Hey Brad,

Thanks for your opinion. I have learned over the years I've been on KickAS to value it highly. However, it is your opinion. The facts are as you stated, the US has a healthcare system that is the envy of the world. The law in any state I've ever lived in is that no one can be refused treatment because they can't afford it. That could be different in Michigan, but I somehow doubt it. You are right, though. If someone does not avail themselves of the services, they won't get treated. And, they may not be first in line, but we are a generous nation, and we will not refuse medical care to anyone. That's the Law.


Hi Dean,

You are partially correct about hospitals not being able to turn people away. Under the Federal Emergency Medical Treatment and Labor Act of 1986, any hospital that accepts money from Medicare (which is almost all private and public hospitals) must provide a screening exam to any patient who comes to the ER to determine if any emergency medical care is required. If it is determined that no emergency exists, than hospitals can then turn away any patient they want to, including those that do not have an insurance or other ability to pay for the hospital's services.

If it is determined during the screening that an emergency condition does exist--and this includes active labor--then a hospital may not legally turn that patient away. The hospital is required to treat the patient until such time that the emergency condition has been made stable. Under the law, stabilizing the patient means that the hospital has provided enough necessary treatment to assure that the patient's emergency condition does not deteriorate during transport to a different hospital, nor once the patient arrives at the new hospital (that is, no deterioration occurs as a result of the transfer to the new hospital).

That's it--that's all they have to cover. If you do into an ER and they determine you have a non-emergency condition, you can be denied service in all 50 states no matter how sick you are; basically, you can be denied service in such instances for ANY reason at all, but one of the most common ones is because the patient had no medical insurance. So, let's say a person in his/her 20s and apparently in good health except for the obvious case of the flu the person has shows up in an ER with a fever of 102, vomiting, and a bad cough. It's Friday night, your doctor doesn't open until Monday, no free clinics in the area, so the ER is your only option. Well, if that's the case, and you don't have insurance, you are likely going to be SOL.

Luckily, in pretty much every state, there is at least one hospital (and often more than one) that is either a charity hospital that provides completely free services to those with no insurance who can't afford treatment, as well as other public hospitals that have established policies where they will not refuse treatment to any patient, but any treatment provided is not free. Under their charters, every hospital has set up guidelines for how to handle patients without insurance. Some will request a certain amount of money up front before they will admit someone, and if the patient does not have it, they are sent elsewhere. More common are hospitals that will work with the patient to set up a payment plan that the patient must agree to meet before the hospital will provide services. In addition, some hospitals use a sliding scale approach to billing patients for services. With this method, the hospital sits down with each patient and determines how much the patient can pay, then sets up a payment plan based on that number.

Thus, I think there are some rather huge and scary holes in the idea that hospitals must treat every patient even if they don't have insurance or can't afford to pay. Sure, receiving care in an emergency situation is often the most important thing, and that is in place. But the whole stabilization thing seems a little open for interpretation, to say the least. These days, hospitals do EVERYTHING they can to keep any patients from dying in their hospital. To which I bet everyone replies, "Well, duh." Unfortunately, I don't mean they will provide every cutting edge treatment they can in order to save patients' lives. No, I mean that they will do whatever they can to ensure a patient is out their door and either sent home or transferred to a another hospital if they are afraid a patient might die in the very near future. One of my good friends is best friends with a hospital administrator, and he told her that it is absolutely shameful what hospitals do today in order to make sure as few deaths as possible occur on the premises. One way they can do this is to adopt a VERY broad interpretation of "stabilization," which allows them to transport they call stable, even though they are aware that any stability is very temporary and that the patient is very likely to die in the next 12-24 hours. Proving they didn't properly stabilize a patient in court is usually very difficult.