Emergency Room care is a national policy, but the price tag is very local.

Young: Rethink the emergency-room logic when it comes to health care

"People have access to health care in America. After all, you just go
to an emergency room."

— President Bush

That's right, Mr. President. And thanks for pointing out what's wrong
with a status quo you've done almost nothing to alter. Welcome to the
ER. It is America's answer to a phony debate. Health care: Is it a
right? Of course it is.

Bush, in that quote, is referring to
EMTALA, a policy that seems absolutely reasonable on its face (It specifies that a person cannot be refused emergency medical care at an ER, regardless of their citizenship, ability to pay, etc). But despite being mandated at the federal level, there is no federal funding specifically to cover the uninsured who arrive at the E.R.

The association's "Texas Medicare Manifesto" demands reimbursement rates that keep up with the cost of providing services. The National Governors Association sounds just as furious. It has denounced Medicaid regulations proposed by the Bush administration to shift billions of dollars in costs to the states. Where states don't pick up the slack, hospitals and ERs will.

That's how everyone ends up paying for the uninsured. Stop assuming the free market will resolve this.

This is not just a problem of uninsured citizens.
For example, if an illegal immigrant goes into labor, they can go to the local E.R. for their delivery. Since they're likely working illegally, they're almost certainly going to be uninsured. The costly price of that delivery is never paid for, and the hospital eats those costs, which they have to make up elsewhere.
I understand that illegal immigrants are paying huge amounts of taxes for government services that they never use (like 7 Billion dollars in Social Security a year) but these funds are not directly connected to the services they DO use.
The uninsured man unable to go in for check ups who then suffers a massive heart attack is a tragedy that could have been avoided, and a huge expense that will need to be paid. That he will even live long enough to collect social security is in question.

But when it comes to the cost of national coverage, statists' concerns about the price tag are disingenuous. We already pay for the uninsured through hospital costs and insurance rates. If more had health insurance, with real preventive care and health maintenance, we would have a healthier country with fewer pressures on hospitals and health-care costs.

The illegal immigrant angle is the only aspect missing from John Young's article that I can see, but since the list of "Gotcha's" on healthcare reform is so long, I can understand missing it, or deliberately omitting such a complication from this solid commentary. It'd confuse the message he's presenting, the the ER is not a local doctor's office, nor a health insurance fix.

The ER is expensive, it's "cataclysmic" care, for the unexpected tragedies. We don't rely on just the fire department to control fires in the home. We have smoke detectors, fire extinguishers, buckets of sand. It's far cheaper to keep a clean stove than it is to have the fire trucks hose down your burning home.

My personal point is, there will need to be ways to pay for everyone for health care reform to work. Taxing even low income workers (illegal or legal) directly will at least make sure there is some system in place for them, so that their first visit to a doctor is at an earlier, safer, cheaper time than when they have to be driven there in all-too-expensive ambulance.