Something some politicians obviously don't understand about healthcare

We (the media, the politicians, regular people who care) are all agog about the most recent development in the discussion about the nation's health care:  the GOP proposal to repeal (partially) the Affordable Care Act.

I've heard a quote from a Congressman that uninsured people can always use the emergency room for their health care.

No!  That is wrong on so many levels, so let me hit the high points.

The emergency room is the most expensive environment to receive routine care.  The reason, primarily, is that the fixed costs associated with an ER are high because the ER has to be prepared to treat the most critically injured or ill patient.

Next high point:  An ER, by law, cannot turn a patient away regardless of the patient's ability to pay.  When an ER sees an uninsured patient (at an average cost in excess of $1200, that patient must pay out of pocket.  Since few of us are prepared to fork over that much money, the care falls into the category of "uncompensated".  But a hospital has to stay in business, so how does it cover the cost of that care?

A public hospital, underwritten by a city or county government, turns to the taxpayer to make up for the loss.  In addition, it may, like the private hospital, attempt to shift costs to insured patients, by raising prices to recover the costs, hopefully, from those patients' insurance companies.

One of the motivations behind the Affordable Care Act  was to provide insurance coverage to more people so that they could go to their doctor for their routine care and not strain the health system's emergency rooms' resources.

Twenty odd years ago, when Tennessee conducted the great Tenncare experiment, converting Medicaid to a managed care model and expanding Medicaid coverage, the hospitals were primary supporters of the effort, for precisely this reason.

So reducing the number of insured lives will eventually hit everyone's pocket, either through taxes or through higher insurance costs.

So, please, get it out of your head that the ER is the best safety net for uninsured people.  It doesn't provide appropriate level care and it is too expensive (especially when you multiply one visit by 24 million lives).

What do you think?