Free Markets, Free People


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.

~McQ

Twitter: @McQandO

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25 Responses to Emergency rooms aren’t closing because the market doesn’t work, but because it does

  • What was the phrase you used?

    Oh right: “never let reality stand in the way of your reality”

    Well, “never let reality stand in the way of your reality

    It has less to do with a lack of doctors and MORE to do with a diversion of funding. But nice try, thanks for playing along!

  • Coupla thangs…
    1. there are new players in the market…the McClinics that specialize in emergency care, or the ones in your grocery store that serve as a minor-care provider.  TOTALLY innovative market responses to needs of locales, and offering their services at a bargain price.
    2. emergency care is high-risk care, from a med-mal stand-point.  Commercial horsepiddles would NATURALLY opt out, thus lowering their insurance and other costs.

  • I disagree – I think he does say it outright.
    After all, he says “We can’t expect the market to allocate critical resources like these in an equitable way.” – notice my emphasis added.
    The market is, indeed, not “equitable” in terms of providing Free Healthcare – because Giving Stuff Away Because Someone Thinks It Would Be Nice To Have For Free is not what markets do.
    If there is a “failure” here, it is not of the market, but of the idea that healthcare that’s “free” will be provided by anything other than charity or fiat.

    • Gots to ALWAYS remember the law that there is no free good.  One might really, really, really think (delude oneself) that it would be “nice” and/or “fair”.  But is is just one of those damn hard-assed realities the Collective wants to go away.
      Markets tend to allocate resources efficiently…which is the MOST one can hope for.  They also provide for freedom.
      The rest is handled by good people helping each other because they have the means and they are good people.  It works every time it is tried.

  • Hospital emergency rooms, particularly those serving the urban poor, are closing at an alarming rate even as emergency visits are rising

    This uses that same odd form of logic that can’t understand why crime goes down when the prison population goes up.

  • To complain that “the market” doesn’t provide free health care is like complaining that a Coke machine doesn’t dispense free steak dinners: it isn’t what the thing is supposed to do.  I suppose that some – perhaps many – libs are sufficiently stupid and uneducated that they don’t understand this, but the lib policy makers certainly do… and they don’t care.  Their goal is to ELIMINATE the market, which they hate because they don’t control it and hence can’t use it to pay off their pals and make a mint for themselves. 

    Part of the problem is that the conservative / libertarian position is that the free market is the best economic model.  “How can you claim that when it allows people to suffer????” It’s hard to counter a sob story about some poor person who suffers or dies because they can’t afford a $10k procedure with the argument that the free market is what made it possible to have that procedure in the first place.

    Hospital emergency rooms, particularly those serving the urban poor, are closing at an alarming rate even as emergency visits are rising…

    If market forces were allowed to work, the increase in demand would eventually result in increased supply, i.e. there would be more doctors, ER’s, etc.  However, the market is handcuffed by several factors:

    (1) By law, the ER’s cannot demand that all those poor people actually pay.  Why provide MORE goods and services for free?  And how can ANY business stay in existence when it makes no money?  Really, I suppose it’s incorrect of me to say that increased supply follows increased demand; increased supply follows increased PROFIT (or the reasonable expectation of it).  The government has done a superb job of reducing / eliminating profit in the ER market, so it’s no wonder that supply dries up;

    (2) The numbers of doctors is (as I understand it) rather tightly controlled by the med schools and, ultimately, the AMA, which tends to keep numbers down, presumably to keep doctor-doctor competition down;

    (3) Due to our revolting legal system, medicine is a financially high-risk endeavor; investing in a hospital or a medical practice is a dicey proposition when a hustling shyster like John Edwards can convince twelve Oprah-watching morons that a plaintiff should be awarded millions of dollars in damages if a doctor or nurse slips up.  Further, to reduce the potential for a lawsuit, doctors are hyper-careful, ordering ridiculous batteries of tests to treat even the most simple and obvious maladies JUST IN CASE there’s some other condition.  Somebody has to pay for all of that.

    • In Massachusetts, access time to doctors has gone thru the roof (somewhere over 40 days for most doctors).  All of this has people heading to the emergency rooms for anything requiring treatment in less than 40 days.
      So instead of reliving the load on emergency rooms, increased access and implied rationing has made the problem worse.

    • I have to say this…
      1. I think our tort law system is a market-based system that has evolved with the development of markets, and TENDS to plug holes in the system.
      2. Having done some med-mal in Texas, it is impossible to win a suit on the basis that somebody “slips up”.  There has to be a departure from the standard of care, and it is not by any means a “mistake”.
      3. Doctors are smart human beings…but they are human beings.  Therefore, we can say that many of them are irrationally worried about stuff that does not actually exist or they see as being a much bigger problem than it is in reality.  This can lead to some of the defensive medicine you complain of.  The standard of care is all they have to worry about.
      4. The medical profession…like the legal one…does NOT police against bad practitioners…rather the opposite.  It  SHOULD.  It does not.  A bad doctor or nurse or dentist can kill or maim your kid, or destroy the health of your wife, and there HAS to be a way to BOTH compensate for that, AND punish the quack.

      • With regard to med-mal, I can only say that John Edwards built a huge mansion by convincing jurors that a dead little girl was speaking through him, NOT by convincing them that a doctor departed from the standard of care.

        A good friend of mine is an MD.  The fear of a lawsuit is quite real and reasonable, which accounts (at least in part) for the huge malpractice insurance premiums that she has to pay.  I have also chatted with ER docs and nurses who tell me the same thing about defensive medicine: they know that they MUST do it because the threat of lawsuits is real.

        RagspierreThe medical profession…like the legal one…does NOT police against bad practitioners…rather the opposite. 

        This is something that has always bothered me.  As I understand it, doctors are certified by their state medical board, so shouldn’t the state (heaven help us!) investigate and punish malpractice?  My friend did her residency in Louisiana and actually has good things to say about their state malpractice review system.  Apparently, they have a board that reviews complaints.  In most cases, the doctor is found to either have done nothing wrong or else simply made a human error, and nothing more is heard.  This helps keep the ambulance chasers under control.

        It may be that there really aren’t too many suits brought and won on the basis of “a slip-up”, but the damages are so huge and the cases are so notorious that they seem to be a bigger problem than they are.  But, again, those malpractice insurance premiums are high for a reason.

        • Doc, Edwards did NOT build that mansion on one case.
          He did NOT win an individual case WITHOUT proving a deviation from the standard of care (or he could not survive summary judgment in Texas).
          CAUSATION is where Edwards practiced voodoo law.  This is a separate and distinct issue from a breach of the standard of care.
          Some cases…TOOO many…have involved junk science on causation.  The silicon breast implant cases are awful examples.  So too are Edward’s line of cases.
          But a lot of doctors live in irrational fear.  They should be educated in reality.  Often, they are not.

          • I didn’t mean to imply that one case got him his mansion, but rather that he made a mint by suing doctors.  It may well be that most of his cases were legit (my wife is a lawyer here in No. Carolina and says that Edwards is quite well regarded as an attorney), but the “she’s talking to you through me” case indicates that at least one was won through despicable tactics.

            Do you happen to know if statistics are available about the odds of a doctor being sued during the lifetime of his practice?  I’m sure that the insurance agencies have tabulated them.

          • rags, it is not irrational to fear that an OJ Simpson style jury can decide to ruin your life because “all them doctors is rich from rippin off poor people and they can afford it.” THAT’S the reality. And doctors are quite well educated in it.

  • I love this line from the article;

    “The aim of the analysis was to figure out what characteristics make a hospital emergency department likely to close, Dr. Hsia said.”

    Sorry, doc, but you are a bit late to the party. Those characteristics have been known and studied for years. And, as docjim505* mentions, you can hardly say that market forces are running emergency rooms when there is a mountain of state, federal, and local regulations governing them.

    *Any relation to Levi505staightfitjeans?

    • No.  I’m more of a “whatever’s cheapest at Wally-world” guy.

  • Nice wimp out on my comment, chump.
    Just so we’re clear on this, I propose single-payer healthcare and your rebuttal is “B-b-b-but Romneycare has the same problems!”
    Romneycare? Really? Which is about as close to single payer as your mom?
    In fact, your mom is probably closer since I hear she’ll cover anyone, but I digress…
    You keep pedalling that Big Wheel, and you’ll make the Tour de France, Missy!

    • Kinda missed the point of my post ,didn’t ya, Sweetpea? What does “single payer” do? And what isn’t the problem it solves (see RomneyCare as an example)? Let me know when you manage to noodle it out.

  • Dr. Hsia said, especially emergency care. “We can’t expect the market to allocate critical resources like these in an equitable way.”

    Whenever i see a “Dr.” in front of quotes like this i always want to ask them how equitable or fair it would b if their years of schooling and expertise were suddenly considered a human right, and their profession tantamount to being a slave of the state because of it. How does a teachers wage sound dear doctor? No? don’t like that? Well too bad your now effectively a slave of the state by right of its people to receive medical care at a price they wish to pay, your only recourse is to quit…until we decide we need more doctors and force you to work. It’s our right!

  • Bruce,  I gather we’re supposed to gather intelligent views from a guy who can’t come up with something better than to insult your mother?

    Strong argument, no?  Rational, informative, reasonable.   Yeah.  Doesn’t quite get the part that giving everybody insurance doesn’t guarantee actual medical CARE or the instantiation of medical care practitioners, does he.

    But, hey, the law mandates, and via the magic wand of the law, the practitioners WILL appear, and they WILL take these jobs, and they WILL selflessly sacrifice whatever is necessary for the greater good of mandated health insurance.  While ‘jackwagon’ gets to keep whatever job he has, doing whatever it is he does, that makes him happy, at whatever rate of pay he thinks is fair.

    Someone needs to be reminded that ‘health insurance’ is NOT the same as ‘health care’.    There’s a Homer Simpson moment in there, but if he can’t gather that from the Massachusetts evidence I guess he can continue to fall back on insulting people’s mothers.

    • Ya know, after I read a comment twice, and STILL don’t get WTF the writer was trying to convey…
      I notch it up to STOOOOOOOOOOOOOOOOOOOOOOOOOOooooooooooooooooooooooooooooopid on their part.

  • 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.

    And this, from the overgrown junior high snotball (more proof that Churchill was right about being a liberal after 18 means you have no brains):

    UPDATE: Some jackwagon named Bruce McQuain over at QandO.net decided that the most inspired rebuttal he could have was…well, let me post my rebuttal to this asshat here, since he moderates comments:

    Just so we’re clear on this, I propose single-payer healthcare and your rebuttal is “B-b-b-but Romneycare has the same problems!”

    Romneycare? Really? Which is about as close to single payer as your mom?

    In fact, your mom is probably closer since I hear she’ll cover anyone, but I digress…

    You keep pedalling that Big Wheel, and you’ll make the Tour de France, Missy!

     

    • Well his reality is that “single payer” will cure all ills. It obviously conflicts with what appears to be actual reality. And I doubt he’ll ever figure that out.

  • My solution is to cut the pay of doctors so the operating costs of an emergency room are cheaper.

    :P

    • Doh! Harun!  Why didn’t we think of that before!   Hell, we can do that with EVERYTHING!  Farmers, builders, plumbers!  You’re a genius, I’m tellin ya!

      And if we force bright students to become Doctors and such, we can increase the supply and lower their pay even further, further lowering costs!

      • Si, bueno!  Es verdad!

      • Yeah, there’s a reason I call Democrats “Copperheads”. They are and always have been the party of slavery. Calling a plantation a collective doesn’t change the fact that most of the inhabitants are slaves.