William T. Bradley, a physician in Texas, adds the following to our discussion of emergency room care…
To expand slightly on the response you already got, the answer is, of course, money: Hospitals are not traditional businesses. The problem with your analogy is that Starbucks expands to bring in more customers who'll pay 5-10 bucks for 39 cents worth of coffee in a paper cup. In the ER, it's often the reverse. The hospital will be paid little or nothing for most of the people who show up, and will spend lots of money treating them. If Starbucks were forced to provide lattes to anyone who showed up, regardless of their ability to pay, they'd obviously have much less impetus for expansion.
There are theoretically supposed to be mechanisms to pay for some of the care of the indigent, but these often require extensive administrative efforts on the part of the hospitals and patients to access, and the reimbursements are quite small. Exacerbating the problem is that much of what the ER sees are not emergencies, but people who don't have or can't afford a doctor, coming in for minor problems, or sometimes just to get medical refills or a doctor's excuse.
The result is that, from a business standpoint, the ER is a hugely money-losing proposition. Many hospitals maintain them only because they are required to. The waiting times are horrendous, but the hospital simply has no financial incentive to shorten them. Even the most altruistic facility would find it hard to keep the doors open if they expand more than is absolutely necessary.
Your best course of action, as a patient, is to have a physician you can call for help, and who can, if necessary, admit you to the hospital without going through the ER. Assuming your mother is on Medicare, that may be easier said than done. Here in Texas, primary care physicians who can afford to take new Medicare patients are extremely difficult to find, and I imagine it's worse in California. Political pressure on your congresspeople to stop cutting Medicare payments to physicians would of course be beneficial, but that leads us into another complex topic.
I'm sure everything you say is right. The Starbuck analogy was one of those comparisons that's good for about a sentence and a half before it collapses under its own weight.
However, let me add a few anecdotal nuggets into this. When I was hospitalized briefly last February, I was admitted (sort of) by my doctor. Though he works with Cedars-Sinai — his primary office is elsewhere — even he couldn't get me directly into a room. He had to send me to the Emergency Department where I spent four hours in the waiting area…and the time is only part of it. Those are awful places to be, surrounded by people in pain, people with coughs and little germ clouds you can almost see hovering about them, people agonizing over what the hospital costs will do to their lives, etc. During my wait, my doctor came over to the hospital to see patients and stopped off in the E.R. where he arranged for me to bypass much of the admissions process and then explained my medical situation to the appropriate people. He also located and briefed the specialist who was going to be supervising my treatment. He and the specialist then came out to find me in the waiting room and we discussed my case there…and it still took many hours after that for me to get to the moment where someone finally began treating my swollen, crimson calves.
I understand the money part of this. But I took up around six minutes of actual attention in that Emergency Room and they billed about eight thousand dollars to my health insurance for that part of my little stay. It would seem to me there's got to be a way the finance part of this can be made to work. That's worse than the markup on the Starbuck Decaf Komodo Dragon Blend®.
I should add to all this that I've had several trips to hospital emergency rooms with my mother when the problem was not agonizing pain in her foot but something that might have turned out to be a heart attack. Some of these times, I drove her there — I also drove my father in twice when he had what turned out to really be heart attacks — and a couple of times, my mother went in via ambulance. In the ambulance cases, she received immediate treatment at the hospital expanding on what the paramedics had already begun. In the non-ambulance visits, we got in relatively fast, though that may have been in part because I'm rather large and when my mother's health is on the line, quite loud. (Remind me some day to tell the story about how when my father had his first heart attack, he got in quickly because one of the physicians in the E.R. turned out to be a friend of mine from high school — someone I didn't even know had become a doctor.)
In those cases, the Emergency Rooms could not have performed much better. I just don't think they work well for people who aren't experiencing chest pains. There are a lot of things that can kill you and/or yield great agony that aren't chest pains. I saw too many of them last night at that hospital.