ONE top argument for national health insurance turns out to be based on a false assumption. We’ve long been told that it’s the uninsured who are clogging hospital ERs. Turns out that it’s actually Medicaid and other insured patients behind most misuse of emergency-room care.
Which means that health-care “reform” would make the problem worse.
ERs are indeed dangerously overcrowded; having worked in a busy city ER for more than a decade, I can tell you that the “extra” patients interfere seriously with basic care. But the solution doesn’t involve giving more people insurance coverage — it requires turning more people into wise consumers.
A recent PriceWaterhouse Coopers survey found that half of patients who visited US emergency rooms over the last year did so unnecessarily. More to the point, it showed that Medicaid patients use the ER at least twice as much as the uninsured do.
The PWC survey also found that Massachusetts, with one of the nation’s lowest rate of uninsured residents because of the state’s “universal coverage” mandate, has one of the highest utilization rates of ERs. A study in the Journal of the American Medical Association last year found that the ER-overuse problem extends to all insurance.
The problem is that insurance makes it too easy to use urgent-care facilities, like the ER, for minor problems. Which means that giving more people comprehensive health insurance, as all the bills in Congress would do, will only worsen ER crowding.
Meanwhile, the same bills would also cut payments to hospitals via Medicare, Medicaid and other public programs by hundreds of billions of dollars — so ERs would get fewer resources to deal with the higher caseloads.
Indeed, the cuts envisioned by Congress could also force hospitals to eliminate outpatient clinics and reduce their staffs of MDs — leaving fewer effective alternatives to the ER.
Already, fewer than half of all US doctors accept Medicaid patients — and Medicare cuts have more of us turning away those patients, too. Health-care “reform” promises more of the same — meaning that ever more insured Americans will have no alternative, not even a doctor’s office, except . . . the hospital emergency room.
Marc Siegel is a practicing internist in New York City and a Fox News medical contributor.