ERs in the US are required to provide stabilizing care to patients who come in, even if the patient can't pay, by law. It's a law because otherwise some of them wouldn't.

I hope that was a joke

They protected the neighbouring property.

Did you miss that part where US Americans ration their insulin and die or collect money for life saving surgeries via gofundme?

This mandate makes sense from a moral point of view, especially for true emergency situations. However, the act didn't take care of the cost of care, which was placed on hospitals and ultimately passed on to other patients and the government. Obamacare attempted to address this issue.

EMTALA also distorted US healthcare be redirecting poorer people to expensive emergency care rather than preventive or primary care, which might well serve many of their needs better. That's also something that Obamacare was designed to fix.

$80 billion of 3.4 trillion. A rounding error.

It's one thing to declare something too dangerous and work on containment, but what's being described here isn't that.

Reinstating the penalty is going to cost political goodwill, which is why the Dems aren't doing it.

Regardless of whether the penalty is or is not in place, I wouldn't recommend being poor and sick, regardless of whether you are insured, or are freeloading.

Additionally, the whole point of these cases was not simply to get rid of the penalty. The idea was to get rid of the penalty so they could go back to the supreme court and again claim that the mandate is unconstitutional because now there is no "tax" associated with it.

I don't know where things are at now, but it seems unlikely to go anywhere now because it would be difficult to argue that buying insurance is required at all at this point. So we are left with the backup gop strategy of hoping that disarming the mandate will simply bankrupt the program. At least until republican voters wake up and realize that the program is miles better than what we had before.

The court case as a whole argued that because the GOP changed the ACA in a manner that made part of it (the $0 fee) illegal, the entirety of the ACA should be made illegal.

The fifth circuit agreed with some of the arguments in the case (the fee one), but did not practically change anything about the ACA.

And then SCOTUS, surprising ~everyone, ruled that actually the whole of the ACA is constitutional.

Look at this timeline, and you tell me - who spent years trying to re-introduce the free rider problem, and to break the ACA? Congress, the president, and the plaintiff states... or the fifth circuit, which ruled that a $0 fee (whatever that is) isn't a tax?

Now, as of 2022, we are in a world where the ACA has been thoroughly litigated, and is still here, with the free rider problem hanging like a millstone over its neck.

It should have never been a tax specifically because it's an unconstitutional act. Calling it a tax is the letter vs the spirit of the constitution.

If you and others like yourself want to ensure everyone has health insurance then __make it mandatory for the state to pay for it__. Anything else and you're just taxing the poor for being poor.

That is an interesting opinion, but at this point, both a conservative, and then a super-conservative, packed-with-federalist-society SCOTUS has disagreed with you twice on this issue (5-4) and then (7-2). It's about as written-in-stone as you can get in the United States.

The courts think this is above-board, the executive thinks this is above-board, most of the public thinks its above-board, it's safe to say its above-board.

lets not use that as justification, shall we?

carrying private service X is required for you to exist in the united states. If you don't pay for X, you get fined Y as a punishment.

yep, I'm sure the powers-that-be considering that above-board should be the only justification we need!

It was also perfectly constitutional, hence the need for that 13th amendment.

You're going to need a better complaint than 'it's unconstitutional', as this is pretty verifiably constitutional. The people who have been empowered[1] by the founding fathers to determine what is, and what is not constitutional have determined that this is constitutional. It's not a matter of opinion at this point.

> carrying private service X is required for you to exist in the united states.

And that's nothing new. Government can compel all sorts of things from you. Showing up to contribute your labour to a jury duty. Involuntary servitude in the military. Taxing the land you live on. Every society - even this society - provides you with privileges, and requires obligations from you.

This obligation has been ruled to be well within the legal framework of this society, and if you don't like it, you should look into passing a constitutional amendment on the subject.

[1] Actually, SCOTUS' powers in this sphere are what's unconstitutional, but we all pretend that they are.

the question is whether or not the government can force you to pay for a __PRIVATE__ service just for __EXISTING__ within the borders of the US.

There is __NO PRECEDENT__ for this. The closest you can get are things like car insurance where you're required to carry insurance in order to drive on US roads. You can choose not to drive, you cannot choose to "not exist".

That puts this into an entirely different category. The fact that it originally got rationalized as a tax opens a whole different can of worms. Good luck refusing to pay taxes.

It also pales in comparison to the burden and costs of existing system in the US.

If your point is just that the US healthcare system is far more-broken than most, and in some unique ways, all for no good reason—sure, yeah, of course that's true.

For deaths, there's maybe 300 accidental deaths, 10,000 - 15,000 homicides, and like 60,000 suicides. Non-death injuries scale similarly, with the caveat that like 6,000 ish people per year try to kill themselves with a gun and fail, but still injure themselves.

Reading the article, that's not true.

They watered down the fence line to protect someone else's land.

> Firefighters did eventually show up, but only to fight the fire on the neighboring property, whose owner had paid the fee.

> "They put water out on the fence line out here. They never said nothing to me. Never acknowledged. They stood out here and watched it burn," Cranick said.

So to your examples...

> They will save your life. They won't treat your trick knee, erectile dysfunction, or failing vision.

It would be closer to the story if it was "they won't save you, but they'll spray down everyone else with a disinfectant to protect them from your disease."

I thought in the US, hospitals were only required to stabilize, not treat, non-paying patients. For example, if someone has cancer, they are not required to perform surgery or chemotherapy, just stabilize their symptoms at the moment.

So will firefighters. They'll save your life to the best of their ability, no matter any contracts, payments, taxes, etc.

Saving your house is another matter.

We’ll always risk to reward. But more and more the phase after life saving is trending toward “surround and drown” - not that I want to fight like detroit in the 2010’s, but yes we do make a call sometimes to stop risking when lives are all confirmed safe.

Did capitalism hit America so hard that they kicked them back to the Roman Era (yes, I'm referring to Crassus here)?

The United States is enormous and many parts of it are incredibly sparsely populated. For example, Niobrara County in Wyoming has a population of 2,467 and an area of 6,810 km^2, or a population density of 0.36/km^2.

For comparison, the Northern Borders province, the least dense province in Saudi Arabia, has as population density of 3.4/km^2, almost ten times more people per square kilometer.

People outside of the US really have no idea how empty much of the country is. I think there's an assumption that just because much of the land is livable (i.e. not desert, bare rock, etc.), it must occupied. But that's simply not the case here.

I am not judging the way things work in the US, just commenting that I don't think that population density is relevant here as the issue is one of right.

Now, of course, if you live 100 miles from the nearest town it may well take hours for the police or firefighters to show up when you call them. That's another issue.

As a side note, in this very case the issue wasn't remoteness since they could have had access to firefighters for a small annual fee. Rather it was a legal and administrative issue. But I would indeed be curious if voluntarily paying a fee rather then being taxed can have an impact on any enforceable expectation of service.

It is absolutely relevant because services can only be logistically and economically viable at certain levels of density. Fire services aren't very useful if it takes them a two-hour drive to reach the fire. So they have a maximum radius where they are useful. They only provide value to the people within that radius. If the density is too low, then there aren't enough people in there to afford supporting fire services.

You're not addressing my point, either, which is that there is a big difference between getting a crap service because you're hard to reach (which does happen including here in Europe) and having no right to call for help in the first place.

Again, I am not criticising, I am just thinking that there are different, separate issues here.

They inherently are. If these neighborhoods have fire coverage equivalent to that of a metropolis, but they would be paid for via taxation at the rate of $50K per year per household, that's not economically viable.

So in general people who live is more isolated houses end up being effectively subsidised by everyone else.

In your example the 'problem' stems from a tax base that is too narrow because of administrative and political choices.

In any case, that is NOT the point of my previous comments.

That being said, the locality in question sounds very much like the low density suburban locale that I'm currently living in. It costs a pretty penny for the government to maintain services here, since there are only about 100 homes in an area at the edge of the desert (which at a rate of 75 per home per month as stated in the article wouldn't be able to cover a basic firefighting service). Of course, that does not bother the government in providing funds for everything from a local police station, hospital (yes, not a clinic), fire station, municipality, garbage collection, etc. The only thing missing (for the local Arabs mostly) is a government school, but then folks with families don't bother with it.

I could draw a similar example of my place in India, which has similar low density characteristics, and to make matters worse, is located in a hilly part of the district, but that doesn't stop the govt. from providing a local police force and fire fighting service complete with a helicopter.

Some amenities are basic needs that if you don't receive, then what the hell are you paying taxes for? Freedoms per second?

And no, I'm not a stranger to America's vast landscape. The fact stands that there should have been better zoning - or don't expect any facility at all, but don't make news out of it.

On a side note, the main link of this thread quotes the example of insurance companies in London in the 1830s, who would compensate each other in case their firefighters took action on fires not in their jurisdiction. If our forebears had such sensible foresight and collective responsibility, then why not America today?

Or you could just let people live where they want to live and make sure they are aware of and agree to the consequences of that choice, which it sounds like they were in this case.

> If our forebears had such sensible foresight and collective responsibility, then why not America today?

Seems like you're generalizing an awful lot from one random news article that is news largely by virtue of the fact that what it describes is unusual.

Neighbourhood is the operative word here. In some parts of the rural United States, homes are far away and far between. Public services of the kind expected in populated areas are impractical, particularly for protection of property rather than life.

With that as a baseline, some "rural" areas maintain this peculiar, low-cost characteristic even as they become more populated. There's a degree of self-sorting behaviour as well, since some residents become attracted to the area specifically for its vanishingly small local tax burden.

“Unincorporated land” means that the landowners have chosen not to incorporate (create) a municipal (ie city/neighborhood) government.

It’s “rugged individualism”.

Virginia is also technically a Commonwealth and not a state as well.

In fact Hospitals were not required to treat you until 1986, which was part of the COBRA act.

Prior to that there was a large practice of "Patient Dumping" where a hospital would kick you out if they found out they you couldn't pay for your treatment. Hospitals in the US would literally let you die out side the ER doors.

https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_an...

The same logic could apply to police... what if all the crime is coming from an unincorporated part of town? Do you just go and start policing it (kind of like an invading army occupying)? Or do you erect borders / station patrol cars near key locations?

They will save you from an acute emergency, stabilize you, then dump you into a care home with inadequate care or to the street as appropriate, where you play the long game of succumbing to whatever ails you.

The FD had tried for years to find a workable solution and failed because the people in the unincorporated part of the county just didn't want to pay for fire services. IIRC, the county had tried three times in the previous decade to pass taxes to either fund the municipal FD or set up their own; three times the residents of the unincorporated part voted against it. The FD had tried retroactively charging owners, and spent more on collections than they'd earn.