The Emergency Canard

In the runup to Obamacare, we were told that universal healthcare would actually cut costs. One of the big reasons was that it would cut down on expensive visits to the Emergency Room. Newly insured people, we were told, would go to the doctor to get problems addressed early rather than waiting until they exploded into $10,000 write-offs.

You know where this is going, don’t you?

Just like the “if you like your plan, you can keep your plan” promise, the promise that Obamacare would make health care less expensive by expanding coverage was always a crock. Nationally, it’s estimated that we spend about $50 billion a year on uncompensated care for the uninsured. But Obamacare spends $250 billion a year of taxpayer money on covering the uninsured. Only in Washington is spending $250 billion to address a $50 billion problem considered “savings.”

Finkelstein and Baicker, in their new Science article, looked at emergency-room records for 24,646 residents of the Portland, Oregon area, spanning 12 regional hospitals, who had participated in the Medicaid experiment. The study was co-authored by Sarah Taubman of the National Bureau of Economic Research; Heidi Allen of the Columbia School of Social Work; and Bill Wright of Oregon’s Portland Medical Center. The authors found, as they had previously, that the subgroup that had gained coverage under Medicaid showed no improvement in the management of their chronic medical problems, such as high cholesterol, high blood pressure, and diabetes.

They also found that those on Medicaid used the emergency room 40 percent more than the uninsured did—1.43 ER visits per Medicaid enrollee, as against 1.02 for the uninsured. More to the point, a majority of the emergency room visits were unnecessary, because they involved conditions that could easily have been managed outside of the ER.

This is the second study Finkelstein has lead on the Oregon experiment. The first showed no improvement in health among Medicaid enrollees. The most it showed was some improvement in mental health because they weren’t as worried about medical bills.

This was always completely predictable. When you give people something for free or at a steep discount, they use more of it. This is Econ 101. At least half of the Medicaid patients didn’t need to go to the ER. They either had problems that could wait for a primary care doctor or problems that could have been prevented by an earlier visit (oddly enough, giving irresponsible people insurance does not magically make them responsible people).

The Left is responding to this inconvenient truth by touting Oregon’s recent attempts to bring down ER costs. So far, Oregon has brought them down a bit but this involves capping overall spending and far more active involvement in individual healthcare. ER spending has fallen … relative to its exploded peak. It is still way above 2008 levels. This is the Obamacare equivalent of “the deficit is falling faster than at any time since WW2″.

The Obamacare defenders are also pointing out that the study shows a lot less stress among the previously uninsured now that they are insured. While that’s great for them, Reihan Salam points out the obvious:

Imagine if the debate over the Affordable Care Act had unfolded as follows — the president stated that in the interests of improving the mental health of low-income uninsured Americans, but not necessarily improving their health along other dimensions, he hoped to pass a large and expensive Medicaid expansion; to address the needs of the medically uninsurable population, he intended to implement a series of new insurance regulations that would, among other things, prompt the cancelation of large numbers of insurance policies serving the individual and small group insurance markets, with the net result being a reduction in the number of Americans with private insurance coverage, despite new subsidies aimed at low- to moderate-income households; and to finance these new initiatives, he’d restrict the growth of Medicare expenditures and he would raise various new taxes. It’s not obvious to me that this bundle would have struck many voters, including Democratic voters, as attractive.

Many people, including Roy and Salam, tried to warn us that this would happen. They were ignored. Or they were called liars. Or they were told they didn’t “care”. Or they were called tools of the insurance industry.

Oh, about that last bit.

Our favorite film-maker has emerged from his blue-collar mansion to opine on Obamacare. As is usually the case with Captain Deceptive Edit, we get a good point surrounded by bullshit:

I believe Obamacare’s rocky start — clueless planning, a lousy website, insurance companies raising rates, and the president’s telling people they could keep their coverage when, in fact, not all could — is a result of one fatal flaw: The Affordable Care Act is a pro-insurance-industry plan implemented by a president who knew in his heart that a single-payer, Medicare-for-all model was the true way to go. When right-wing critics “expose” the fact that President Obama endorsed a single-payer system before 2004, they’re actually telling the truth.

Ah, Mr. Moore. There’s some comfort in knowing that you will always correctly identify the problem and always come to the exact wrong conclusion about it. He says something very true: that this legislation was designed and crafted by the insurance industry to essentially milk a $100 billion a year subsidy out of the government. But he immediately goes to single payer because that’s how his knee jerks.

This is the new Liberal Pravda. The first pravda was that Obamacare was going to work great and we would demand single payer because it was so awesome. Now it’s that Obamacare sucks because it’s not single payer. Once Obamacare starts to “work” — in the sense that my grad student buddy’s care “worked” — I suspect they will go back to the first pravda. Because to people like Michael Moore, every fact points to the need for single payer. When the sun rises in the East, it proves we need single payer. Because single payer — with the socialism, wealth redistribution, centralized control and conformity it entails — is their goal. As we can see from the Oregon ER debacle, whether it actually improves healthcare or saves money is incidental.

Everything about Obamacare was a lie. It isn’t saving money, it isn’t saving lives, it isn’t working properly and it’s wrecking the individual insurance market. I suppose I should take some grim satisfaction in watching everything we said and were pilloried for come to pass. But I don’t. These are people’s lives. This is our money. This didn’t have to be.

Comments are closed.

  1. Mook

    Freakonomics Emergency Room Myths

    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.”

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  2. Seattle Outcast

    I’d love to see the data on that.

    I’ve been to the emergency room a few times; kidney stone, stitches, bleeding out my ass – you know, the usual stuff. I’ve never been in the presence of someone that didn’t actually need to be there – the shark bite victim being the most obvious. I’ve taken other people to the emergency room for one reason or another over the years as well; bad fall, stitches, pneumonia, burns, twisted ankles, etc. It’s not as if I haven’t spent time there and all I get is “information” dispensed by news commentators, special interest groups, and doctor shows to make up my mind with.

    I’ve always wondered about these claims of hoards people showing up with a cold or a case of the sniffles and running up massive bills they don’t pay – I’ve just never seen these people.

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  3. hist_ed

    I’d say the same SO except for one person. Years ago I was at an insurance intro after being hired for a retail chain. They talked about ER coverage and that the insurance company wouldn’t pay for obvious non-emergencies. A blond (yes very stereotypical) asked how was she to know what qualified. She once went to the ER because of a bad sun burn and wasn’t covered. The rest of us tried to stifle chuckles, not entirely successfully. She became defensive and someone else said “just ask someone with brown or black hair.” The room erupted. The commenter apparently narrowly avoided being fired but later said it was worth it.

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  4. AlexInCT

    A blond (yes very stereotypical) asked how was she to know what qualified. She once went to the ER because of a bad sun burn and wasn’t covered. The rest of us tried to stifle chuckles, not entirely successfully. She became defensive and someone else said “just ask someone with brown or black hair.”

    I bet you they left out red hair because them bitchez is crazy…. :)

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  5. Hal_10000 *

    I’ve been to the ER a couple of times. Once when my daughter was having trouble breathing because of croup. Twice with my gallbladder. Once recently when my mom was having problems with her knee. The latter was more of an urgent care thing but her insurance was twitchy about it.

    Being from a medical background, it is not THAT common to see people in the ER for bullshit but neither is it that unusual. We have gotten people in for routine burns and scrapes and “just to get checked out” after a sports collision or something.

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  6. Seattle Outcast

    A “bad sun burn” can range from being a bit red to being covered in large blisters that leave scars. I’ve seen the gulf coast sun leave pasty white people on IVs and morphine for a week as they have their bandages changes twice a day.

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  7. Miguelito

    It’d be interesting to see the stats focused on hospitals along the southern border. I assure you the ERs here quite are often full of illegals and the hospitals take huge hits in costs, though a lot of it is a real emergency, just uninsured and/or illegals. You should see how few people in the Ronald McDonalds house, staying to be near their kids, can speak English.

    I also find it interesting the phrasing of “off-hours primary care doctors.” If it’s not an emergency wait until tomorrow or hit an urgent care vs the ER. But comparing off hours use of the ER for a non emergency vs off hours pay would, of course not look as bad.

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  8. Xetrov

    I went to the emergency room once for a sunburn over a weekend – a second degree burn complete with infected blistering skin that required antibiotics, and some good pain meds. It was ugly, and very very painful.

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