The uninsured, it’s said, use emergency rooms for primary care. That’s expensive and ineffective. Once they’re insured, they’ll have regular doctors. Care will improve; costs will decline. Everyone wins. Great argument. Unfortunately, it’s untrue.
A study by the Robert Wood Johnson Foundation found that the insured accounted for 83 percent of emergency-room visits, reflecting their share of the population. After Massachusetts adopted universal insurance, emergency-room use remained higher than the national average, an Urban Institute study found. More than two-fifths of visits represented non-emergencies. Of those, a majority of adult respondents to a survey said it was “more convenient” to go to the emergency room or they couldn’t “get [a doctor’s] appointment as soon as needed.” If universal coverage makes appointments harder to get, emergency-room use may increase. [Robert J. Samuelson]
Well I could have told them the same thing. Throughout my military career and my subsequent experience with Naval Hospitals as a retiree – the Emergency Room is always full and the majority of cases are non-emergencies. Active duty personnel and their families of course do not pay for health care coverage and yet they use the E.R. casually when they could in fact have made an appointment to being seen during the day. For some it is more convenient for them to go to the E.R. after hours then to take off from work with a regular appointment – even though the E.R. wait is much longer.
This has always been one of my pet peeves in that I use the E.R. only for serious situations or when directed by the appointment line to go to the E.R. instead.
Though in part the same was for the regular sick call in the Navy in that a majority of people would show up for trivial health issues that could have been easily treated with over the counter medicine. When it is available and free people are more likely to use it – which is just common sense born out by my own experience. It took me ten years in the Navy before I visited a Navy Clinic for treatment. They asked me where the rest of my medical record was since they couldn’t believe it was my first time in. I am pretty sure I am in the minority of only using healthcare when actually needed.
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We’re Air Force and avoid the base hospital like the plague. It’s an awful experience. My kids see one of 60 pediatricians and two are special needs. At one time a doctor wanted to give my child medication that would have had terrible consequences. They don’t know their patients and don’t read the charts.
We have universal health care already in this country with military medical. It’s not run well. And yes we’ve seen the ER filled with people too.
I work for a hospital (business office). Our ER visits fall into the following categories:
1. Patients with real but non-emergent conditions who don’t want to wait for an appointment;
2. actual emergencies (including injuries that might not actually be really serious, but could believably seem really serious – better safe than sorry);
3. people faking injuries to get out of work, school or home responsiblities (especially common for the school district employees);
4. people who are freaked out because something on TV scared them into thinking they have [disease of the week] – H1N1, SARS, west nile, you name it;
5. drug seekers (people who pretend to have injuries so they can get vicodin or other potentially recreational drugs);
6. Medicare/medicaid patients who can’t find physicians accepting new medicare/medicaid patients;
7. indigent using the ER form primary care.
So we’ll move a bunch of people from category seven into category six. Big improvement.
I’ve worked manual labor for 20+ years, never had insurance. The one time I went to the ER I was bleeding and had a bone showing. Most poor people, when they have some complaint, get something at the drugstore and stay home if they can. Who would want to go to the hospital when you don’t have to?
My experience (as uninsured and knowing a lot of guys in a pretty low- to no- insurance field (construction), is that typically the people without insurance aren’t coming to the emergency room unless they think they’re dying, because the emergency room costs money too, and most of the uninsured can’t afford the full day off work it can take to receive treatment at an emergency room.
I always scratch my head at the argument that universal coverage will swamp our hospitals and doctors. If we don’t have enough hospitals and doctors to serve the whole population, isn’t that already evidence of a severely dysfunctional society?
Anyway…I grew up in Canada. I think I saw the inside of a hospital twice – and one of those times was my birth (the other time my arm had been chewed up by a dog). Obviously the first few years of expanded coverage would result in a lot of previously uninsured people seeking previously denied treatment (like my husband and I are this year, now that we have employer subsidized health insurance and a better income). But people who are not in the habit of seeking medical attention for common aches and pains will not suddenly change those habits just because they can.
Last year, my 81-year-old mother had to wait in a wheelchair for two hours before emergency room personnel could even do triage. She was recovering from her first chemotherapy treatment; she had such a severe diarrhetic reaction that she became dehydrated. The reason she had to wait? The emergency room was filled to the gills with Latinos who weren’t nearly as sick as my mother. I finally raised Hell with the charge nurse; 10 minutes after that, my mother was finally admitted!
Whenever you hear the bishops gush about immigration policy, remember what you read here. The bishops don’t give a damn about the poor and vulnerable, unless those same poor and vulnerable serve their ambitious interests.
Why didn’t your mother’s pcp deign to see her? Further, denigrating immigrants or the bishops really isn’t productive in this conversation.
I agree with the statistics cited. I’ve personally been told by the pediatrician’s staff to take me child to the ER when she had an ear-infection since they were too busy with well child care to actually see a sick child.
At the college I went to they offered “Free” medical care to the students, which basically meant you could be seen by an intern and given a prescription. Any tests would cost extra, but 90% of the usage (based on my observations) were people with mono/colds/looking for birth control.
I have a strong aversion to going to the doctor needlessly, yet I went there often for minor issues, partially to ease my roommates mind, partially because I could and it was nice to have some medical person say “yup, you’re sick.”
I fully agree that when something is “free” it will be used more not less, even by those who would otherwise not use it.
I have been living with horror stories of ERs and the bureaucratic medical system we now have, and do not think that more government agencies in the mix will improve anything.
Like the night I went into the ER with multiple symptoms of heart attack. I waited about 30 minutes. Before they would address the symptoms, I was put through a battery of psychological tests. This was capped by a huge bill from a doctor who was not present and who would not accept payment from my admittedly weak plan.
This same ER had turned away my son whose eye was bleeding after being hit by a rock. Their reason: the ER waiting room was full of people in turbans who had brought in a woman with a cold.
I rushed my son to another hospital where they took care of the problem before asking his name. Our plan paid for this without question.
So a few weeks later my godson took me, semiconscious, to the second ER. I was admitted and in that hospital for three days. The plan, represented by an adminstrator 500 miles away, declined to pay for this, “because you did not make an appointment through your primary physician in advance, and we do not approve of that hospital.”
My daughter went to our longtime family doctor who has an advanced degree in obstetrics. The plan insists that all OB patients be sent to a storefront doctor from India, and will not pay our well-qualified doctor for such services. My daughter wanted to have her baby in the nearest hospital, a Catholic facility with a good reputation. The plan’s doctor told her no, and that she must deliver the baby in a Hindu birthing center some 50 miles away, adding that the Catholic hospital “doesn’t do babies”. The latter surprised us since my son was born there in one of the largest OB centers I’ve ever seen.
What we don’t need is more bureaucracy, and what we do need is getting the decisions on medical care back in the hands of the doctors and their patients.
For the record, Catholic Mom, my mother went to her oncologist when she had the problem; the oncologist sent her to emergency. Regarding the bishops and immigrants, do you know how many emergency rooms have had to close in California (where I live) because of the overload? Because of those closures, people who really need emergency care will have to travel farther to get it — if they get it at all — and will have their lives placed at greater risk. Unfortunately, the dunderheaded bishops are so infatuated with their conceptions of “social justice” that they don’t realize what’s going on.
Location varies a lot, but a LOT of the people I saw coming through the ER in hospitals where I worked were uninsured but already eligible for Medicaid. They hadn’t bothered to apply because they didn’t need it. Should be mentioned as well that a lot of the people in that category do not take advantage of such things as free immunizaiton clinics either. AnneG in NC