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As you know I have been very active in the health care reform debate.  You also know I believe the health care system in this country is broken and needs to be fixed.  Lastly, you know I hate just about everything in the PPACA  (health care reform law).  I was wondering this morning what is the bill and the system trying to accomplish?

Initially, I thought the goal of the bill was to bring down the cost of health care?  Then there became a fine line between health care and health insurance, it kind of became health insurance reform.  The costs did not come down.  There are now mandates as to what has to be in an insurance policy that actually increases the costs of health insurance.  The bill expands Medicaid which will put the States at a financial burden.  We have told the insurance companies how to run their companies with telling them how much of their income has to be spent on claims, administration and commissions.  This has reduced agent commissions, while driving many agents out of business.  We have seen many carriers also leave the health insurance business.  The bill mandates that all Americans purchase health insurance, which may or may not be constitutional. 

My questions as I examine this bill are was this mandate to purchase insurance an attempt to insure the previously uninsurable?  Was it attempt to get more people to buy insurance to spread the risk over many people?  Was it to stop people from going to the Emergency Room and basically getting FREE care?  That is interesting and maybe a law worth repealing there.

In 1986, Congress passed what was called the Emergency Medical Treatment and Active Labor Act or EMTALA.  EMTALA requires that hospitals provide emergency care to anyone who needs it regardless of citizenship, legal status, or the ability to pay for the services.  There are a few ways that a hospital can opt out of EMTALA, but very few hospitals could function without some of the government funding they are given so virtually all hospitals are covered by EMTALA.

This is part of our health care problem. Since hospitals have to treat patients without getting paid, we all pay.  That is part of the cost of care that is talked about.  If they have to treat people for free, they must charge more to the people who can pay (insurance companies).

Perhaps instead of EMTALA or maybe as part of EMTALA we have a financial responsibilities portion of the bill that requires you to pay for services rendered, kind of like when you go to the store to buy groceries.  If you have insurance, great, if you do not, you still have to pay your bills.  I do not want a system where we let someone just die because they have no assets or ability to pay either, but there has to be some obligation somewhere.

Unfortunately, at some point we will all need medical services, whether it be for accident or injury, sickness, or as we age our bodies break down.  Sadly in one way or another we are all participants in our health care system.  Some of us are doing it responsibly, other irresponsibly.

The PPACA law focuses on preventative services such as no co-pays for Mammograms and immunizations, it is good to practice prevention, but these are all services that you can pay for, kind of like your auto insurance does not pay for oil changes, but most of us still change our oil every 3000 miles.  Most of the preventative services are not done in the emergency room, so we still did not really address where the most expensive portion of health care really takes place.

Another situation in regards to, the emergency room is an EMTALA hospital has to accept Medicaid patients.  Now Medicaid pays about 88 cents for every dollar of care so many doctors have stopped taking Medicaid patients.  Where do those clients end up?  The emergency room!  So in this case, the hospital is not un-compensated, but they are under-compensated.  Since the PPACA bill expands Medicaid, we will have crowed and under-compensated hospitals.

When we are trying to fix the healthcare system, we need to examine the entire system, that is doctors, hospitals, insurance companies, lawyers ( malpractice lawsuits) and pharmaceutical companies and dissect the bad part and the good parts piece by piece.

Thanks for reading!

Eric  Wilson is President of I Sell Health, Inc.,  a Chicago area insurance agency.  You can reach him toll free at 888-448-5370 or online at