The Medical Freedom Channel

One of the primary tenets of healthcare ‘reform’ efforts might not be quite so infallible after all, and could send of socialized medicine scurrying for another paradigm on which to build their cases. Additionally, evidence cited by so-called ‘compassionate conservatives’ with regard to immigration and the welfare-state, may now have collapsed under the weight of reality.

ITEM: According to the results of a study just released by the Center for Studying Health System Change, a nonprofit research organization in Washington, D.C., there’s no direct correlation between an increased in the percentage of people with health insurance, and decreased use of hospital emergency room facilities. In fact, according to their figures, the effect may be the exact opposite.

The study, completed in 2003 but only released this month, was done via a telephone survey of some 46,000 people in 12 major American cities. Among those showing the largest percentage of ER visits per capita, Cleveland, Ohio, led the field, followed closely by Boston, Mass. Both registered well above the national average of about 32 visits per 100 people, with Cleveland tallying almost 40 such visits, and Boston just over 36. At the other end of the spectrum, the greater Los Angeles region (Orange County, Calif.) had the lowest use, at about 21 visits per 100 people.

However, if you were to ask the advocates of “full insurance for all,” Bostonians should therefore rank among the worst cities, in terms of participation in health insurance coverage. In fact, that’s not the case: Boston actually has the lowest rate of uninsured among the 12 cities studied, at a mere 5.7 percent of the population. (One wonders why the edict of mandatory universal coverage was such an urgent matter for Massachusetts pols, when most other cities, including all of those in the survey, rank considerably worse in this category. It smacks of the “full employment” often sought by social-welfare advocates, even in times when unemployment has been well below normal levels.) Cleveland was also relatively low in the numbers of uninsured (8%), while those Orange County low-use citizens had over twice as many uninsured residents (18%). Once again, the results were the inverse of the expectation.

Another widely held belief, in this case on the part of the “closed borders, stop illegal immigration” forces, is that such people, Hispanic or not, tend to bulk up emergency-room usage and drain resources that way. The study seems to debunk that as well, noting in the CSHSC press release that, “Contrary to popular belief, communities with high levels of uninsured, Hispanic or immigrant residents generally have much lower rates of per person hospital emergency department (ED) use than other communities.” Again, the percentage of immigrants was lower in both Boston and Cleveland, with the worst overuse of ER facilities, and highest in Orange County (15-16%), where the study figures on ER use were the lowest.

One of the study’s leading researchers notes the misreading of this issue, stating in the press release that “Hispanic immigrants – a high proportion of whom are uninsured – are not heavy users of EDs compared to other individuals, including whites with private insurance. And their numbers are still too small in the vast majority of communities nationwide to have a major impact on the health care system in those communities.” The study in fact shows non-citizens having “about 17 fewer ED visits per 100″ than citizens do, while uninsured people had “16 fewer visits on average than Medicaid patients, about 20 fewer visits than Medicare beneficiaries and roughly the same rates as privately insured people.”

A Boston Globe article announcing the study results speculates that if the problem lies elsewhere, it could have more to do with the difficulty these days in getting your own physician, whether chosen or assigned by a coverage plan, to see and treat you, given the glut on doctor visits which presently prevails. We suspect this is a bit closer to the truth, along with the trend for physicians refusing to treat for some conditions, whether for “moral” reasons or otherwise (and with the current controversy over Plan B, it seems only a matter of time until “doctor shopping” becomes de rigeur in that realm as well).

What does this mean? Well, for one thing it appears to put the lie to both xenophobic America-firsters (who want “closed borders until the welfare state is destroyed”) and “single-source for all” health insurance advocates (who seem to think everyone being “covered” is the key to cutting costs), thus slapping both conservatives and progressives with a dose of reality. The bottom line seems to be that, whatever the cause of overuse of Emergency Rooms, it is not nearly as simple as some would claim it to be.