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May 15, 2008
EMTALA backfires
Very good analysis of the consequences of the well-intentioned law, EMTALA. This law has had a significant effect on my practice since before its inception. I was in med school while it was being debated, and graduated about the time that it was incorporated into the OBRA, then COBRA law, as it was first designated. (The Consolidated Omnibus Budget Reconciliation Act- meaning that this huge law with a huge impact was initially part of the bill to "balance the budget." This really adds to the irony.)
As with other well-intentioned laws, this one over-reaches by attempting to prescribe what I am still convinced should be a private contract.
However, once medicine became a force of social reform, requiring government payment and control, it was inevitable that laws like EMTALA would become a necessity. The payor had to assure that all subjects would be treated equally. To put it more starkly, the master has the right and responsibility to see after all his slaves.
For decades, in order to draw in reluctant physicians, reimbursement under government programs was lucrative. Then it became necessary to tighten those payments. In order to maintain the control, the payor then forbade balance billing. EMTALA was just one more step to assure control of the system.
The question remains, what is the next step of control now that EMTALA is backfiring? The original plan by Cabot called for physicians to be salaried employees. This has to a large extent been accomplished. It only remains to capture the rest. As I observed in Eastern Europe, when I made my decision to enter med school, doctors were vilified, then enslaved to the state. The people deserve no less.
| By Robert Maddox | 4:40 PM
Comments
Posted by: sharon (Telling) O'Donnell at August 22, 2008 6:36 PM
Posted by: Chuck Hartman at August 30, 2008 1:28 PM