LET THEM GO TO EMERGENCY ROOMS.

LET THEM GO TO EMERGENCY ROOMS. (That is my feeble attempt to find something like "Let Them Eat Cake" for the title of this post.) Dan Froomkin gives us this beautiful quote from the president on the topic of access to health care:

Bush spent a fair amount of time talking about health care yesterday, as well.

"The immediate goal is to make sure there are more people on private insurance plans. I mean, people have access to health care in America," he said. "After all, you just go to an emergency room."

So. Except that emergency rooms are not conveniently located in neighborhoods all over the country, emergency rooms are not well suited for the provision of primary care and tend to charge rather heftily for those services, emergency room care fails to provide the kind of continuous care that is really needed and the real intended customers of emergency care (people with emergencies) will have longer waiting times than necessary if the same places are also used for primary care.

Neither are emergency rooms going to provide preventive care or prenatal care for the poor, for example, and it is highly unlikely that the care the poor receive in emergency rooms is timed correctly from the point of view of best health outcomes. I suspect that people wait until they just can't take the pain any longer before going to an ER. This means that illnesses are more advanced and treatment less likely to succeed than if primary care was provided in the communities of the poor.

Kevin Drum made a great point about all of this:

And as long as we're on the subject, it's worth noting that emergency rooms have only been required to treat all patients regardless of ability to pay since the 1986 passage of the EMTALA Act. The Reagan and Bush Sr. administrations, unsurprisingly, did little to enforce it. Bill Clinton tried to step up enforcement in 1994, but in 2003, after Bush Jr. became president, he approved new rules that loosened EMTALA regulations.

In sum, emergency rooms are an expensive, inappropriate and unreliable way to provide primary care for the uninsured.

--J. Goodrich

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