There are all kinds of mystifying claims being made about the tax reform bill that was passed by the Senate last Friday. One is that 38% of Americans won’t receive a tax cut under the plan. Putting aside the good news — that 62% of Americans will receive a tax cut under the plan — the crepe hangers seem to be ignoring another inconvenient truth: that 40% of Americans pay no tax at all.
Another grave pronouncement made about the bill is tied to its provision to eradicate the individual mandate (aka tax), which will effectively kill Obamacare. This morning, Larry Summers, who served as Treasury secretary under Bill Clinton and White House economic advisor under Barack Obama, announced on CNBC that 10,000 Americans will die every year from lack of health coverage if the bill is signed into law.
“I think this bill is very dangerous,” he said on CNBC’s “Squawk Box” program. “When people lose health insurance, they’re less likely to get preventive care, they’re more likely to defer health care they need, and ultimately they’re more likely to die.”
As grim as that sounds, I suspect that deep down Summers, who was also president of Harvard for a while, knows better. While it is true that uninsured, working-age Americans have a higher death risk than their privately insured counterparts, it is also true that many in this group habitually make poor lifestyle choices, which hasten their early deaths.
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Another factor that Summers is conveniently ignoring is a federal law that has been on the books since 1986 and which requires that anyone coming to an emergency department be treated, regardless of insurance status or ability to pay. The law, known as EMTALA (short for the Emergency Medical Treatment and Labor Act), was originally intended to be limited to emergent conditions — women in labor, for example, or patients complaining of chest pains — but thanks to poor supervision, it has been abused, effectively creating a costly and unwieldy situation where uninsured patients are given carte blanche to use the emergency department as their primary care physician.
One ED doctor writes at KevinMD:
To be brief, EMTALA is an unfunded federal mandate … which, de facto, has made it a crime to tell anyone ‘no’ in the ER. …
No doubt there is a strong tradition in western medicine to treat first and seek payment later. This dates to Hippocrates and is part of the original oath. My question is this. How far should this obligation extend, and, should it be extended by force of law rather than by individual choice? My answer is that the obligation should never be extended de jure. Medical schools, training programs, and hospitals can choose to extend this requirement to their students and physicians and the students and physicians can choose to participate or not, but the government does not have this right. Seems to me we fought a war over a similar issue, for this is analogous to taxation without representation, only this tax is paid in time, liability, and money.
There is no question that the health care system in this country is broken. Under Obamacare, it became more broken by forcing Americans to buy a product whether they wanted it or not. Eliminating that requirement — by killing the individual mandate to finance tax cuts for Americans — is a good thing.
