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—We agree with Dr Hass that emergency department overcrowding is a sign of the inadequate provision of ambulatory care. Increasing the availability of primary care by improving the incentives for providing those services should decrease the demand for emergency department services. However, the distribution of that care will remain inequitable as long as a significant proportion of the population does not have an adequate way to pay for these services. While charity care might bridge some gaps, recent history suggests that it is far from sufficient to guarantee universal access.Dr Kunst suggests that universal access to care and cost containment are mutually exclusive. To be sure, expanding coverage by simply building on the inefficient health system that currently exists in the United States invites aggravation of the cost predicament. However, the US General Accounting Office and others have demonstrated the potential for administrative savings from national health
Bindman AB, Grumbach K. Patients Leaving Emergency Departments Without Being Seen by a Physician-Reply. JAMA. 1992;267(2):233. doi:10.1001/jama.1992.03480020041019