“Don’t Blame Crowded ERs on the Uninsured” is the pitch-perfect headline of an article by Suzanne Bohan in the San Mateo County Times and other papers.
The articles reports on a UC-San Francisco study that reports that asks “Are the Uninsured Responsible for the Increase in Emergency Department Visits in the United States?” and answers “no.” In fact, the “proportion of adult ED visits by persons without insurance was stable across the decade,” roughly in the 14-15% range.
Despite the belief that the uninsured are the majority of those crowded in our emergency rooms, I note that this figure is a bit lower than the overall percentage of uninsured people in the country, which is around 16%.
This is consistent with other findings, such as a 2004 Urban Institute report by researchers Zuckerman and Shen on ocassional and frequent ER users. That paper concludes, in part, “The uninsured and the privately insured adults have the same risk of being frequent users… It seems hard to blame the overcrowding of EDs on the uninsured.”
MISSING THE MESSAGE: Some conservative commentators will use this research to attack the notion that of a “hidden tax” that we all pay in our premiums for having such a large uninsured population, and to attack the notion of health reforms and coverage expansion generally. I get a very different lesson from the study.
I too have been a skeptic of the Governor Schwarzenegger’s “hidden tax” rhetoric, because it led people to blame the uninsured for high health costs, rather than the reverse.
If the uninsured go to the emergency room, they have only a right to be stabilized. But even then, they get a bill–typically the biggest bill they will see in their lives, and often one that is inflated well above what an insurer would pay for the same service. No wonder they may actually go to the ER less.
LOTS OF FACTORS: That said, there’s nothing inconsistent with saying that the uninsured, when they finally do go to get care, are in a worse condition since they let their conditions linger and mestatisize, costing the health system more money in the long run. Or that the uninsured get the bill, but some face bankruptcy not being able to pay, and as a result leave the hospital unpaid.
In other words, I think the real world in health care is more complicated than one cause. Some uninsured get the care they need. Others go without and simply die. And in between, some uninsured wait until the problem gets worse. And some of these factors end up costing the health system. So reforming health and increasing coverage is needed and urgent, even for the regular, insured California.
SOLUTIONS: So how much is the “hidden tax?” I don’t know, but it’s real. But I think the focus should be on fixing the system, not the victims of that system:
* We all pay when McDonald’s, Wal-Mart, or Applebee’s don’t, when some employers don’t pay their fair share. Those who are uninsured are those who fall through our health system that relies on voluntary employer contributions.
* We should ensure that those who are uninsured are not overcharged and thus discouraged from getting needed care. California passed a fair hospital pricing law in 2006, and other protections would be helpful.
* We who are *insured* would not go to the emergency room as much if we had the ability to get timely access to care to primary care and specialists. There’s pending regulations for insurers and providers at the California Department of Managed Health Care.
Our health care system doesn’t have just one problem, and doesn’t have just one solution. The new research helps us understand that.