At
The New York Times, Aaron E. Carroll—professor of pediatrics at Indiana University School of Medicine and
Incidental Economist contributor—
cautions supporters of Obamacare not to get too carried away with the idea that all this new access to health insurance is going to be the silver bullet for saving money in the healthcare system as a whole through the miracle of preventive care. Some of the most expensive health care—in emergency rooms—will probably increase, he warns, based on the evidence:
There were many people without insurance who would have benefited from care, but didn’t get it because they couldn’t afford it. It’s likely that, given Medicaid or very cheap private insurance, they would choose to obtain that care. There’s no reason they wouldn’t use the emergency room to get it, and that turns out to be what has happened in practice.
A study published in March examined how the health care overhaul in Massachusetts affected emergency department use there. Researchers found that increased insurance coverage resulted in more use of the emergency department, regardless of age and issue. Another study published on the Oregon Health Insurance Experiment found that giving people Medicaid also increased their use of the emergency department.
Even more recent studies show that increasing people’s access to care increases their use of more invasive care. Researchers in Michigan compared the prevalence of surgery in Massachusetts, New Jersey and New York both before and after Massachusetts went to universal insurance in 2007. They found that expanding coverage was associated with a more than 9 percent increase in discretionary operations and a 4.5 percent increase in nondiscretionary ones. They estimated, based on their results, that the A.C.A. could lead to more than 465,000 additional discretionary surgical procedures within a few years from now.
There are a lot of issues at work here. For example, for a lot of newly insured people, the emergency room will be the default choice because they can't get sick leave from their jobs to get themselves or their kids to the doctor during regular office hours. Or life is just really complicated sometimes and the emergency room is the best option. Or you decide, since you have health insurance and it will be covered, that maybe you really should get those chest pains you're having right now checked out. Having health insurance is a very good incentive to use it. There's another thing about health insurance reform: it doesn't take the profit incentive away for all that elective surgery, and the knowledge that a patient has health insurance might make a provider likelier to recommend it.
There are trade-offs in healthcare systems, as Carroll explains. Having access and quality and lower costs all at the same time, under our current model particularly, isn't really possible. But, as he also says, "sometimes good things cost money." The bottom line isn't the best measure of a healthcare system.