As a society, we tend to shy away from change.
(That might be putting it a bit too diplomatically: We hate it. Look at how we adapted to integration, gay marriage, and New Coke.)
So it should come as no surprise that we still treat the emergency room as the medical equivalent of a McDonald’s drive-thru.
As recently as 2012 – the latest year for which data is available – 80 percent of emergency room patients over the previous calendar year went there because they lacked any other kind of care. And while at least one out of every five Americans visit the emergency room in a given year, less than 12 percent of those visits result in actual hospitalization.
And what sends those 110 million people to the ER? For kids, it's simple cold symptoms, while injures force grown folks to the ER more than anything else. And despite the fact that the number of visits grow at a pretty steady pace of 1 million a year, the numbers of actual hospital and ER rooms continues to fall.
Now we have the results of an ER doc poll that seems to suggest ER visits are on the rise. Apparently, roughly 75 percent of ER doctors insist visits are rising.
This poll – an admittedly informal one representing a small slice of the nation’s doctors – elicits the usual suspects of knee jerk, and often contradictory, reactions.
1. “They lied!” After assuming this Joe Wilson impersonator points to the administration, it’s hard to infer that from this story. If anything, more people having insurance – which is one of the actual points of the law – means more people are going to get care. Nevertheless, the percentage of ER patients without insurance has remained steady. And, if anything, hospitals have become much more proactive (if not aggressive) about pursuing payment in advance of service.
2. “It’s working!” Again, for the PPACA sympathizers/cheerleaders, I don’t think this particular data point is one of the relevant metrics by which you can measure the success of this law. Are there fewer uninsured people than five years ago? Sure. But there also are fewer unemployed people, too. More people with jobs means more people with insurance. If anything, all this data suggests is that we’re as ignorant about making health care decisions as we were before PPACA.
3. “There’s a doctor shortage! We’re doomed!” Yes, it’s true; there are fewer primary care physicians than there were a decade ago. But docs have been throwing in the stethoscope long before PPACA. In fact, I bet coming up with a real, reasonable Medicare doc fix would do more for doctor retention than repealing PPACA. But, more importantly, we have more options than ever before, as well. Sure, 20 years ago, we had our family doctor or the emergency room. Now, we have wellness clinics at the nation’s largest pharmacy (Walgreens) and retailer (Wal-Mart). We have more than 9,000 urgent care centers across the country, with anywhere from 50-100 more opening up every year. And, except for Texas, we have telemedicine, which is growing faster than urgent care centers – often leaving much more satisfied patients.
4. “Blame it on the Mexicans!” Or the Guatemalans. Or Venezuelans. (One of my regular trolls played the immigrant card last week when I hinted at the hypocrisy of diehard Red states such as Texas and Florida, who take in far more federal dollars than anyone else. Sounds like the kind of lack of personal responsibility for which liberals are typically blamed.) But contrary to popular belief, most immigrants come to this country in better health than when they leave it – especially the ones who survive. A new CDHC report reveals that children born of immigrants are in much worse health than their parents on several different levels. As Bloomberg reported this week, “This is known as the Hispanic paradox: lower mortality despite lower social and economic status.” Maybe assimilation really is the American way, since it features such great Americans benefits such as obesity, diabetes and more sedentary lifestyles. Who could resist?
No, I draw none of these conclusions from this ER report. If anything, as I alluded to earlier, I see it as a failure of consumers to adapt to changing health care models. It’s a failure of providers and payers to bridge the gap between them. And I see it as a failure of brokers who aren’t doing enough to educate their clients. Because, trust me, whoever is able to make that connection with consumers will be the one who walks away with the IPO.