Former President George W. Bush blithely asserted to a national (virtually global) audience that the U.S. already has universal health care — “all they have to do is go to the emergency room”. Bush unwittingly demonstrated his unconscionable ignorance of health care imperatives and basic economic principles.
The cost of emergency department (ED) services is several multiples of costs in physician offices. In U.S. inner cities the ED is the “doctor’s office”. Uninsured persons typically don’t have a family physician. Child care medical needs as well as daily incidents – best handled in a family physician’s office — are cared for by the ED staff — the doctor surrogates in these communities.
Also, uninsured persons typically postpone doctor visits until the problem can no longer be tolerated. They are sicker when they are finally evaluated and the services needed are more extensive. When these services are performed in the ED the total fees are significantly higher.
American society as a whole pays an ongoing hidden tax to support these unpaid ED fees. Costs to those who have the ability to pay are increased across the board. Employers, employees, and self-employed persons pay much higher annual health care fees owing to this single factor.
ED services deteriorate as well as a consequence of overutilization. ED’s are typically understaffed and undersupplied. Emergency departments are designed for emergencies. ED usage for non-emergent services is inefficient and inappropriate, causing services to deteriorate across the board. The result is a distortion of the mission of the emergency department and ineffective delivery of services to those who need care the most.
In addition, the mission of ED staff is to stabilize the patient. Ongoing care and prophylaxis are not part of the ED mission. The standard of ED care is to refer patients back to their family physicians. But uninsured patients do not have such a resource.
Non-emergent usage of the ED — a significant problem in itself — is the effect of the underlying lack of effective health coverage. Universal health care would restore balance to ED utilization and the economic benefits would be experienced by our entire society.
