The New York Times-20080127-Put the -Emergency-- Back in the E-R-- -Letter-

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Put the 'Emergency!' Back in the E.R.; [Letter]

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To the Editor:

As Emergency Room Delays (editorial, Jan. 19) notes, the nation's failure to provide universal health care puts all citizens at risk. But the system is not being clogged by uninsured patients seeking routine care.

The reality is that the majority of the uninsured delay seeking any care until they are very ill. The overriding reason for lengthening wait times is the boarding of acute patients, sometimes for days in emergency departments, while waiting for inpatient beds on other floors.

The American College of Emergency Physicians supports the drive for national health care reform. But as part of that reform, let's not forget about solving basic staffing and bed shortages, and the reimbursement issues that contribute.

America's emergency departments are filling in the gap to save lives, despite a broken health care system. But they cannot continue providing this vital safety net without proper financing and resources, and without adequate, comprehensive health care reform.

Linda L. LawrenceWashington, Jan. 23, 2008

The writer is president of the American College of Emergency Physicians.

To the Editor:

If every American had a local primary care center that was open until 8 p.m. and opened on weekends, and staffed with a team of professionals that included doctors, nurse practitioners, physician assistants, visiting nurses, psychologists, social workers, physical therapists and pharmacists, we would have no emergency room delays and health care that costs 40 percent less than we are paying now, and we would have a health care system instead of a mess that is also a dangerous maze.

Why don't we just build it? Talk about economic stimulus. We would employ all those out-of-work construction crews, and make American products affordable again by allowing our businesses to function unencumbered by a health insurance system that doesn't work and costs way too much.

And we might actually get a health care system that delivers health to the many, instead of profit to the few.

Michael FineScituate, R.I., Jan. 19, 2008

The writer is a doctor and co-author of a book about how to build our health care system.

To the Editor:

It is convenient to believe that the nation's failure to provide health insurance for all Americans is one very plausible interpretation of a disturbing increase in waiting times at emergency rooms. This connection is, at best, a nice thought.

There is plenty of merit to the idea of universal health coverage as an economic and social phenomenon.

But it cannot so automatically solve the problems -- such as increasing access to primary care to help alleviate emergency room overcrowding or routing patients to less crowded emergency rooms -- that contribute to the long lines.

Long wait times are a management dysfunction, whether in an emergency room, the Department of Motor Vehicles or a Starbucks. They are a failure of management's task and responsibility to efficiently and effectively place people where they need to be at a particular time.

Before we accept universal health coverage, we ought to demand better management.

Lee H. IgelNew York, Jan. 19, 2008

To the Editor:

My mother, who is 89, recently had two extremely traumatic experiences in the emergency room. One time she waited over 36 hours, the other time over 20 hours, before they found a room for her. Both times she emotionally came apart, and her condition dramatically deteriorated.

Since reactions such as my mother's are extremely common, I think there should be a special emergency room for older people that at least tries to mitigate, as much as possible, the nightmare of dislocation, as well as some of the horrible spinoff damaging effects of being there. Separate emergency rooms are already in place for children and people with asthma.

Sadly, there's no way of escaping the fact that what happens on the bottom floor of a hospital has an impact on what later happens on the upper floors.

Robert RothNew York, Jan. 20, 2008

[Illustration]DRAWING (DRAWING BY TIM GOUGH)