ANN ARBOR, Mich. Two major health reform laws, enacted 25 years apart, both try to meet an ethical standard to provide broad access to basic health care. Neither quite gets there -- but it's not too late for modern health care reform to bring the nation closer to a goal of comprehensive and coordinated care for all.
That's the conclusion of a commentary published in the new issue of the Journal of the American Medical Association by a team of University of Michigan Health System physicians.
The authors a family physician, an emergency physician and a primary care pediatrician/internist take a hard look at the implications of the ethical standard set in 1986 by a law that mandated universal access to emergency care. They assess the ability of both that law, and the Affordable Care Act of 2010, to meet the standard of providing access to basic health care to all who live in the United States. They conclude that both laws fall short of that standard.
But, by learning from the quarter-century of the nation's experience with the emergency care law called EMTALA they say the current Congress and administration may still be able to implement and tweak the ACA so it comes closer to the public's ethical expectations.
The crux of the issue, they write, is that the ACA doesn't ensure access to preventive care for all, nor coordination among all types of health care. An estimated 30 million people will still be without insurance even after all of its provisions take effect.
"Health care in the U.S. is sometimes treated as a right and sometimes as a privilege," says U-M health care policy researcher Katherine Diaz Vickery, M.D., a Robert Wood Johnson Foundation Clinical Scholar who also sees patients at U-M's Ypsilanti Health Center. "When we compare EMTALA and the ACA, we see that while emergency care is treated as a right, primary care, it seems, is treated as a privilege."
EMTALA focused on taking care
|Contact: Kara Gavin|
University of Michigan Health System