Only Universal Insurance Can Save the ERs

The terrible choices that doctors, nurses and patients must make when 44 million Americans lack health insurance are not just the stuff of prime-time drama. Though television programs like “ER” and “Law & Order: Special Victims Unit” explore these stories weekly, the suffering of those without coverage does not end when the closing credits roll. Real doctors in emergency rooms face tough decisions daily about the uninsured.

Eight out of 10 uninsured Americans are from working families. They’re teachers, farmers and small-business owners; 8.5 million are children. Most of the uninsured work but earn only modest incomes. They earn too much to qualify for public programs but too little to purchase private health insurance. Most are caught in an economic bind that, to put it simply, is very unfair.

This crisis is growing worse. According to a survey of emergency physicians released by the Robert Wood Johnson Foundation and prepared for “Cover the Uninsured Week,” these doctors see the system as being on the brink of disaster. A clear majority believe that the single most important thing we can do to improve healthcare is to make sure every man, woman and child has health insurance. Why?

The rising number of uninsured Americans who use emergency rooms as their primary source of care threatens to overwhelm emergency departments. The problem is virtually the same everywhere -- here in Los Angeles as well as in other U.S. communities, in urban, suburban and rural hospitals.

According to the surveyed ER physicians, the 44 million uninsured are less healthy than the insured and die younger. And the Institute of Medicine agrees, estimating that 18,000 people die each year because they lack coverage.

Those uninsured individuals fortunate enough not to expire before their time tend to be sicker and have more serious medical conditions than patients with health coverage. A staggering 94% of emergency physicians say it is “more difficult arranging or securing follow-up care for an uninsured patient with a serious problem than for a patient with health coverage.”

The effects of this crisis on those with true medical emergencies are very clear. One need look no further than the interminable waiting lines in ERs or the shortage of ER staff that have become the norm.

Although there is a moral imperative to secure health insurance for every American -- and we are not advocating one solution over another -- there is also a practical and self-interested reason to do so. The quality of emergency care declines for everyone when the ER is packed with non-urgent cases and emergencies that could have been prevented with health insurance.

Almost half of emergency physicians report that their hospitals’ urgent-care departments are stretched beyond capacity on weekdays; the problem grows worse on weekends.

Emergency physicians are trained to determine on the spot what’s an emergency and what’s not, and they believe we have little time left to avoid a healthcare calamity. Over the years, we have learned much from our nation’s emergency doctors, and we take their advice very seriously. We proudly join them in calling for healthcare coverage for all. It is the right thing for everyone.

Neal Baer MD is executive producer of “Law & Order: Special Victims Unit”; Noah Wyle, star of “ER,” is national spokesperson for “Cover the Uninsured Week.”