Emergency Rooms are not the Problem

From the always interesting Freakonomics blog:

The overutilization of emergency rooms is often cited as a dangerous symptom of America’s broken healthcare system. But a new Slate article from Zachary Meisel and Jesse Pines offers a rosier picture of emergency room usage, and dispels several pervasive myths. They write that E.R. care represents less than 3 percent of healthcare spending, only 12 percent of E.R. visits are non-urgent, and the majority of E.R. patients are insured U.S. citizens, not uninsured, illegal immigrants. Meisel and Pines also point out that E.R. visits don’t necessarily cost more than primary care visits: “In fact, the marginal cost of treating less acute patients in the ER is lower than paying off-hours primary care doctors, as ERs are already open 24/7 to handle life-threatening emergencies.” Ultimately, Meisel and Pines believe that emergency rooms are functioning as they’re supposed to, as “an always-available resource to alleviate pain, make sure your baby is not truly ill, and patch you up after a nasty fall is vital, even if it turns out that your condition wasn’t as serious as you feared.”

In 2001 Milton Friedman suggested the ideal way to improve US healthcare:

reverse past actions: repeal the tax exemption of employer-provided medical care; terminate Medicare and Medicaid; deregulate most insurance; and restrict the role of the government, preferably state and local rather than federal, to financing care for the hard cases.

But he admits that this is politically impossible. Instead he suggests:

A more radical reform would, first, end both Medicare and Medicaid, at least for new entrants, and replace them by providing every family in the United States with catastrophic insurance - i.e., a major medical policy with a high deductible.

Maybe we should rely more on emergency rooms, not less. Related: Thirty Thoughts on American Health Care, Part I and Part II.