Emergency rooms aren’t closing because the market doesn’t work, but because it does
Emergency rooms in “urban and suburban” areas (not rural – the study is limited to urban and suburban) are closing rather rapidly it seems:
Hospital emergency rooms, particularly those serving the urban poor, are closing at an alarming rate even as emergency visits are rising, according to a report published on Tuesday.
Urban and suburban areas have lost a quarter of their hospital emergency departments over the last 20 years, according to the study, in The Journal of the American Medical Association. In 1990, there were 2,446 hospitals with emergency departments in nonrural areas. That number dropped to 1,779 in 2009, even as the total number of emergency room visits nationwide increased by roughly 35 percent.
Emergency departments were most likely to have closed if they served large numbers of the poor, were at commercially operated hospitals, were in hospitals with skimpy profit margins or operated in highly competitive markets, the researchers found.
Sit there for a moment and let that all sink in. Got it? All ready to go? Now, let this sink in:
“This suggests market forces play a larger role in the distribution and availability of care” in the United States, Dr. Hsia said, especially emergency care. “We can’t expect the market to allocate critical resources like these in an equitable way.”
Really? That’s precisely what the market is doing here – Dr. Hsia just doesn’t like it’s method of allocation or the outcome, that’s all. So the hidden premise here is we (the collective) should allocate “critical resources” (emergency rooms and health care providers) differently than the market does (subsidize) and we’ll say a “market failure” made us do it, mkay?
That’s exactly the case Dr. Hsia is trying to build although it isn’t said outright. Market failure requires we (collective) pick up the slack (through government) and pay what is necessary (no matter how much it puts us in debt) to ensure “critical resources” (ERs and docs) are allocated “fairly” (as we think they should). This is also known as a form “central planning” which has always worked so well.
So that would mean unprofitable requiring emergency rooms stay open and we (collective) subsidizing them. BTW, anyone else find it ironic that there’s competition among hospitals keeping prices down to the point that some ERs are unprofitable, yet we’re consistently told that health care costs are spiraling out of control?
Anyway, as you recall the vaunted ObamaCare is supposed to take care of all this, right, because then even the poor will have insurance. And once they have insurance, they’ll never darken an ER again – except when they have a real live emergency. Well here’s a clue junior, the poor already have insurance – its called Medicaid. The problem isn’t lack of insurance, it is a lack of doctors. And it isn’t going to get better soon. Massachusetts has already demonstrated the problem:
When the Massachusetts Legislature made health insurance mandatory five years ago, supporters of the first-in-the-nation law hoped it would keep patients out of hospital emergency rooms.
Patients with insurance, the theory went, would have better access to internists, family practitioners, and pediatricians, lessening their reliance on emergency rooms for routine care.
There is more evidence today that it did not turn out that way.
Three-quarters of Massachusetts emergency room physicians who responded to a survey last month said the number of patients in their ERs climbed in the last year.
They cited ‘’physician shortages’’ along with a growing elderly population as the top two reasons why more patients come to ERs.
The law ‘’didn’t create an infrastructure,’’ said Dr. David John, chief of emergency care at Caritas Carney Hospital in Boston. “Doctors offices are full to capacity.’’
That’s right … MA’s single payer system is swamped. You can waive your magic wand and behold everyone has insurance, but you can’t waive your wand and make health care providers appear. And most doctors know that Medicaid is probably the worst paying insurance out there, not to mention the bureaucratic hassle that goes with it, so they limit their number of Medicaid patient – a prudent small business decision. Because after all, doctors are small businessmen and women. They employ staff, make payrolls, etc. So, just like hospitals that do the same thing, they’re concerned with – what’s that nasty word? Oh yeah, profit.
Nope, the market isn’t the problem here. It is doing precisely what markets should do. The outcome just isn’t the preferred one.
Oh, and under the category “never let reality stand in the way of your reality” or perhaps “facts, who needs facts, I have an agenda”, we find this.