EMTALA and healthcare
So there’s this law in the US called EMTALA. The Emergency Medical Treatment and Active Labor Act. Basically, it says that if someone comes to an ER requesting treatment, they must be seen by a doctor, and if they are found to be having a medical emergency or in active labor, they must receive whatever care is necessary to stabilize their condition and/or deliver their baby. This is regardless of ability to pay, citizenship, criminal record, anything. You show up, you see the doc. You’re sick, doc treats you. End of story.
As someone who works in an ER, I’m glad for this; it may cost us a lot of money and bring us a lot of inappropriate (in the sense that they could be treated more effectively in a non-ER setting) patients, but at least there isn’t a pile of corpses outside the door. At least I’ve never had to tell a patient “your credit check came back and… sorry. Good luck with that heart attack.”
EMTALA is where we draw the line as a society. It’s where we say that no, we are not willing to watch people die of easily cured diseases, or starve to death, or freeze. We’re willing to let it happen when we’re not looking, and we’re willing to let people go pretty damn sick and hungry and cold, but if someone comes to our doorstep dying… at the end of the day we aren’t quite willing to let them die there.
This has economic consequences. Hospitals spend literally billions every year on uncompensated ER care under EMTALA, and they don’t eat that loss; they pass it on to every other patient in the form of higher bills. If you get medical care or pay Medicare/Medicaid taxes, you’re paying for uninsured people’s care right now.
And you’re not paying for it to be done well. An ER visit costs far more than a visit to a primary care doctor. And ERs don’t provide preventative or rehabilitative care, so people whose only healthcare is the ER are going to visit more often and be sicker when they visit. Forcing people to go to ERs because they can’t afford anything else is not a cost-saving measure. It's spending money on providing worse care.
So the question is not “should we pay for poor people’s healthcare?” Because of EMTALA, that isn’t a choice. (We could repeal EMTALA, but then we’d have to admit that we don’t mind the occasional corpse on the streets, and I like to think society isn’t quite ready for that.) We will pay for the care of people who can’t pay the bill themselves. The only choice is how we pay for it.