Poor people and emergency rooms

Study: Expanding Medicaid doesn’t reduce ER trips. It increases them.

ISTM that there's a pretty clear reason why suddenly giving people health insurance results in increased visits to the emergency room: That's what poor people have done to get the care they couldn't afford in the past.

There are a number of inappropriate things people do when they don't have money and/or power. When I worked in a grocery store, people thought that complaining to the company about poor service would do no good; they just gave the person at the store Hell. The thing is, the person at store level doesn't decide how much help to schedule, nor when to schedule it. They get numbers from on high, and that's what they've got to deal with. I would love to have been able to give the customers the help to which they were entitled, but middle-management had their quotas and formulas to follow, and if people shop at odd hours in poor neighborhoods, so much the worse for them. After all. it's much more important to have short lines when supervisors are in the store than when customers are.

Similarly, poor people have gone to emergency rooms in the past because they knew they would not be turned away. But if they are now covered by Medicare, an obvious solution presents itself: simply tell them that Medicare will not cover their emergency room visit, but it will cover a visit to the Ambulatory Care Center, or their primary care physician, or whatever. IOW, simply tell them that they are in the wrong place.

They will complain for a while, but eventually they will learn to use their insurance coverage efficiently.