Obamacare Encourages Emergency Room Freeloaders

Unless conservatives are able to change the basic philosophical underpinnings of the healthcare debate, there is no hope of ever containing spending even if Obamacare is repealed.

In "The Hidden Costs of Healthcare Don’t Have to Remain Hidden," I pointed out that federal, state and local government spend a combined total of $1.2 trillion on healthcare, which works out to almost $4,000 per person, per year.

This fantastic amount will continue to increase, and increase rapidly, unless healthcare consumers bear some of the cost for their care.

Currently, when one’s income falls below a certain threshold, government healthcare professionals believe that individual is freed from assuming any personal responsibility for their health.

Come down with a touch of diarrhea and the afflicted is instantly transformed into a helpless ward of the state. I suppose the public is fortunate this philosophy doesn’t extend to personal hygiene, too.

Before Obamacare the uninsured depended on hospital emergency rooms to get treatment for genuine emergencies. But they also used emergency rooms when they had a cold, the flu, or a minor malady.

Since ER treatment costs almost $600 more than treatment in a doctor’s office, unnecessary ER usage is wasteful and expensive. Obamacare was supposed to stop this by giving patients insurance and the ability to visit a doctor’s office.

But like all the other Obamacare promises, this one proved false, too.

Laura Ungar reports, “Many hospitals in Kentucky and across the nation are seeing a surge of those newly insured Medicaid patients walking into emergency rooms.”

Obamacare expanded Medicaid eligibility to people that had been using emergency rooms in the past because the care was free and didn’t require an appointment.

So why are they still using the ER?

Planning for the future — buying health insurance for example — is not a priority for the uninsured. That’s why one finds so many iPhones, tattoos and Nikes among this group and so few husbands, high school diplomas, jobs, U.S. birth certificates and clean background checks.

Now they have insurance, but instead of using it to find a primary care doctor and make an appointment — which takes planning. Or, visiting a doctor in a box when they are ill  — less planning, but requires a copay before treatment — they return to the ER where law requires treatment without any payment at all.

A 2007 Kaiser Family Foundation report found that Medicaid beneficiaries were 9 percent of the population but totaled 15 percent of ER visits — that was before Obamacare.

All government has done is make free care easier to obtain, so people increase their usage and taxpayer cost. A Washington Post story illustrates the difficulty conservatives face by offering a solution that contributes to the problem.

Michael Granillo had such a bad case of back pain, “I wanted to be taken care of now. I didn’t want to sit and wait.” Even under Obamacare he hasn’t bothered to get health insurance, so he went to the ER three times in a single week, leaving each time because he had to wait. Evidently the pain wasn’t that bad.

The obvious solution is buy Obamacare and visit a doctor. Instead hospital management makes it easier for Granillo to abuse the system by allowing him to make an ER appointment over the phone.

Previously the wait, which he refused to endure, was the only real cost borne by Granillo.

Now, as long as the phone bill is current, even that feeble brake on ER usage is gone.

Which is where a change in philosophy offers hope. Consumers are sensitive to price differences. The New York Times cites a HealthCore study showing patients with insurance — who weren’t going to pay the cost difference — still chose lower priced medical tests when offered the option.

Currently Medicare and uninsured patients have a choice between doctor copay and the free emergency room. That must change.

My proposal is regardless of income, regardless of malady, regardless of the oppression the white patriarchy has imposed, patients must be responsible for some of the immediate cost of healthcare. This means a minimum copay of $25 to $30 at the doctor’s office and a mandatory copay of three times that amount if they visit the ER.

Only then will ER abuse decline.

To head off the heartless conservative condemns the poor to die criticism, every patient will be allowed one free emergency room visit per year. I’m so soft and squishy that it is okay with me if unused credits rollover to future years.

The crucial change is building a sense of responsibility and obligation among patients by offering options that encourage more efficient usage. It is good for the individual, good for the country and it will serve to reduce the growth of healthcare cost in the future.