Ideas 2012 July/August 2012

Don’t Treat the Sick If They're Poor

Here is a health-care reform that is notable for never being proposed by the people who ought to be for it, namely conservatives: repeal the Emergency Medical Treatment and Active Labor Act, the 1986 law that requires hospitals to treat urgent-care patients regardless of their ability to pay.

Conservatives say the government cannot and should not require people to buy health insurance. The trouble is that the government can and does require hospitals to treat people who don’t have health insurance and who can’t pay. The result is a free-rider problem that runs to tens of billions of dollars a year and, worse, destabilizes the whole system.

According to conservatives, the government should not make people buy insurance; it certainly should not provide coverage for them. That would seem to eliminate the two main ways to deal with free riders. One obvious possibility remains. If you can’t pay for medical treatment, you can’t expect to receive it. Period.

Oddly, proponents of small government and personal responsibility do not propound that idea. It was hinted at, however, in a Republican presidential debate last September. The moderator asked Representative (and physician) Ron Paul, a hard-liner on the subject of individual responsibility, whether an uninsured person in need of urgent care should be left untreated, possibly to die. Answer (of course): “No.”

As Paul spoke, Tea Party types in the audience could be heard shouting “Yes!” They, at least, were being intellectually honest. If conservative politicians were as forthright, we might be able to have the debate we need.

Next idea: Smartphone-Free Socializing

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Jonathan Rauch is an Atlantic contributing editor and guest scholar at the Brookings Institution.

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