This Is A Bad Way To Learn That Urgent Cares Don't Have To See Uninsured Dying Teens
This week, a 17-year-old California boy died from COVID-19, making him the first teenager in the United States to die from the virus. According to a video from the mayor of Lancaster, California, R. Rex Parris, he might not have had to be.
You see, this kid didn't have health insurance. So when he went to an urgent care center, he was denied treatment and told to go to an emergency room. Unfortunately, on the way there, he went into cardiac arrest. While the hospital was able to revive him for six hours, it was just too late and he died. Had he been treated at the urgent care facility, he might be alive today.
Urgent care centers, unlike most emergency rooms, are not bound by the Emergency Medical Treatment and Active Labor Act (EMTALA) and thus, unlike most emergency rooms, they do not have to treat everyone who comes in regardless of whether or not they can pay. They can send you away even if you are very clearly dying. They have absolutely no obligation to you unless you can pay up. Which this kid couldn't.
COVID-19 Daily Update (3/25/2020) youtu.be
The mayor also noted that the child did not have any underlying health conditions.
"He had been sick for a few days, he had no previous health conditions. On the Friday before he died, he was healthy, he was socializing with his friends."
While the boy's death was initially diagnosed as septic shock from coronavirus, his death is not currently being counted in the county's totals. Although he tested positive for COVID-19, the county's public health director has asked the Centers for Disease Control to investigate his death because of "extenuating circumstances that pointed to an alternative diagnosis as well." Reportedly, the boy had health problems in the past, but was currently healthy.
How does that matter?
It is likely that a 17-year-old boy is dead because our health care system is stupid. Because he had to go to a second location and went into cardiac arrest on the way there. I'm sorry to beat a dead horse, especially since it's gonna be at least four years before Medicare For All is even a possibility again, but this is not a thing that would happen if we had a national health care system where sick people could just go and get treatment anywhere without having to worry about costs or health insurance or co-pays or anything else. It's not just that our system is cruel, it's that it is stupid. Especially in the middle of a pandemic featuring a virus that sure the hell does not care if you've been diligently paying your premium or not.
I mean, was it not also a bad idea to just send a patient who obviously had COVID-19 back out into the world to potentially spread it to others? They're gonna potentially let other people get infected because this kid didn't have health insurance?
Now, perhaps you may be thinking, "Ugh, we don't need single payer, we just need to fix this one problem. Just require urgent care centers to be bound by EMTALA, too! There, problem solved! Now they have to take people like this one kid and no one will die because they couldn't get care and my taxes won't go up!"
And yes, they should be. As long as we're doing it this way, they should be. The problem with EMTALA, however, is that it leads to piles of what is called "uncompensated care" and it's part of the reason why hospital costs are so high. In 2018, the total cost of uncompensated care was $41.3 billion. That cost then gets shifted onto consumers who can pay — a fun thing to bring up to conservative dispshits who like to run their mouths about how they don't want to be obligated to pay for the care of other people. Of course, if there aren't enough customers around who can pay extra, the hospitals are just shit out of luck. Many hospitals, especially in rural America, have cited uncompensated care costs as part of the reason for their closures.
For a long while, things were balanced out a little bit on this front by the Hill-Burton Act. Grants were given out to build hospitals and add construction in order to add beds and otherwise physically improve them in exchange for providing a "reasonable volume" of free or low cost care to people who couldn't afford it. Unfortunately, while there are still some Hill-Burton facilities required to provide this care, the government stopped giving out those grants in 1997.
This is not to say that with our current healthcare situation EMTALA isn't necessary. It is absolutely necessary, because people need care in emergency situations. The problem is that we have such an extremely stupid healthcare system that pretty much anything anyone does to try and "fix" it ends up causing other problems as well.
The best solution, clearly, is to have a system where that kid could have walked up to the urgent care facility, been taken care of, and hopefully been able to survive — and then go home without worrying about the bill. That is the least stupid solution of all. Too bad we can't do things that way.
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Robyn Pennacchia is a brilliant, fabulously talented and visually stunning angel of a human being, who shrugged off what she is pretty sure would have been a Tony Award-winning career in musical theater in order to write about stuff on the internet. Follow her on Twitter at @RobynElyse