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.
Posted by Robert Maddox at 04:40 PM | Comments (0)
May 14, 2008
Social Reform
I need to start a book review section, but short of figuring out what that means, I need to make a few comments about The Medical Profession and Social Reform, 1885-1945. It is great study of the transformation of medicine "in the 'spirit' of Johns Hopkins and the atmosphere of Massachusetts General Hospital." (Cabot's phrases)
Flexner said in his report, "the physician's role is fast becoming social and preventative, rather than individual and curative." Flexner is, of course, the fellow who wrote the report recommending that medical schools across the US be forced to follow the Hopkins/MGH model of education, standardizing education, making the physician an academic doctor (requiring a bachelor, usually BS, prior to matriculation and imbuing the principles of "scientific medicine." This was a conscious shift in emphasis. It has been accepted without question that this was a good and necessary shift. It has not been without its negative consequences though, as is true for many social changes that appear to be well-motivated.
Continue reading "Social Reform"
Posted by Robert Maddox at 10:50 AM | Comments (0)