ER in Crisis

Data from the American College of Emergency Physicians, which represents 23,000 ER doctors, paints a chilling picture of a system in decline. The capacity of the nation's emergency systems has decreased by 14 percent since 1993, ACEP says, as more than one thousand hospitals have closed their emergency departments nationwide. Meanwhile, demand continues to increase, with 114 million ER visits reported in 2003, the highest number the CDC has ever recorded.

Emergency care has become, for far too many, primary care and the system is taxed to the point of being dysfunctional.

Much of the demand for emergency care comes from the 46 million Americans with no health insurance, a number that climbs annually.

Regular readers of this blog will know that number can be dissected 20-40-40 to show that:

20% of the 46M (about 9.2M) are eligible for taxpayer funded health insurance but simply have not applied for coverage.

Another 40% (18.4M) earn in excess of $50,000 per year and could afford coverage but simply refuse to make that purchase.

The remaining 40% (18.4M) earn too much to qualify for taxpayer funded plans and presumably don’t earn enough to afford coverage.

Federal law compels hospitals to provide emergency health care, but does not fund that mandate. Hospitals must absorb the cost of patients who can't pay for treatment, and to offset the losses, they often hit uninsured, middleclass paying patients with bigger bills because the hospital is not bound by the much lower negotiated fees they are paid by insurance companies.

Helping those who truly cannot afford coverage is one thing. Paying (in the form of higher premiums) for people who have the means to cover their medical insurance is another.


"Congress does not provide a single dime to help pay for the care that it mandated," said Dr. Robert Suter, a former president of the ACEP, in a telephone interview. "There needs to be government funding to make sure that emergency service is sustained," he said.

And where does the government get their money?

The taxpayer.

Because so much of emergency care is delivered to the uninsured, emergency department treatment is often palliative and designed to stabilize a patient. Someone who is uninsured, or with only Medicaid benefits, is not guaranteed the comprehensive care that may be needed

Full care and treatment comes with the ability to pay either directly or through your insurance plan.

Dr. Peter Viccellio, the head of the emergency department at Stony Brook University Hospital on New York's Long Island, said many doctors refuse to perform surgery on the uninsured or those covered by Medicaid because they are so poorly reimbursed.

This is certainly a moral and ethical issue . . . but it is also a financial one. Why should a doctor provide services by being on call if there is little or no hope of being paid for their work?

The soaring cost of medical malpractice insurance has forced many doctors to give up their practice and has shrunk the number of specialists, such as neurosurgeons, who are available to emergency departments. One doctor said he had 20 specialists on call five years ago. Today he has four. This is true in many hospitals throughout the nation.

Many specialists refuse to work in emergency departments because of the heightened risk of malpractice suits. They cannot be compelled to work in emergency departments

Translation: I can’t pay you doc but I will not hesitate to sue you if I don’t like the outcome.

What a country!