For them and for others, the cost and availability of insurance is simply too high. As a consequence, when they need care, emergent or otherwise, they turn to their nearest emergency department. More and more of the nation's uninsured are passing through emergency departments. It is the only institution where health care is mandated by federal law. Anyone coming to an emergency department with a health concern, regardless of his or her insurance coverage, or the lack of it, must be given a medical screening exam.
Emergency medicine is the only specialty in the United States with such a mandate.
As such, it is the foundation stone on which America's health care safety net rests. The increased use of the emergency department reflects the underlying symptoms of a health care system in crisis. With projections that health care costs will double by the year 2007 and that the number of uninsured will increase to 53 million by the year 2007, it is time to begin a serious and comprehensive national debate that addresses these and other problems. In calling for a national debate, we are mindful that changes to the health care system must be built on the strengths our system has today. Those strengths high-quality medical care, health coverage for Medicaid and Medicare eligible individuals, and insurance coverage offered to millions of workers constitute a basis from which solutions can be formulated.