The problem with emergency rooms

Inadequate emergency rooms are one of the most neglected policy issues in the United States.  Read this depressing article.  Excerpt:

Emergency medical care in the United States is on the verge of
collapse, with the nation’s declining number of emergency rooms
dangerously overcrowded and often unable to provide the expertise
needed to treat seriously ill people in a safe and efficient manner.

Long waits for treatment are epidemic, the reports said, with
ambulances sometimes idling for hours to unload patients. Once in the
ER, patients sometimes wait up to two days to be admitted to a hospital
bed.

As a system, U.S. emergency care lacks stability and the
capacity to respond to large disasters or epidemics, according to the
25 experts who conducted the study. It provides care of variable and
often unknown quality and depends on the willingness of doctors and
hospitals to lose large amounts of money.

That’s
the grim conclusion of three reports released yesterday by the
Institute of Medicine, the product of an extensive two-year look at
emergency care.

This is one reason why we are less well suited to defend against a pandemic or a major terrorist attack than many people think.  Note that emergency rooms are unpriced resources for many users, so this outcome should not surprise the economist.  Did you know that the number of emergency rooms has decreased since 2001?

Are any of you willing to return to pre-1986 policy, when emergency rooms were not obliged to treat all comers?  Is there evidence on how big a difference this law made?  If we expanded emergency room capacity, but kept current law, would we in effect have national health insurance, paid for by an (implicit) tax on other forms of medical care?

Here is an article on how emergency rooms work.  Here is a claim that most people don’t need to go.  A cross-country comparison of the economics of emergency rooms would make for a fine dissertation, and then some.