Disappearing Emergency Rooms Expose GOP Health Care Farce
"People have access to health care in America," George W. Bush declared in 2007, adding, "After all, you just go to an emergency room." But with a new report from the Journal of the American Medical Association (JAMA) showing a steep decline in emergency room capacity nationwide, the ER health care solution championed by President Bush, Mitch McConnell, Tom Delay and other Republican leaders for 50 million uninsured has once again been exposed as a cruel farce.
As the New York Times explained, over the past two decades emergency rooms have been disappearing at an alarming rate even as patients' need for them continues to soar:
Urban and suburban areas have lost a quarter of their hospital emergency departments over the last 20 years, according to the study, in The Journal of the American Medical Association. In 1990, there were 2,446 hospitals with emergency departments in nonrural areas. That number dropped to 1,779 in 2009, even as the total number of emergency room visits nationwide increased by roughly 35 percent.
Emergency departments were most likely to have closed if they served large numbers of the poor, were at commercially operated hospitals, were in hospitals with skimpy profit margins or operated in highly competitive markets, the researchers found...
Emergency rooms at commercially operated hospitals and those with low profit margins were almost twice as likely as other hospitals to close, Dr. Hsia and her colleagues found. So-called safety-net hospitals that serve disproportionate numbers of Medicaid patients and hospitals serving a large share of the poor were 40 percent more likely to close.
That loss of ER beds produces a domino effect, as Americans confront longer waiting times, rerouted ambulances and overcrowding at the remaining emergency room facilities. So even though emergency rooms by law must provide treatment regardless of patients' ability to pay, Dr. Sandra M. Schneider, president of the American College of Emergency Physicians worries "there's a concern that there will be nowhere for them to go."
All of which further undermines the grandstanding of a Republican Party hell-bent on the repeal of the 2010 Affordable Care Act. With 50 million uninsured and family health care costs having doubled over just the past nine years, all the GOP is offering Americans is a trip to the emergency room.
Like a rotting fish, the Republican health care fraud starts at the head. During a July 2007 visit to Cleveland, President Bush unveiled his emergency room cure for the ills of the U.S. health care system. Rejecting the expansion of the successful - and even more popular - State Children's Health Insurance Program (S-CHIP), Bush assured Americans that there was no crisis in medical coverage:
"I mean, people have access to health care in America. After all, you just go to an emergency room."
In November that year, indicted former House majority leader Tom Delay took Bush's health care clown show overseas. Speaking in the UK, Delay announced:
"By the way, there's no one denied health care in America. There are 47 million people who don't have health insurance, but no American is denied health care in America."
But while his comments were greeted in England (as the AP reported) with "derisive laughter," no one was chuckling back home.
The GOP's Emergency Room Health Care Plan also reemerged during the 2008 election. It was repackaged by the architect of John McCain's health care proposals, John Goodman. No one in the United States is uninsured, Goodman, pronounced, because Americans have access to emergency room care. As the Dallas Morning News reported:
Mr. Goodman, who helped craft Sen. John McCain's health care policy, said anyone with access to an emergency room effectively has insurance, albeit the government acts as the payer of last resort. (Hospital emergency rooms by law cannot turn away a patient in need of immediate care.)
"So I have a solution. And it will cost not one thin dime," Mr. Goodman said. "The next president of the United States should sign an executive order requiring the Census Bureau to cease and desist from describing any American - even illegal aliens - as uninsured. Instead, the bureau should categorize people according to the likely source of payment should they need care. So, there you have it. Voila! Problem solved."
Senate Minority Leader Mitch McConnell tried to sell the same snake oil two years ago. McConnell used his appearance on Meet the Press in July 2009 to evade the moral dimension of a nation with millions left uninsured. Regardless, he told NBC's David Gregory, "They don't go without health care":
GREGORY: Do you think it's a moral issue that 47 million Americans go without health insurance?
McCONNELL: Well, they don't go without health care. It's not the most efficient way to provide it. As we know, the doctors in the hospitals are sworn to provide health care. We all agree it is not the most efficient way to provide health care to find somebody only in the emergency room and then pass those costs on to those who are paying for insurance. So it is important, I think, to reduce the number of uninsured. The question is, what is the best way to do that?
Georgia Republican Paul Broun echoed that line. In March 2010, the Neo-Confederate physician Broun warned that "If ObamaCare passes, that free insurance card that's in people's pockets is gonna be as worthless as a Confederate dollar after the War Between The States -- the Great War of Yankee Aggression." Instead, the sick - including the mentally ill - should just go to the emergency room. As ThinkProgress recalled:
One of the most radical opponents of health care reform is Rep. Paul Broun (R-GA). He has said that a public option would "kill people." Last Tuesday, Broun was confronted by a constituent at a health care town hall who explained that he has gone into debt because he can't afford insurance for his major depressive disorder. In response to his constituent's story, Broun said that "people who have depression, who have chronic diseases in this country...can always get care in this country by going to the emergency room."
As it turns out, studies have been warning for years that America's overflowing emergency rooms do not have the capacity, staffing or funding to be the health care solution of last resort. A 2006 report by the Institute of Medicine revealed that U.S. emergency rooms can barely cope with the volume of patients in the best of circumstances:
The study cited three contributing problems to the rise in emergency room visits: the aging of the baby boomers, the growing number of uninsured and underinsured patients, and the lack of access to primary care physicians.
The report found that 114 million people, including 30 million children, visited emergency rooms in 2003, compared with 90 million visits a decade ago. In that same period, the number of U.S. hospitals decreased by 703, the number of emergency rooms decreased by 425, and the total number of hospital beds dropped by 198,000, mainly because of the trend toward cheaper outpatient care, according to the report.
And that's in the best of times; the forecast for the worst of times is grimmer still. A March 2008 study from the House Oversight and Government Reform showed an American ER system woefully unprepared to handle a "predictable surprise" of a terrorist attack on the scale of the 2004 Madrid bombing:
The results of the survey show that none of the hospitals surveyed in the seven cities had sufficient emergency care capacity to respond to an attack generating the number of casualties that occurred in Madrid. The Level I trauma centers surveyed had no room in their emergency rooms to treat a sudden influx of victims. They had virtually no free intensive care unit beds within their hospital complex. And they did not have enough regular inpatient beds to handle the less severely injured victims. The shortage of capacity was particularly acute in Los Angeles and Washington, D.C.
Of course, it is the shortage of both compassion and common sense which is particularly acute in among Republicans in Washington, DC. Because even as America's emergency room facilities continue to vanish, the GOP talking point that "no one is denied health care in America" surely won't.