Our society, as all others have, must face the question: what level of care should we provide to those who are unable to care for themselves? Sometimes that inability is due to conditions beyond anyone’s control—such as ill health or accident. Sometimes it is due to bad choices—out of ignorance, or defiant choices made willfully. These individuals—and even more so their children—will suffer severely if others do not provide what they cannot.
Imagine a child with an unknown father and a single mother on drugs. The child falls down the stairs and breaks his arm. Should our society stand by and say: “Because of the abysmally bad choices made by your parents (who have neither health insurance nor funds to pay for hospital care) your broken arm must go untreated!” Of course not! This shared belief, held by almost all Americans—that no one should be denied essential health care—is the root issue dealt with by Obamacare. If we as a society are going to insist that everyone get health care, we also as a society must determine how it will be paid for.
Our insistence that no one be denied essential health care is embodied in the EMTALA. As stated in Wikipedia:
The Emergency Medical Treatment and Active Labor Act (EMTALA) is a U.S. Act of Congress passed in 1986 [Reagan’s second term] . . . requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. THERE ARE NO REIMBURSEMENT PROVISIONS. [emphasis added] [In other words, Congress required that everyone receive emergency medical care but provided no funding]. . . . In practical terms, EMTALA applies to virtually all hospitals in the U.S.
The cost of emergency care required by EMTALA is not directly covered by the federal government. Because of this, the law has been criticized by some as an unfunded mandate. Similarly, it has attracted controversy for its impacts on hospitals, and in particular, for its possible contributions to an emergency medical system that is “overburdened, underfunded and highly fragmented.” MORE THAN HALF OF ALL EMERGENCY ROOM CARE IN THE U.S. NOW GOES UNCOMPENSATED. [emphasis added] Hospitals write off such care as charity or bad debt for tax purposes. [Which means they pass the cost, at least partially, on to taxpayers]. Increasing financial pressures on hospitals in the period since EMTALA’s passage have caused consolidations and closures, so the number of emergency rooms is decreasing despite increasing demand for emergency care. There is also debate about the extent to which EMTALA has led to cost shifting and higher rates for insured or paying hospital patients, thereby contributing to the high overall rate of medical inflation in the U.S.[i] [Which means they pass the rest of the cost on to those who do pay for hospital care by charging them more].
An emergency room doctor tells me of a young couple bringing in their baby with diaper rash because they didn’t want to pay to go to a doctor and apparently because they had never heard of Desitin.
Obamacare appears to be a genuine attempt to get all of those who are free-loading on the health care system to help pay for it. President Obama, however, was terrified of being accused of raising taxes on the middle and lower economic classes, so Obamacare doesn’t do the obvious: simply compel everyone to pay extra taxes to reimburse hospitals for their care. Instead it compels everyone to purchase health insurance or be fined. The result for the hospitals is the same. They will now get reimbursed by this compulsory insurance. The result for all of the free-loaders is the same. Instead of being compelled to pay a tax, they are compelled to purchase health insurance. Either way it is a compulsory payment.[ii]
The odd fall-out of this political strategy is that President Obama really is taxing those he promised not to tax but refuses to admit it. The cost of this deception to the country is that Obamacare’s compulsory health insurance can only be justified as a constitutionally authorized regulation of interstate commerce—an extension of the already hyper-extended federal power into an area never dreamt of by the drafters of the Constitution. They were very specific in creating a federal government with enumerated powers listed in the Constitution. To make it emphatically clear that nothing should be added, the Tenth amendment to the Constitution states: “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.”
The difference between “Romneycare”—a compulsory health insurance program adopted by the state legislature of Massachusetts—and Obamacare— federally mandated health insurance for the nation—is the Tenth Amendment. Romneycare in no way conflicts with the U.S. Constitution. Obamacare contradicts it. The dangers of using Congress’s power to “regulate commerce . . . among the several states” as the far-fetched justification for Obamacare is that, if upheld, it will (unfortunately, once again) prove that the Supreme Court has erased the concept that the federal government should be one of limited powers and that all residual powers lie in the states and individuals.
All debate over national healthcare should focus on the real issue: Who is going to pay for health care, particularly emergency room care, for those who either cannot or won’t pay for it themselves? When debating Obamacare two things should be emphasized: (1) it really is a tax on the middle and some of the lower class; and (2) it is a quintessential example of federal power being extended far beyond any reasonable reading of the Constitution. There is no debate over whether or not we are going to provide at least emergency room health care for all. Even Reagan believed in that. He just didn’t find a way to pay for it. That is what we should be debating. Is it the role of the constitutionally limited federal government to fund it—and if so, how—or is it one of those issues left to the states by the Tenth Amendment?