What do cops, teachers, and emergency room doctors & nurses all have in common?

In this country, we tend to make them all responsible for dealing with profound social problems that are way beyond their capacities to deal with effectively.

Let’s look at that last case:

It’s often said the USA doesn’t have universal healthcare. There is one place, though, that’s accessible to anyone regardless of ability to pay: the ER.

Mind you, it can still end costing you an astronomical amount! But if you go, they have to assess and treat you under the EMTALA law.

That’s good as far as it goes. But because that duty *doesn’t* apply to many other kinds of healthcare, it causes ERs some major problems.

Problem 1: tons of people in emergency rooms are there for problems they should have seen a primary care doctor about. Only they don’t have one.

So the same people dealing with shootings and heart attacks have to treat (mostly poor) people with everyday or chronic problems.

Problem 2: many of the *heaviest* users of ER care are not there for emergencies.

Some of them need primary care. Some of them need psychiatric care. Some of them are homeless and just looking for someplace warm.
Some of them are just elderly and alone.

Many hospitals have social workers on staff to try to deal with problems that aren’t fundamentally medical (but which often overlap with medical problems, of course).

But it’s not always enough.

In one case, a homeless man checked into an emergency room with hypothermia after sleeping out in freezing weather. He was treated for it, and the hospital tried to connect him with a shelter before he was discharged.

About a week later he froze to death at a bus stop.

The bus stop happened to be on hospital property, so the hospital got rid of it so they couldn’t be liable for lawsuits if something similar happened in the future.

That’s a sad story but not an especially unusual one. Because (as in law enforcement and education, among other institutions), emergency medical care acts as an after-the-fact backstop for people with no nobody else looking out for them.

And it’s simply inadequate to that task.

Certain professions like those will probably always deal with the full range of human complexity and messiness. But a healthier society would avoid overburdening them.

Health policy is part of that story. We’re wise and compassionate enough to ensure everyone gets emergency care but not enough to prevent huge gaps in preventative care.

Ounce of prevention, pound of cure, etc.

Obamacare was a (messy, flawed, partial) attempt at addressing some of those shortfalls.

Republicans spent years trying to kill the system it set up, and partially succeeded. They also left no remotely adequate replacement for it.

But there’s also more going on here than just whether people have insurance coverage.

Like cops, like teachers, ER staff are often put on the front lines of a society that is fraying, atomized, and just forgets about far too many people.