The point that Frakt and Carroll make is well-taken. The fact that emergency room care is guaranteed by the 1986 Emergency Medical Treatment and Active Labor Act does not mean that everyone has access to effective healthcare. But 1986 does seem to me to be the real moment when America socialized medicine – under Reagan! In a real Ron-Paul style free market in healthcare, where everyone has to buy their own insurance or not and deal with the consequences, chronically sick poor people must, in principle, be left, at some point, to suffer and die alone or bankrupted. Something in the American psyche does not want that to be America. Whatever part of the psyche that is, it sure isn't inspired by Ayn Rand. It wants to put a floor under human suffering and sickness, to have a minimal baseline for care. We don't want to see people dying in the streets.
But once you have done that, you have socialized medicine.
You have socialized medicine because most of the people visiting the emergency room will not have sufficient coverage and will be unable to pay. So the costs are shifted to everyone else. Worse, the costs of treatment at this level of emergency are far higher than pre-emptive care. And so we are all in this together already. The question is: does it make any sense to construct a socialized system in this absurdly inefficient way that may actually cost much more and provide much less healthcare than a more coherent system?
This is one reason why America's relatively free market in healthcare has become so costly and inefficient. I mean, here's a question worth asking. In what field of human activity is a free market system consistently far less efficient than a socialized one? Why are those decadent Europeans actually more efficient in providing healthcare than we are?
The Dish 