Editorial: Health care conversation misses the real problem

While it might seem like national politicians are arguing over universal health care, they really aren’t. We already have that. In 1986, the Emergency Medical Treatment and Active Labor Act was adopted by a Democrat-controlled U.S. House of Representatives and a Republican-controlled Senate. President Ronald Reagan signed it into law.

This bipartisan law says that if medical caregivers accept federal payments from Medicare, Medicaid or any federal entity, they must treat and stabilize patients regardless of their citizenship or ability to pay.

For practical purposes, this means that virtually all hospitals, emergency medical treatment teams and ambulance services fall under this mandate: treat first; figure out payment later. This is why hospital emergency rooms fill up as access to health coverage recedes.

However, this does not mean that the cost of emergency medical services for the uninsured just disappears. Hospitals eat some of the cost. The rest is passed along by boosting charges to insurance companies (which, in turn, pass those along to employers and individuals) and by raising the price of health-related goods and services. Read a hospital bill sometime. Bandages and cotton balls don’t really cost that much.

So the real argument is over how to pay for universal care. At present, our fragmented system of third-party payers yields the worst medical inflation in the industrialized world. In 2009, health care spending comprised 17.6 percent of the nation’s gross domestic product. In 1970, it was 7.2 percent.

Health care is crowding out education, criminal justice, transportation and other key areas of government budgets. By the same token, when budgets need to be slashed, health care provides a very large target. Governments slash health services to balance budgets, but all that does is shift the costs.

A prime example is about to unfold as community health clinics are hit with state funding cuts. The Community Health Association of Spokane is facing a $9 million reduction – 30 percent of its budget. CHAS clinics serve about 30,000 people and 40 percent of them are uninsured. The rest pay on a sliding scale. Meanwhile, the governor has called for an end to all subsidized insurance in the Basic Health Plan, which covers 66,000 people statewide.

If these cuts are enacted, budgets can be balanced, but once again the costs will be shifted. Patients who used to get help early on will now be served when their ailments become an emergency. And costs will be spread to everyone else.

No credible national leader is suggesting we repeal the federal emergency treatment law. We aren’t going to let people die at hospital doors. So what the nation needs to do is face up to the fact that we do have universal care, but it is delivered in a horribly expensive and painful way.

We need to turn the system around, so that health care can be available early in the process and in predictable ways. In addition, we need to measure outcomes so we get better value from our health care dollars. That, in turn, will widen access.

This is the debate the nation needs to have. The current one isn’t based in reality.