Cuts to aid, insurance will push ERs past the brink

The 33 million people losing coverage will overwhelm hospitals

- ERIC SNOEY GUEST CONTRIBUTOR

JOHN MOORE Getty Images EMERGENCY DEPARTMENT personnel at Harborview Medical Center in Seattle prepare for a blood transfusion.

BACK IN 2007, President Bush was being challenged on his opposition to the Children's Health Insurance Program which provides health coverage for children in families too poor to afford private insurance, yet too "wealthy" to qualify for Medicaid.

His response was honest, if characteristically clumsy: "People have access to healthcare in America.

After all, you just go to an emergency room." In a way, he wasn't wrong. By law, ERs must evaluate and stabilize every patient who walks through the door, regardless of complaint or ability to pay. But by saying the quiet part out loud, Bush laid bare an uncomfortable truth: Emergency departments are not just for emergencies, and never have been.

I've been an ER doctor at an inner-city trauma center for 35 years. And while I've seen plenty of gunshot wounds, drug overdoses and heart attacks, true emergencies-the kind that animate medical dramas on television are a comparatively small part of what I do. It's the "worried well," the "sick and stoic" and everyone in between who keep us busy. They're all resigned to using the ER as a standin for unavailable primary care.

ER docs like me hear it every day: "My doc is booked up and can't see me for three months." "The nurse line told me to come because the office is closed." "It's probably nothing, but I'm worried." "I don't have insurance, a doctor or my medicine." When there is no place else to go, everything is an emergency. Offering high-quality, sophisticated care, day or night, without a reservation, ERs have long served as spackle for a gap-riddled healthcare system. But emergency care of any kind is costly, resource intensive and increasingly being swamped by unmet needs for primary care: issues best handled elsewhere that end up in the ER for lack of better options.