July 18, 2014
There Is No ‘Free’ Healthcare in U.S.
by Dan Munro
The argument that free care is dispensed through emergency rooms is flat-out false. The costs are simply rolled in elsewhere by the hospitals.
There is no such thing as “free” healthcare in the U.S. There are people who access healthcare at low (sometimes even no) cost, but the people delivering the service aren’t providing it for free, or, if they are, it’s an ad-hoc charitable donation.
There is one exception that I know of, but the clinics typically only run over weekends (when providers can donate their time and skill). The exception is called Remote Area Medical and is staffed with clinical volunteers, so there is no charge to patients — and no payment to providers. It’s as close to “free” as I think we’ll ever get. Here are some images of what a weekend RAM clinic looks like:
RAM has been featured on “60 Minutes” and other news-magazine shows. It’s run by Stan Brock, who founded it. It derived its name — Remote Area — from the idea that it would deliver healthcare to remote regions of the globe. In fact, it started with medical “expeditions” to Latin America in 1992. Today, 60% of RAM clinics are held in rural or urban America. I encourage everyone to watch the 13 minute 60 Minutes episode – from 2012. (60 Minutes – RAM Medical Missions in the U.S. – A Lifeline.)
RAM aside, the argument that EMTALA (Emergency Medical Treatment and Labor Act of 1986) is “free” care delivered through the emergency room is flat-out false. The costs accrued through every emergency department (for every patient, service and supply) is simply rolled into the books under a category called “uncompensated care.”
Uncompensated care is among the three categories of healthcare that for a hospital amount to negative margin. The other two are Medicare and Medicaid. The only remaining opportunity for “positive” margin (and keeping the doors open) is through commercial insurance. That chart (courtesy of L.E.K. Consulting) looks like this: