America’s Ass-Backward Non System of Health Care — Controlling ER visits

You may have heard from Rush Limbaugh and others on the right that we already have a system of health care. That is, emergency room care is available to everyone whether they can pay or not.

What’s not said is that this care is the least efficient and most expensive in the world. And that these unpaid costs are ultimately borne by the local hospital, other patients and other insurers–private as well as Medicare. This raises the cost of health care to all of us. I can’t imagine any thinking person would think this an adequate solution–except as noted above.

Now Washington State, offers a brilliant solution to the problem, by limiting ER visits to 3/year for people covered with Medicaid.

The trouble is all in how you define an emergency.


If a condition is left unspecified, that means it turned out to not be connected to a more dangerous ailment such as a heart attack or stroke. But doctors say that result can’t be known until patients are treated.

“Do (patients) know the difference necessarily between heartburn, heart attack, a blood clot in my lungs and a sore rib?” asked Dr. Stephen Anderson, president of the American College of Emergency Physicians’ state chapter. “These people shouldn’t be sitting at home trying to self-diagnose.

Medicynical Note: Rather than provide outpatient care for these patients as an alternative to ER care and thereby encourage use of more cost effective facilities, we simply cut off all access. Amazing.

This non solution leaves the ER’s and hospitals with a financial problem. Medicaid patients with chest pain that is non cardiac and other problems that turn out not to be “serious” will not be covered by Medicaid . Other patients without any insurance will continue to use ER’s and accrue bills that will not be paid. The cost of their care will still be passed through to other patients and insurers.

The solution solves nothing and simply avoids facing the fundamental issue in our non-system of care–that it is not a system.

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