Why American Healthcare Costs So Much

A simple example of how uninsured people in emergency rooms is not a rational way to run anything:

I am a physician in a pediatric emergency department.  Every day, I can easily count about $10,000 that are wasted in our department because of overtesting, overtreatment, and bureaucratic regulations.  The ER pregnancy test is a wonderful example. 

Pretty much every day, a teenage girl comes to the emergency department because of abdominal pain (or because they just want to see if they are pregnant).  Because the pain might mean something serious if the patient is pregnant, a pregnancy test is necessary. In my town, a pregnancy test can be bought at the dollar store (yes, for a dollar), but in the emergency department, we have to collect a urine sample and send it to our lab for the test to be done. The test in our lab is essentially the same as the $1 pregnancy test, but government regulations (the CLIA laws) prevent us from performing the test in the department unless we go through a lot of paperwork, training, and government review to make sure we are performing the test reliably and then undergo random quality assurance checks and yearly reviews.

The test takes about 5 minutes, but because it has to wait behind all the other tests the lab is performing, the average turnaround time for the emergency department is about 1 1/2 hours.  This of course clogs the department, contributes to longer waiting times for others waiting to be seen, and increases costs enormously.  Of course for many of our patients, the ER visit is "free," so it saves them a dollar.  It is tempting to ask patients to go out and buy a pregnancy test and report the results to us, but of course the risk involved is too great, not to mention the downside of dissatisfied patients.

This is but one small example of the type of thing that occurs thousands of times every day in emergency departments across the country, costing unfathomable amounts of money and huge amounts of time and frustration to both physicians and patients.