Study: people given insurance coverage use ER's *more* rather than less

One of the strengths of a decentralized system versus a centrally-directed one is that with the former, new ideas are tested on a small scale first.  That gives people a chance to see if the new idea or program, y'know, works.  If it turns out to be a disaster, the damage isn't nearly as great.

But of course, under our new, enlightened emperor this old, outmoded way of doing things has been junked in favor of revamping the health insurance system for the whole nation, all at once.  But the new all-at-once way is really better, because Obama.

So...one of the big arguments for Obamacare touted by Democrats and True Believers was that people who didn't have health insurance or money used emergency rooms for their routine health care.  Everyone agreed that this was terribly expensive.  But if you gave people health insurance, the Dems claimed, they'd stop using emergency rooms for routine care.

For example, in 2009 Obama said:

I think that it’s very important that we provide coverage for all people because if everybody’s got coverage, then they’re not going to the emergency room for treatment.

As it turns out, this theory has actually been tested in one state.  And the results were...unexpected:

Supporters of President Obama’s health care law had predicted that expanding insurance coverage for the poor would reduce costly emergency room visits as people got care from primary-care doctors instead. But a new study in Oregon has [found] that the newly insured actually went to the emergency room more often.

The study compared thousands of low-income people randomly selected in a 2008 lottery to get Medicaid coverage with people who entered the lottery but remained uninsured. Those who gained coverage made 40 percent more visits to the emergency room than those without insurance.

The finding casts doubt on the hope that expanded insurance coverage will help rein in rising emergency room costs just as more than two million people are gaining coverage under the Affordable Care Act.  Instead, the study suggests that raising the number of insured people may result in even more people using emergency rooms, increasing costs.

Nearly 30 million uninsured Americans could get health insurance under the law, about half of them through Medicaid. The first policies took effect on Wednesday.

The "Marvelous Understatement Award" goes to one of the authors of the study--Katherine Baicker, an economist at Harvard University’s School of Public Health.

“I suspect this finding will surprise many in the policy debate,” she said.

Gosh, if only the Dems had been willing to wait til this study was completed, we might have had a chance to fine-tune that mahvelous piece of legislation called Obamacare.  But that's just not their style, y'know?

An M.D. commenter had some insight:

Medicaid patients have no motivation to *not* use the ER, even if they have a primary care physician (take it from me). I'm a primary care internist in an upstate community. If I tell my Medicaid patient they do not need an antibiotic for a cold, they are likely to just go to the ER to get what they want, as it's "free" there.

Another commenter relates,

My sister, an emergency room MD in a large, inner city hospital, predicted that the poor would continue to use the ER as a doctor's office. Having health insurance, she said, would require people to find a doctor, make appointments in advance and get themselves to and from the doctor's office.

By contrast, to go to the ER they just dial 911, get a lift and a voucher for a taxi ride home. It all takes place on their schedule (aside from the ER wait) and costs them nothing. Having a Medicaid card doesn't change the basic equation.

Oh, and for those who think this story was from a horribly biased source that you wouldn't stoop to use as a bird-cage liner, you're absolutely right:  It's from the NY Times.