Indecent, Ctd

A reader writes:

This: "America, moreover, has a law on the books that makes it a crime not to treat and try to save a human being who walks into an emergency room" … is not precisely true. And it's not precisely true in a way that fits perfectly into the libertarian project.  

The Emergency Medical Treatment and Active Labor Act (EMTALA) requires "participating hospitals" to provide care to anyone needing emergency health care treatment, regardless of citizenship, legal status, or – most famously – ability to pay.  "Participating hospitals" are those who participate in the Medicare program.  In practice, virtually every hospital participates.  But, for example, Shriners Hospitals, Indian Health Centers, and VA Medical Centers are not subject to the law.  Nor would be any hospital that opted out of Medicare.  

EMTALA has to be structured this way to be constitutional. Congress can impose virtually any restriction, even ones that would otherwise be unconstitutional under the Tenth Amendment, through Medicare conditions of participation, with the result that it applies only to participating facilities.

The Ryan budget and other proposals from the libertarian/Tea Party right pledge to put the government out of the business of paying for healthcare.  If Medicare becomes a set of subsidies beneficiaries use to purchase private health insurance, then EMTALA is dead.  If hospitals no longer participate in the Medicare program, then there is no way for Congress to require such treatment in a manner that would survive constitutional scrutiny.  In this way, the GOP has put forward a proposal to end EMTALA.

Another writes:

Eliminating the emergency room care law does not seem practical. How would paramedics or doctors in an emergency room deal with an unconscious patient lacking ID who requires immediate lifesaving care? Even if the hospital could determine that the patient was insured, how would they know if the patient had enough money to pay the deductible?

I don't think this is a hypothetical question. And I'm pretty sure that anyone who needs emergency care wants and expects the paramedics/doctors to begin treating them immediately. This would end up affecting the insured as well as the uninsured, and it's not hard to imagine the outrage that would occur when someone whose life could have been saved dies because precious time was wasted verifying that the patient had adequate insurance.

Also, in Ron Paul's answer he claimed that churches and private charity would take care of the sick in the absence of government. I hear this a lot from libertarians, and private charities certainly do provide a great deal of care. It would be wonderful if private charity could solve our social problems without any need for government programs. But if they had been able to solve the problem on their own there wouldn't have been any need for government programs. And the idea that care for the poor is strictly the domain of churches and private charities isn't just pre-New Deal, it's practically pre-Renaissance.