The dogs on Main Street howl
Cus they understand
That I can take one moment in my hand
Mister, I ain’t a boy
No, I’m a man
And I believe in a Promised Land
Bruce Springsteen, Promised Land
I was watching the Grammys last night, feeling my age. I felt like Eastwood’s character in Gran Torino, yelling at the kids to get off my lawn but also appreciating even the performances I didn’t really get. Talent and good ideas come in different shapes, sizes, colors and packages. Sting wasn’t better than Kendrick Lamar, P!nk and Bruno Mars just because he’s my era.
In 1986, Congress passed the Emergency Medical Treatment & Labor Act (EMTALA), as part of the Social Security Act, requiring hospital emergency rooms to screen and stabilize patients as a condition for participating in the Medicare system. In theory, this means that all patients (even the indigent and uninsured) can obtain treatment for emergency conditions. Before EMTALA became law, our healthcare delivery and insurance system experienced fundamental changes. The HMO Act of 1973 moved us toward a profit-centered model of private institution health care delivery – which persisted into a PPO model and then began to fail in the 1990’s. The Employee Retirement and Security Act of 1974 (ERISA) codified the employer health insurance markets that we have only recently begun to unravel. In the interim, health care and insurance costs continued to skyrocket at a pace much faster than anywhere in the world. The homeless and uninsured alike began using emergency rooms as a first line of treatment, an exceedingly expensive way to access healthcare. During the debate over the Affordable Care Act, these consumers were glibly referred to as “free riders” when, in fact, they were simply people locked out of the outmoded system of insurance the ACA was meant to replace. Meanwhile, the scourge of hospital patient dumping – particularly in large cities – continues despite EMTALA. Our political system appears incapable of fashioning and instituting a reliable and effective form of healthcare delivery.
1974 is also the year that hip hop culture was born. Legend has it that DJ Kool Herc, inspired by construction workers tapping into the base of street lamps to hack power, set his turntables up one summer night at a street corner in the Brooklyn neigborhood of Cedar Park. Stealing power from the public grid, he drew a crowd of three thousand. Two turntables and a microphone – borrowing bits, pieces and samples of culture to create something new.
I have a feeling somebody is going to figure out this health care thing. But it won’t come from where you might expect. Those ideas are tired.
Here are a series of stories and resources to learn more about EMTALA.
2017 Baltimore Patient Dumping
2015 Los Angeles Skid Row Patient Dumping
Patient Dumping: US Commission on Civil Rights, 2014
2007 Los Angeles Skid Row Patient Dumping
1999 National Medical Association Journal Studying Patient Dumping of the Uninsured Across America