If you go into Madera Community Hospital’s emergency room, it is likely that you will sit beside people who will pay little or nothing for the treatment they receive.
That’s largely for two reasons. The first is that Congress requires hospital emergency rooms to see almost anyone who walks in the doors, regardless of ability to pay. The second is that those who do pay often use state or federal aid to do so. Others hand over proof of insurance provided by their employers or their parents. Relatively few are self-insured or pay in cash.
When the hospital sees non-paying patients, who eventually pays for the patient care that is administered? We do. Federal and state grants provide some money for that free care. Other patients who pay through insurance, or who pay cash, also finance that free care in the fees they pay for drugs and procedures.
That hardly seems fair, and it isn’t. It also is one of the reasons the United States has the most expensive national health care system among industrialized nations.
The question is whether the Affordable Care Act will improve fairness or care. Now that the Supreme Court has weighed in, it would appear we’re about to see. Will all the uninsured people now go out and buy health insurance? Don’t bet on it. We’re about to suffer more health-care consequences because neither Congress nor the president had the smarts or the will to provide a system which would work.
If the nation feels compelled to extend health care to all its citizens, we have a good model. It’s called Medicare. To extend Medicare to all would require paying to Medicare the money now spent on private insurance and Medicaid. Medicare then would pay our doctor and hospital bills.
Those who wished to do so would purchase private supplementary policies, as many Medicare recipients do now. Medicare would contract with private companies, such as health insurers, to manage payments and try to prevent fraud. Premiums would be paid in the form of payroll taxes on employees and employers, just as they are now.