More on health care

Someone close to us went to the hospital the other night because a chronic condition had turned into a crisis. They waited for hours in an ER because, otherwise, they'd have to wait weeks for an appointment that might have treated the problem in 15 minutes. This was a chronic issue that, if left unchecked, could become life-threating. Conversely, if treated well in a timely fashion, it could be just another medical issue in a collection of medical issues with which this person and her family lives.
This isn't  a case of impatient patients wanting to jump the queue by elevating a concern to a crisis. This, according to the guidance given by many of  support resources, is the plan. Well-connected people going through their ordinary channels could get this person to see the right medical professional in anywhere from three to eight weeks. So, for the same condition and likely the same longer-term treatment plan, the best option is one that costs probably two orders of magnitude more.
Recent studies have confirmed that many of the savings in emergency room expenses that we expected from universal coverage didn't occur. (See the Boston Globe article, Emergency room visits grow in Mass.) We got it wrong in our assumptions. We assumed that ER expenses were being driven up by uninsured people using emergency services to get free care.
Not so much. Rather, as in this case, people with health insurance come to the ER because they couldn't see their regular doctors in time. (The Globe article suggests that this is due primarily to lack of access to primary care physicians. That may be true generally, but we shouldn't overlook the issue of timely access to specialists.)
The simple and wrong solution would be to make emergency room access more difficult to obtain. Insurance companies can and will and perhaps even do make it more difficult for their customers to use their insurance at the ER without some kind of pre-authorization.
A more complete solution is more complex, primarily because lots of people are making a good living off of the current systems. To make a change involves diverting some portion of our resources from crisis management toward timely and preventative solutions. (Cue the story of the River Babies.) A few preventative services are already in the pipeline for Medicare in 2011.With a few more good ideas, we might just make it.