According to new data from the California Office of Statewide Health Planning and Development reported by Kaiser Health News, the number of trips to the ER in the state grew 20 percent from 2012 to 2017. The wait time for patients who are admitted as inpatients is up to five and a half hours, a 15 minute increase over 2012. More startling, however, is that the number of people leaving the ER before the doctor was done treating them has risen 57 percent since 2012.
Kaiser reported that California patients who leave before their care is complete are more likely to be uninsured or on Medi-Cal, the California Medicaid program. Fresno County, which has the highest poverty rate in California, had the highest rate of patients leaving the ER, at more than 5 percent.
Sometimes, even patients who leave the ER because they can’t afford the care end up with a big bill. Last year, Vox reported on the case of a woman who received an ice pack from an ER after falling and hitting her head, then left because the plastic surgeon who would have treated her was out-of-network—the usual cause of surprise medical bills. Yet she still received a bill for $5,751.
In the recent House Rules Committee hearing on Medicare for All, emergency room doctor Dr. Farzon Nahvi testified that he has patients who “walk out Against Medical Advice out of concern for the cost of their treatment.” He told the story of one appendicitis patient who asked to be given antibiotics and discharged because of the cost:
I told her about the possibility of a perforation of her bowels, an abscess formation, sepsis from her infection, and even death. This wasn’t an exaggeration, this was the truth. She sat back, asked for some time, thought about it for a long while but she eventually did decide to leave. In her own words she said, “Thanks doc, I appreciate all you’ve done, but I just don’t know if I’ll be able to afford this — I’m going to take my chances.”
The specter of lines around the block and people waiting forever to see the doctor is frequently used to criticize single-payer plans. The Partnership for America’s Health Care Future, a healthcare industry-backed lobbying group, frequently talks about the wait times under single-payer.
This has always been bunk—as Vox’s Sarah Kliff wrote in 2014, “most research doesn’t suggest any particular relationship between the financing model [of healthcare] and how tough it is to see a doctor.” In the UK, she pointed out, it’s easier to get a same-day appointment to see a doctor than in the U.S.
But it’s especially galling to see the healthcare industry make this argument when wait times are already so bad in America, especially for the poor. And, of course, measuring wait times at the ER or the doctor’s office doesn’t tell you how many people delay or never seek care because of cost, which is a problem that essentially doesn’t exist under healthcare systems that have no patient cost-sharing.
The anti-Medicare for All crowd might think fearmongering about wait times is a promising strategy, but they might find it falls on deaf ears when so many people already experience inexcusable waits for care—whether that’s at the ER, their doctor’s office, or because they just can’t afford it.