Rationing and the role of the emergency department as society's safety net

Emergency medicine has an integral role in the establishment of universal a ccess to health care for all persons living in the United States. Currently , emergency departments provide the only unfunded mandate available to mill ions of American residents who otherwise have no access to health care cove rage. Any effort to establish universal care must accept health care ration ing as a basic principle, and establish a minimum standard of benefits to w hich all human beings are entitled in this country. People and employers sh ould be allowed to purchase additional care based on their willingness and ability to pay, but under no circumstances should anyone be denied a basic package of health care benefits. Emergency care must be part of those basic benefits. Emergency medicine charges should be structured so that they are not unduly onerous to society, and should reflect true expenses, including marginal costs for nonurgent care. Emergency physicians (EPs) and hospital administrations should recognize their critical role in serving society in roles that are not strictly medical, and allocate resources to benefit the general population in the greatest way. This role will be expanded to incl ude preventive care, to provide for basic pharmacologic coverage as needed, and to provide necessary immunizations when traditional primary care has f ailed. We have a moral obligation to recognize that resources are limited a nd to allocate them so as to benefit the greatest number of patients in the greatest way. As members of the medical profession best equipped to assume such a task, it is incumbent upon EPs to act as advocates to the public to enable us to fulfill this mission.