconciled these two concepts, mainly, one can stake out a grand platform of opt out, yet embedded in that platform is a back door to both receive life saving care, and also have the ability to escape or moderate payment.

I do understand that some will risk crushing debt and then preserve their credit and reputation and pay up. I will give those folks a pass, but they are likely the minority, ie, those that can pay 100% full freight into a hospital bill.

However, this disconnect must be explained. I hardly doubt any elimination of the individual mandate will offer the option of simultaneously expunging EMTALA from the books.

Would Gov’s Pawlenty or Perry attempt to offer an opinion on this matter? I would even take a second rate op-ed columnists’ fair shot. You dont want the mandate. Fine. Lets make “inactivity” mean what it really implies.

Brad Flansbaum

Bradley Flansbaum, DO, MPH, MHM works for Geisinger Health System in Danville, PA in both the divisions of hospital medicine and population health. He began working as a hospitalist in 1996, at the inception of the hospital medicine movement. He is a founding member of the Society of Hospital Medicine and served as a board member and officer. He speaks nationally in promoting hospital medicine and has presented at many statewide meetings and conferences. He is also actively involved in house staff education.

Currently, he serves on the SHM Public Policy Committee and has an interest in payment policy, healthcare market competition, health disparities, cost-effectiveness analysis, and pain and palliative care. He is SHM’s delegate for the AMA House of Delegates.

Dr. Flansbaum received his undergraduate degree from Union College in Schenectady, NY and attended medical school at the New York College of Osteopathic Medicine. He completed his residency and chief residency in Internal Medicine at Long Island Jewish Medical Center in New York. He received his M.P.H. in Health Policy and Management at Columbia University.

He is a political junky, and loves to cook, stay fit, read non-fiction, listen to many genres of music, and is a resident of Danville, PA.

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