A Philosopher's Blog

Emergency Rooms & Obamacare

Posted in Business, Ethics, Law, Medicine/Health, Philosophy, Politics by Michael LaBossiere on January 24, 2014
Typical scene at a local emergency room

(Photo credit: Wikipedia)

On the face of it, the idea seems reasonable enough: if a person has health insurance, then she is less likely to use the emergency room. To expand on this a bit, what seems sensible is that a person with health insurance will be more likely to use primary care and thus less likely to need to use the emergency room. It also seems to make sense that a person with insurance would get more preventative care and thus be less likely to need a trip to the emergency room.

Intuitively, reducing emergency room visits would be a good thing. One reason is that emergency room care is rather expensive and reducing it would save money—which is good for patients and also good for those who have to pay the bills for the uninsured. Another reason is that the emergency room should be for emergencies—reducing the number of visits can help free up resources and lower waiting times.

As such, extending insurance coverage to everyone should be a good thing: it would reduce emergency room visits and this is good. However, it turns out that extending insurance might actually increase emergency room visits. In what seems to be an excellent study, insurance coverage actually results in more emergency room visits.

One obvious explanation is that people who are insured would be more likely to use medical services for the same reason that insured motorists are likely to use the service of mechanics: they are more likely to be able to pay the bills for repairs.

On the face of it, this would not be so bad. After all, if people can afford to go to the emergency room and be treated because they have insurance, that is certainly better than having people suffer simply because they lack insurance or the money to pay for care. However, what is most interesting about the study is that the expansion of Medicaid coverage resulted in an increase in emergency room visits for treatments that would have been more suitable in a primary care environment. That is, people decided to go to the emergency room for non-emergencies. The increase in emergency use was significant—about 40%. The study was large enough that this is statistically significant.

Given that Obamacare aims to both expand Medicaid and ensure that everyone is insured, it is certainly worth being concerned about the impact of these changes on the emergency room situation. Especially since one key claim has been that these changes would reduce costs by reducing emergency room visits.

One possibility is that the results from the Medicaid study will hold true across the country and will also apply to the insurance expansion. If so, there would be a significant increase in emergency room visits and this would certainly not results in a reduction of health care costs—especially if people go to the expensive emergency room rather than the less costly primary care options. Given the size and nature of the study, this concern is certainly legitimate in regards to the Medicaid expansion.

The general insurance expansion might not result in significantly more non-necessary emergency room visits. The reason is that private insurance companies often try to deter emergency room visits by imposing higher payments for patients. In contrast, Medicaid does not impose this higher cost. Thus, those with private insurance will tend to have a financial incentive to avoid the emergency room while those on Medicaid will not. While it would be wrong to impose a draconian penalty for going to the emergency room, one obvious solution is to impose a financial penalty for emergency room visits—preferably tied to using the emergency room for services that can be provided by primary care facilities. This can be quite reasonable, given that emergency room treatment is more expensive than comparable primary care treatment.  In my own case, I know that the emergency room costs me more than visiting my primary care doctor—which gives me yet another good reason to avoid the emergency room.

There is also some reason to think that people use emergency rooms rather than primary care because they do not know their options. That is, if more people were better educated about their medical options, they would chose primary care options over the emergency room when they did not need the emergency room services. Given that going to the emergency room is generally stressful and typically involves a long wait (especially for non-emergencies) people are likely to elect for primary care when they know they have that option.  This is not to say education will be a cure-all, but it is likely to help reduce unnecessary emergency room visits. Which is certainly a worthwhile objective.

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9 Responses

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  1. T. J. Babson said, on January 24, 2014 at 8:57 am

    “On the face of it, the idea seems reasonable enough: if a person has health insurance, then she is less likely to use the emergency room. To expand on this a bit, what seems sensible is that a person with health insurance will be more likely to use primary care and thus less likely to need to use the emergency room.”

    I frankly cannot see why anyone would believe this as primary care doctors cost far less than the emergency room. If you are short of money and need a doctor, why pick the emergency room?

  2. ajmacdonaldjr said, on January 24, 2014 at 10:31 am

    “Modern medicine is a negation of health. It isn’t organised to serve human health, but only itself, as an institution. It makes more people sick than it heals.” ~ Ivan IIlich (“Medical Nemesis” (1976)

    Read more: MEDICAL NEMESIS: THE EXPROPRIATION OF HEALTH (.pdf) – http://www.desireerover.nl/wp-content/uploads/2011/10/MEDICAL-NEMESIS-Ivan-Illitch.pdf

  3. apollonian said, on January 24, 2014 at 1:36 pm

    ObamaCare Is Not Mere Disaster, But Absolute Catastrophe, Never Doubt

    I agree most heartily w. AJ, just above–that’s what’s really going on.

    And golly gee, Mike, but I must say I don’t see any need to be defending ObamaCare w. death-panels or agonizing about this ridiculous quandary u totally manufacture. Don’t forget Ron Paul is an MD–so is his son, Rand, as matter of fact–they have the best analysis for this entire issue regarding ObamaCare, which is absolute and un-mitigated catastrophe, not mere disaster.

    Freedom and the free market is the way to go, but this isn’t good enough for u, eh? Freedom and free market are what’s worked–nothing else comes close.

    ObamaCare is simply a fascistic monopolization over health-care by the big Insurance companies–it’s not even “socialized medicine” at all. And now prices are going up up up for everyone, benefitting ONLY the topmost, richest people, hurting everyone else, and this is just the beginning–then there’s the police-state necessary for administration which people are only now beginning to realize.

    What a ludicrous exercise in nit-picking btwn “primary-care” and “emergency room” visits, when the free market gives generously for all answers and possible problems.

    So Obama LIED THROUGH HIS TEETH to sell his monster which then the suckers all swallowed, the Congress and Senate all bought and paid-for by the oligarchs, backed by the US Federal Reserve criminals who print-up all the funds they ever need, purpose being to mass-murder the people and “reduce population,” this in accord w. AGENDA-21.

    So what can one possibly say? Well, there’s just this: we’re in “Decline of the West,” by Oswald Spengler, and one must surmise it had to come to this AGENDA-21 genocidal horror, ObamaCare death-panels necessary part, the destruction of present health-care in USA and, further, the rise of evermore powerful police-state to enforce and make it work.

    And nothing seems to be able to stop the horror–no reasoning, no facts suffice or make any impression. Catastrophe is what people seem to want, whether they admit it or not–as they’re assured that it’s all “good,” and it’s “for the earth,” as if this is justification. And as long as there’s football games on TV, the suckers go along.

    So it just goes to show the determinist, hence CYCLIC course of history. But as the oligarchs of ZOG continue to “win,” the slaves and people will die-out, and the oligarchs who are left will begin to eye one another w. ever-greater suspicion, and then they will inevitably begin to in-fighting. The remnant of humanity thereafter will have it upon themselves to start civilization over once again, to starting the CYCLE anew, I guess.

  4. T. J. Babson said, on January 24, 2014 at 2:24 pm

    You can’t just show up in the emergency room with a hangnail and no money and expect to get free medical care.

    You can show up in the emergency room with a hangnail and insurance and get medical care.

    • WTP said, on January 24, 2014 at 3:24 pm

      You can in the universe between Mike’s ears. That’s the only universe that is relevant here. Said universe also comes with a convenient reset button. So you can have this conversation all over again in a few months’ time.

    • Michael LaBossiere said, on January 24, 2014 at 7:36 pm

      A person would have to be lacking in wisdom to want to go to the emergency room for a hangnail.

      • WTP said, on January 24, 2014 at 9:49 pm

        So, you mean people like college professors? OK cheap shot…but still…you mean philosophy professors, right? I mean none you know, but…

        • WTP said, on January 25, 2014 at 12:57 pm

          Just to be clear, some people need everything ‘splained, a person would be lacking in wisdom to take TJ’s point literally. As TJ demonstrates below.

      • T. J. Babson said, on January 25, 2014 at 12:03 pm

        Mike, the problem with most primary care doctors is that they first want you to become an established patient before they will see you at short notice. Since a lot of people do not bother to establish a relationship with a doctor, their only real options when they need a doc are urgent care centers, walk-in clinics, and emergency rooms.

        I expect the use of all 3 will grow with O-care.

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