Emergency rooms are the only type of medical facility in the U.S. where patients have a right to receive care, regardless of whether they carry insurance or not. Intended for the rapid treatment of people in crisis, emergency departments have become a safety net for all kinds of conditions—at a cost of $48 billion a year and rising. Crowded ERs are symptoms of a deeper and more complicated problem. It is not just people without insurance who rely on the ER and can’t pay their bills. More commonly, people with health insurance seek emergency care often because their physicians are too busy, they can’t get to see a specialist, or the out-of-pocket costs for office visits prevented them until too late.
There was a time when the public avoided hospitals. Before the ER emerged, sick people preferred to receive medical care at home, tended by family members or paid nurses, and doctors made house calls. (That was still true, albeit less frequently, when I was a boy in the 1940s and early ’50s.) Nineteenth-century hospitals were places of last resort for the poor, migrant laborers, and travelers who had nowhere to rest or no family to care for them. In addition, wards were plagued by hospital-borne bacterial infections with doctors offering few cures, except anodyne ones like rest and nourishing food. Revolutionary changes followed the embrace of germ theory in the 1870s and 1880s, which brought about an era of militant sterilization. Procedures that used to occur on kitchen tables now required a disinfected operating theater—and this made hospitals indispensable for modern surgery. A surge of innovations from the 1930s onward, including effective antibiotics, diagnostic imaging, dialysis, and corticosteroids, allowed the medical profession to achieve an unprecedented degree of effectiveness.
In 1900, an accident victim would have been carried home to recover or die, and few hospitals had an “emergency ward.” By 1945, all that had changed and hospitals began to organize their critical care resources into emergency departments, staffed by specialists whose techniques developed from the battlefield medicine of World War II. With new blood banks and defibrillators, they achieved miraculous effects, and the emergency entrance was open “night and day… round the clock.”
In my 80s, I have often found myself a patient in emergency rooms. Recently, I had to go for some insufferable leg pain to what was regarded as one of the best emergency rooms in the country: NYU Langone. It was Friday night, and it was crowded, and the hospital bed was laid outside a room with curtains. There were a wide range of people sharing the ward: a homeless, bearded man with a foot infection (a regular in the emergency room); a drunk muttering in Spanish; a Hassidic grandmother who had trouble breathing and was reading a prayer book; a college student who overdosed on drugs; and a handsome middle-aged woman who seemed to have had a stroke, and whose daughter was in tears and attentive to her every need. The ER seemed fully staffed. But it wasn’t always easy to make contact either with the nurses or doctors, and that made the wait time excruciating. Of course, the usual norm in the ER has always been a great many—I assume necessary—tests and long delays. And in my own experience, despite feeling bored and oppressed being there, the ER almost always succeeded in meeting my needs. Still, I complained about how hard it was to get the attention of some of the staff, many of them hidden behind computers and seemingly spending their time joking around with each other. It was a seven-hour stay, and I didn’t get out until five in the morning. Though at the end, they were there to help.
Whenever I end up in the ER, I think there must be a more comfortable and effective way of dealing with patients. The rooms should be larger, with each patient having their own dedicated space, and the tests must be administered more rapidly. But it is hard to believe that anything dealing with public health from medical research to the state of our hospital will see marked improvement as the cutting of public services accelerates under the destructive Trump/Musk regime.
