Certainly not you, at least according to the political left. Here is what Chris Jacobs has to say:

• Paul Krugman has taught me that “Patients are Not Consumers” and that “making [health care] decisions intelligently requires a vast amount of specialized knowledge”;
• The Center for American Progress, in making “The Case for Bureaucrats in Health Care,” has taught me that health care is different from buying shoes;
• Ezra Klein has taught me that “consumer-directed health care is a silly idea” because “patients are not qualified to evaluate good care”; and
• CMS Administrator Donald Berwick has taught me that “I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care.  That is for leaders to do.”

Full Chris Jacobs article here.

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Austin Frakt of the Incidental Economist recently reminded readers of a 2002 article in the journal Health Affairs that estimated the number of Canadians crossing the U.S. border for elective care. The study  examined data from the 18,000 Canadians who participated in the National Population Health Survey.  In the previous year, only 90 of those 18,000 Canadians had received care in the United States; only 20 of them had done so electively.

In Austin’s view, this is a trivial number. However, this survey was conducted in 1996-1997, when the population of Canada was about 28,846,761.  This implies that about 32,052 Canadians received elective care in the U.S. in 1996 if the sample results are representative.  More recently, the Vancouver-based Fraser Institute estimated 44,794 Canadians received nonemergency medical treatment outside Canada in 2010.  According to Fraser, 825,827 Canadians were waiting to see a specialist, for treatment or for surgical procedures in 2010. This implies the number of those coming to the US was equal to more than 5% of those waiting.

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Such tragic deaths happen every day in U.S. hospitals…. a crowded ED is more than a nuisance; it is a threat both to individual patients and to overall public health. Still, the financial imperatives of hospital operations trump patient safety. The GAO has noted that many hospital administrators tolerate ED crowding and even divert inbound ambulances rather than postpone or cancel elective admissions.

The passage of the Affordable Care Act may actually make stories like my mother’s more common, as 32 million more Americans seek access to an emergency care system that is already overwhelmed.

Those of us who have dedicated our careers to health care must confront the fact that our inability (or, more likely, unwillingness) to reduce the waits and delays that bedevil emergency care is harming and even killing our patients.

Entire New England Journal of Medicine article is worth reading.

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