Monday, July 16, 2012


There are now 50.7 million medically uninsured people in the United States, one of every six of us. More, actually, since many who believe they’re insured learn at the most inopportune time that their policy, despite high premiums, is so thin and narrow that it’s virtually worthless.

What are the uninsured to do? Traditionally, we’ve directed emergency departments to serve them regardless of their ability to pay. We do that because the alternative is to let them die in the streets, which can create a traffic and disposal problem. 

In treating them, emergency departments, mandated to maintain expensive equipment and hypertrained staffs, turn out to be awesome money losers for hospitals. For their part, hospitals try to compensate by soaking those patients who are insured or seem solvent. (The ED that treated me for two hours a few months ago billed Medicare ten thousand dollars, and accepted eight hundred.) That is, we are all paying through the nose, via taxes and premiums, for the expensive, however desultory, care indigent patients receive.

We could look at this and say, “Wait a minute. We’re essentially paying for the care of the indigent anyway, and because they use EDs, paying through the nose. Why not cover them instead with standard care, for less?” 

That’s what a sane society would do, but we’re not there yet. As Winston Churchill said, “Leave it to the Americans to do the right thing…after they’ve tried all the wrong ones.”

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