No Oil for Pacifists: More Healthcare Myths

The President plumped for Obamacare in part because covering the uninsured supposedly would save taxpayer funds used to subsidize emergency room treatment:

[T]hose of us with health insurance are also paying a hidden and growing tax for those without it -- about $1,000 per year that pays for somebody else's emergency room and charitable care.

Massachusetts, of course, has universal health insurance coverage--which hasn't cut healthcare costs or wait times. Nor has it reduced reliance on emergency rooms:

The number of people visiting hospital emergency rooms has climbed in Massachusetts, despite the enactment of nearly universal health insurance that some hoped would reduce expensive emergency department use.

According to state data released last week, emergency room visits rose by 9 percent from 2004 to 2008, to about 3 million visits a year. [NOfP note: the figure represents growth above population change.]

When the Legislature passed the insurance law in 2006, officials hoped it would increase access to primary care doctors for the uninsured, which would improve their health and lessen their reliance on emergency rooms for the flu, sprains, and other urgent care. Residents began enrolling in state-subsidized insurance plans in October 2006; everyone was required to have coverage by July 1, 2007.

But, according to a report from the Division of Health Care Finance and Policy, expanded coverage may have contributed to the rise in emergency room visits, as newly insured residents entered the health care system and could not find a primary care doctor or get a last-minute appointment with their physician.

So why was Obama wrong? According to the National Center for Policy Analysis' John Goodman, the reason is that government-run insurance systems encourage more emergency room use than private insurance:

A common myth is the belief that the uninsured use the emergency room a lot more than people with private health insurance. Yet as the figure shows, the percent of uninsured going to hospital emergency rooms every year is not much higher than for those with private insurance. (And after adjusting for health status, there is no difference in the average number of visits.) Medicaid enrollees, on the other hand, visit emergency rooms significantly more often than either the insured or the uninsured.

Why is that? The main reason appears to be that Medicaid fees are so low that patients have difficulty finding private practitioners who will see them. Often, the emergency room turns out to be the only place they can access care. Studies show that even the uninsured have an easier time making doctors' appointments than Medicaid enrollees.