The Corpus Callosum

These two things might be connected.  The Washington Post reported yesterday on the findings of a CDC report on emergency room preparedness.  The Economic Policy Institute reported on further erosion in health insurance coverage.

Crowded ERs Raise Concerns On Readiness

By Christopher Lee
Washington Post Staff Writer
Thursday, September 28, 2006; Page A11

Emergency rooms at many hospitals are routinely stretched to the breaking point, raising concerns that they would not be able to handle victims during a terrorist attack or natural disaster, according to congressional testimony yesterday and a new federal study.

Between 40 percent and 50 percent of emergency departments experienced crowding during 2003 and 2004, the study by the Centers for Disease Control and Prevention found. It deemed an emergency room to be crowded if so many patients flooded in that ambulances had to be diverted to other hospitals; if people in urgent need of care had to wait an average of more than an hour; or if at least 3 percent of patients simply gave up and left before being seen....

Health insurance eroding for working families
Employer-provided coverage declines for fifth consecutive year
September 28, 2006 | EPI Briefing Paper #175

by Elise Gould

More Americans are uninsured because of the continued erosion in employer-provided health insurance, the most prominent form of U.S. health insurance. The number of people without health insurance grew significantly for the fifth year in a row. Nearly 46.6 million Americans were uninsured in 2005—up almost 7 million since 2000. The rate of those without insurance has grown 1.7 percentage points during this period, from 14.2% in 2000 to 15.9% in 2005...

...As with workers, the downward trend in employer-provided coverage for children continued into 2005. In the previous four years, children were less likely to become uninsured as public-sector health coverage expanded. This year that trend reversed and the number of uninsured children rose 361,000 to 8.3 million in 2005. This is the first time in seven years that the rate of uninsured children has increased....

The WaPo article mentioned that the problem 0f crowded emergency departments in drawing attention in Congress.  They quote spokespersons from the American College of Emergency Physicians and the Emergency Nurses Association, and various other organizations.  Everyone agrees that it is a problem.  

They have some reasonable ideas.  For example, it was suggested that the VA health system could be tapped in the event of a civilian emergency.  That would make sense, but only for large-scale disasters.  

Others say that we need to find ways to reduce overcrowding.  Increasing the proportion of persons with insurance would help.  To some extent, allowing insurance programs to deteriorate in effectiveness is exacerbating the problem.

The basic problem, though, is the fact that surge capacity is extremely expensive.  In order to have surge capacity, you have to have some highly-compensated persons who are getting paid while not seeing patients, and some expensive physical structures that are being maintained while not being used.

We can't approach this problem simply be spending more money.  We would need to have some sort of policy analysis to show if that would be a good use of scarce resources.  We know there will be natural disasters; we think there will be more terrorist attacks.  But how much do we want to spend on that, while other problems compete for our attention and resources?