...and then they would send me a bill

And then when the bill's recipient doesn't (can't) pay the bill, they send it to collection, and when that can't be collected they write it off. (Which jacks up the rates on care overall because eventually they WILL make their money, but from the deeper pockets.... I think of our high co-pays as part of what allows -- de facto-- our poorer neighbors to get any care at all.... an unarticulated tax.)


But from the view of the patient, people go to the ER for medical care because they know they will get at least some degree of treatment and that eventually the phone calls to pay for it will stop. They don't go there because it's cheaper than office care, but because there is less insulting interaction at the counter over the money, and because by the time they decide to brave the counter at the ER, the need just about IS an emergency.

I've done it myself-- stewed all day about not being able to afford an office visit I know I probably need (our expensive "coverage" is minimal), but by the time it's midnight, I know I just can't wait till the morning and that at least the ER will do what it can. We of course pay the co-pay, but some can't. Yes, in a large city it will be "stabilize and discharge," and the population density will make that a fast turnaround with cursory "care." But it's better than nothing, and in rural health care it is often quite fine care "called" "stabilizing."

Ya know, we spend a lot of pastoral time in the ER with folks of all economic abilities, so we do know how the system works (poorly!), and it IS a runaround, but to confuse being able to pay an ER visit and being able to pay a doctor's office visit is just not quite an accurate reflection of the actual economics of the healthcare business that allows the ERs to do what they do.

~S~