I was fortunate enough to recently have a brief exchange with a Republican candidate for US Senate in Oregon. For being so busy, she spent some time with me discussing the problems she sees with the ACA. She is only one person, but she touched on a number of themes that may help me to understand why it is so hard to find common ground.

Let’s say for argument’s sake, that nobody wants to see the poor or children go without needed health care. Let’s also assume that nobody wants to see emergency medical care or chronic illness bankrupt anyone. Pleasantly, this seemed to hold true for the would-be Senator. The biggest rift between our points of view appeared to be the extent to which we believe this actually happens.

She seemed to believe that being uninsured is a simple economic trade off. From her vantage point, being uninsured is a matter to be resolved between you and your doctor and would not accept the notion that substantive differences in outcomes are likely or even possible based on the question of insurance. In her mind, If an uninsured person accidentally shoots himself, and requires life-saving treatment, a few things will occur:

1) That individual will get all the care they need
2) If they can’t afford treatment, it may just take a long time to pay off
3) If the person is really poor, then the hospital will most likely just waive their fees or negotiate a discount and care for them anyway

She also kept telling me that organizations like Christian Health Ministries do a much better job than either the government, or traditional insurance companies.

She did acknowledge that there is a bankruptcy risk imposed by healthcare costs, but only hypothetically. She doesn’t approve of skipping out on your bill unless you are really poor and even then she felt strongly that there are plenty of options.

So what’s the problem? I think from her vantage point, there is no problem except maybe the cost of healthcare. Furthermore, the only thing that should be appropriate to control costs would be the free market; the government would have no business being involved in the solution.

The assumptions she makes are at least partially, if anecdotally, true.

I had a question about this though. Assuming the system operates in this way, why is it that our friend who shoots himself gets admitted into the hospital even if he has no means to pay for his care? Compassion and good will? Actually, it is called the Emergency Medical Treatment and Active Labor Act. It was put in place by the government actually to address a specific problem which was that hospitals were dumping uninsured patients to other facilities when they suspected or learned that the patient had no means to pay for care.

What is really interesting about this, is that the statistics showed that many patients who were moved or rerouted based on economic concerns were about 2 times as likely to die than those who were cared for and not transferred or re-routed.

Isn’t this government overreach as well? Many claimed so. Yet without this legislation, treating the poor was a losing proposition. If this is really about rejecting socialism, why should hospitals be forced to deliver care to people who can’t pay? If you don’t think hospitals should turn out non paying customers, you are actually a little bit of a socialist. You simply prefer the costs to be hidden in your doctor bill and not your tax bill.