Perhaps you've heard about the guy who is wrecking the American health care system. He is uninsured, has no major medical problems, and loves the emergency room. He is said to stroll in about once a month to various E.R.s around town for reasons as diverse as a simple cold or an STD check. He usually asks a doctor to excuse him from work and complains if he doesn't get a prescription for narcotic pain medication. The cost of his medical care is unnecessarily high because for his complaints, the E.R. is more expensive than a doctor's office would be. But our legendary visitor doesn't have a primary-care doctor: Why should he, since everything he needs is at the local E.R.?
If you believe the conventional wisdom, the E.R. abusers of our nation are especially responsible for many problems in health care. They fill up E.R. waiting rooms and because they can't (or won't) pay their medical bills, the insured patients who prudently wait for weekday appointments to see their doctors end up bearing the costs of the abusers' in the form of higher insurance premiums. The oft-repeated claim is that if we can just find a way to get the abusers out of the E.R. waiting rooms, we'd eliminate many of the high costs associated with health care in the United States.
The problem is that this story of the healthy, cavalier, uninsured E.R. abuser is largely a myth. E.R. use by the uninsured is not wrecking health care. In fact, the uninsured don't even use the E.R. any more often than those with insurance do. And now, a new study shows that the increased use of the E.R. over the past decade (119 million U.S. visits in 2006, to be precise, compared with 67 million in 1996) is actually driven by more visits from insured, middle-class patients who usually get their care from a doctor's office. So, the real question is: Why is everybody, insured and uninsured, coming to the E.R. in droves? The answer is about economics. The ways in which health information is shared and incentives aligned, for both patients and doctors, are driving the uninsured and insured alike to line up in the E.R. for medical care.
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