What one advocate of health care cuts doesn’t understand about emergency room care

ERs are expensive and focused on…emergencies

Emergency rooms are made for emergenciesWith cuts to MaineCare on the table, doctors and health policy analysts have made the point that people who can’t get their care through clinics and doctors’ offices will be going to emergency rooms.

This will stress those hospital-based facilities and deliver far more expensive care.

To one of the main advocates of these proposed cuts, the coming shift to ER care doesn’t quite add up.

Opponents of the Governor’s proposal have tried to argue a two-front war. On one hand, they argue, limiting access to free health care is bad for those who face cuts. On the other hand, those facing cuts will not really be denied health care, but their over-utilization of emergency rooms for care makes it a greater public burden than simply extending free benefits. The results of this study show clearly that the latter argument is entirely without merit.

Another argument pushed by the Bangor Daily News and others opposed to LePage’s cuts is that, as Eric Russell of the BDN reported a Democrat insider saying, ‘people will die’.

This advocate’s take is wrong. Here’s why:

1. The care delivered outside of emergency rooms is not the same as what ERs do. Thus the claim that “those facing cuts will not really be denied health care” is wrong.

ERs do not provide screenings or on-going care.

A diabetic will not get the monitoring he needs. Thus a small issue that could be caught in a regular clinic visit will turn into something much more serious — and expensive.

The result could even involve a disability, such as when a small foot sore, not uncommon to diabetics, is untreated, becomes severely infected, perhaps gangrenous, and the man’s foot cannot be saved. An amputation is both costly and affects his life quite a lot.

2. While saying “people will die,” is strong language, studies indicate 45,000 Americans die each year because they did not receive the care they would have if they had health coverage.

As I wrote recently, “Consider a man who doesn’t know he has colon cancer until a large mass is discovered and the cancer has spread, or a woman whose high blood pressure is not treated until she has had a massive stroke. Yes, both can be seen at the emergency room, but not for screening or ongoing treatment. Untreated conditions damage the body, cause death and cut short individuals’ work lives.”

ERs do not perform screening colonoscopies nor mammographies. These can find pre-cancerous conditions or cancers when they are relatively small. Early detection leads to treatments that may prevent any problem from developing or which nip the cancer in the bud.

The very study cited by the supporters of health care cuts found that people who received Medicaid had 60% more mammographies than those without.

(And, of course, if a screening test detects cancer and treatment is needed, it’s not going to be treated in the emergency room.)

The only way that the argument that ER care is perfectly adequate makes logical sense is if the supporter of these cuts quoted above thinks that colonoscopies and mammograms — not to mention blood pressure and diabetes screening and care — don’t save lives. And, while that would be logically consistent, it would be incorrect. Screenings and on-going treatment do save lives.

In short, it’s certain that “limiting access to free health care is bad for those who face cuts.” ERs are no real substitution for that care, while shifting care to these venues undermines health and leads to crowded conditions for those with true emergencies.

Amy Fried

About Amy Fried

Amy Fried loves Maine's sense of community and the wonderful mix of culture and outdoor recreation. She loves politics in three ways: as an analytical political scientist, a devoted political junkie and a citizen who believes politics matters for people's lives. Fried is Professor of Political Science at the University of Maine. Her views do not reflect those of her employer or any group to which she belongs.