ER crowding could get worse

Obamacare -- the Patient Protection and Affordable Care Act -- was enacted in March, though many of its provisions won't take effect till 2014.

(The exception are the taxes to fund the huge new bureaucracy, which kick in this September starting with a tanning salon tax and a beefed-up "1099" tax -- the latter expected to raise $17 billion over 10 years, all by itself.)

But it didn't take four years for indications to surface that Obamacare could actually make things worse.

"Emergency rooms, the only choice for patients who can't find care elsewhere, may grow even more crowded with longer wait times under the nation's new health law," The Associated Press reported this week.

"That might come as a surprise to those who thought getting 32 million more people covered by health insurance would ease ER crowding," writes The AP's Carla K. Johnson. "It would seem these patients would be able to get routine health care by visiting a doctor's office, as most of the insured do. But it's not that simple."

Contrary to popular perceptions, The AP found "People without insurance aren't the ones filling up the nation's emergency rooms," for one thing. Instead, the biggest users of emergency rooms, by far, are the beneficiaries of Medicaid, the tax-funded medical welfare program for the low-income and the disabled. The new health insurance law will increase their ranks by about 16 million, while "Many family doctors limit the number of Medicaid patients they take because of low government reimbursements," The AP reports.

Massachusetts passed an insurance mandate back in 2006, on which the pending federal scheme is largely modeled. Yet Massachusetts reports ER visits have continued to rise since the law passed.

"Just because we've insured people doesn't mean they now have access," said Dr. Elijah Berg, a Boston area ER doctor. "They're coming to the emergency department because they don't have access to alternatives."

No access? But weren't Obamacare and Romneycare both supposed to guarantee everyone "access"?

There are plenty of areas in American health care with no crowding or waiting -- plastic surgery comes to mind.

Plastic surgeons perform elective procedures, and are free to set profitable rates. ERs, in contrast, are seen as losers. The American Hospital Association reports a 10 percent decline in the number of U.S. emergency departments serving the public from 1991 to 2008, even as ER visits rose dramatically.

The obvious economic solution would be to raise rates, serving only those who can be trusted to pay in full.

Unfortunately, no matter how "progressive" and "altruistic" it may sound, the doctrine that health care is a "right" for which no one should have to pay -- a sacred precinct into which such Philistine undertakings as price-setting should never be allowed to intrude -- leads to less pleasant outcomes, as the Soviet Union spent 75 years demonstrating.