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September 24th, 2010
11:39 AM ET

Opinion: Emergency care as the new primary care

George Bush once famously (or infamously) commented that health care is indeed available for all:  You just go to the emergency room.

Unfortunately, this is a reality for a significant swath of the American people, and the problem continues to worsen.  A report in the September issue of Health Affairs points out that less than half of the 345 million annual visits for acute-care problems take place with a patient’s personal physician.

Nearly a third of these visits takes place in the emergency room.  The ER is of course the right place for bleeding wounds, crushing chest pain, and motor-vehicle accidents, but an enormous chunk of these visits are not actually emergencies.

Most of these visits more properly belong in the category of “urgent care” — rashes, mild-moderate pains, urinary infections, coughs, fevers, and so on.  The type of things that are easily and routinely handled by outpatient primary-care doctors.

Some of this misuse of the ER falls under the rubric of access: patients have primary-care doctors, but are unable to obtain timely appointments. But most of this is attributed to patients who do not have primary care doctors, usually because they don’t have insurance.

The latter is one of the key pillars of the health-care reform bill that passed this year. Providing health insurance for all its people is an obvious basic tenet of civilized society.

To hear that Republican politicians, unable to repeal the reform bill, are now working to chip away at it is infuriating. Where are our ethical priorities as a nation? Somehow we can afford tax cuts for the wealthy, but we can’t afford health coverage for our fellow Americans.

I invite these politicians vowing to undo health-care reform to spend a year without health insurance.  See what it’s like to take care of your children without reliable primary care medicine.

Oh, and I recommend picking up a few hefty novels; it can be quite a long wait in the emergency rooms.

The opinions in this commentary are solely those of the authors.

Danielle Ofri is associate professor of medicine at New York University School of Medicine and editor-in-chief of the Bellevue Literary Review. Her most recent book, “Medicine in Translation: Journeys with My Patients.” is about the care of immigrants and Americans in the U.S. health care system.


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