As I wrote last week on Critical Condition, emergency room visits in Massachusetts have increased, despite the fact that universal health care was supposed to solve that problem. PPACA is likely to nationalize the phenomenon. John Goodman has an excellent piece up on the Health Affairs blog in which he explains why this happens. It turns out that it is Medicaid patients, rather than the uninsured, who clog emergency rooms:

As we pointed out in a recent National Center for Policy Analysis (NCPA) Brief Analysis, the use of the emergency room by uninsured patients is not that much different than usage by the insured. The heaviest users of the ER (in proportion to their numbers) are Medicaid patients, probably because Medicaid rates are so low that physicians are not anxious to see them. And the reason why that is important is that more than half of the people who gain insurance under the new health reform bill will enroll in Medicaid.

Health insurance leads to more, not less, utilization of health care.

In general, people with insurance consume twice as much health care as the uninsured, all other things equal. The trouble is that the new health insurance law has no provision for increasing the number of health care providers. As a result, when people try to increase their use of physician services, many will be disappointed and a large number are likely to turn to the emergency room when they cannot get their needs met at doctors’ offices.

The conflation of health insurance with access to health care is one of the biggest epistemological problems with the progressive approach, one that the ensuing decade will lay bare.