Hey SCOTUS, we already have a federal mandate for health care

US law requires emergency rooms to treat patients regardless of their ability to pay. As a hospital CEO, I assure you, we already have a form of universal health care. We simply fund and supply it in an exorbitantly expensive way. Obamacare's individual mandate provides the solution.

Charles Dharapak/AP
Supporters of President Obama's health-care reform law (known as Obamacare) rally in front of the Supreme Court March 27. As court justices debate the constitutionality of the law, op-ed contributor Brian Keeley defend's the law's 'individual mandate,' calling it 'a much better option to our current by-default health-care insurance system.'

The United States, the richest nation in the world, is the only advanced country without some form of universal health care for all its citizens. And the US now spends around 18 percent of its gross domestic product on health care – the highest percentage in the world.

So while the Supreme Court debates the constitutionality of the health reform law (aka Obamacare) and, more specifically, of its individual mandate, let me share my own perspective as the president and CEO of Baptist Health South Florida, a $3.6 billion not-for-profit health-care organization with seven hospitals, 30 outpatient centers, and 15,000 employees.

America already has a universal health-care mandate. We simply fund it and supply that care in a nonsensical, inefficient, exorbitantly expensive way. Let me explain.

While countries such as Great Britain have a government-run, single-payer (or “socialized medicine”) system, others, such as business-friendly Switzerland, have a totally private system.

Switzerland utilizes private health insurance companies and requires all of its residents to purchase health insurance through an individual mandate. It reformed its system several decades ago to a fashion similar to what is included in the Patient Protection and Affordable Care Act signed by President Obama. According to the World Health Organization, quality of care in Switzerland is high, everyone has access to care, and Switzerland spends only 11 percent of its GDP on health care.

The so-called individual mandate in Mr. Obama’s health-care law is a mechanism used to require all uninsured residents, including the young and the healthy, to buy health insurance. One of the key concepts of insurance is to spread risk among as many people as possible by getting them all into the same “risk pool” – the healthy and the sick, the young and the old, and, more important, those with pre-existing conditions.

Contrary to some of the current political rhetoric, the concept of an individual mandate was proposed by the conservative Heritage Foundation, and even endorsed in earlier times by Republican presidential candidates. If the Supreme Court rules that the individual mandate is unconstitutional, the entire health-care reform program will be in jeopardy, because this idea of spreading risk and its associated costs is the underlying foundation (and intent) of the law.

Our current system is unsustainable because it is just too costly. The upcoming demographic tsunami of baby boomers will undoubtedly overwhelm our existing system capabilities and drive costs up even higher. As the global economy continues to accelerate, it appears America’s industrial competitiveness will only further diminish.

The best argument to implement universal health care through an individual mandate, other than the national embarrassment that the wealthiest country in the world does not provide basic health care for all its citizens, is that America already provides universal health care – by default. It’s called EMTALA.

The Emergency Treatment and Labor Act (EMTALA) was passed by Congress in 1986. It essentially requires every hospital with an emergency room to screen and treat all patients who present themselves and require emergency treatment – regardless of citizenship, legal status, or ability to pay. This is, in essence, a federal unfunded mandate without a provision for reimbursement.

Many uninsured people simply use the emergency room as an access point for “free” health care. While free to them, the cost of providing care of these so-called “free riders” is shifted to others.

Accessing health care through hospital emergency rooms is not only very expensive; it is a terrible misuse of scarce resources. Since health-care providers must absorb the expense of these non-paying patients, the providers simply shift the cost to those who can pay more: that is, privately insured patients.

Hence, rather than everyone sharing in the cost of health care, those with private health-care insurance are paying for those in their plan (risk pool) – and also for those who do not have insurance.

As the ensuing premiums for privately insured patients continue to rise, more and more are priced out of the insurance market. This actuarial death spiral will continue until very few will be able to afford health insurance for themselves and their loved ones (or their employees).

There is a much better option to our current by-default health-care insurance system: It is the individual mandate, which requires that everyone must buy insurance and be part of the national risk pool. This is a much more intelligent and equitable way to ensure a basic level of health care for all – in a fiscally responsible manner.

Brian E. Keeley is president and CEO of Baptist Health South Florida, a $3.6 billion not-for-profit healthcare organization based in Coral Gables, Fla. with seven hospitals, 30 outpatient centers, and 15,000 employees.

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