Wednesday, March 22, 2006



Academic economists, by focusing nearly all their attention on the price system, ignore many critical mechanisms people use to allocate scare resources. Queues, for example, serve as a means to equally and fairly divide scarce resources. My recent visit to Florida gave me ample opportunity to observe queues on the highways, in a hospital emergency room, and at amusement parks. Each place displayed a rich message of social cooperation and conflict.

The ER in the Florida hospital located in Celebration, Florida, partakes of the general craziness common to so much of central Florida. After checking in and getting screened, I approached the nearest empty chairs.

"Those chairs are occupied," said a woman seated nearby. She sounded angry. I waved my arms over the empty seats, trying to find the invisible occupants. A couple of people laughed at my antics, but the hostile woman was in no mood for humor. "It's a woman with a baby, she went to change a diaper" she said. I wandered over to the other side of the waiting room.

Aren't cell phones wonderful? What a blessing! For nearly four hours, I was able to hear a woman seated nearby explain, through her cell phone, to her family and friends that she last took her meds three weeks before, last slept two days before, and had decided to try to get more meds. She thought maybe she was going crazy and needed the meds worse than the rent, car payments, and so forth.

I watched people carry in bags from MacDonald's, Chick-Filet, and Kentucky Fried Chicken. I supposed their loved ones got hungry during the six or seven hour wait.

A tall, heavy set man with slicked back, oily black hair came in with a small, wiry woman. He looked acutely ill. After a few moments, he was seated in a wheelchair and whisked away. A short time later, the woman who had accompanied him sat near me.

"How long have you been waiting?" she asked.

"About four and a half hours."

She shook her head. "In Brazil, we would never allow such a thing. It's outrageous, it's intolerable. Why do you Americans put up with it?"

"Many of us are annoyed with the state of healthcare in our country," I said. We chatted a while more, then my turn for service came.

It turned out the woman from Brazil told me only part of her story. The next day, at the pharmacy, I ran into her again. The tall man approached me, "Weren't you there, in the emergency room last night?"


"How long did you end up waiting?"

"About six and one-half hours.

"I told them I had chest pains. I really just had a bad cold. But if you say you’ve got chest pains, they look at you right away."

I said nothing.

"Back in Brazil, I’m a doctor. In Brazil, you have to have a good plan. If you have a good plan, you get seen quickly. I never have to wait more than a few minutes. Not like here. But if you don’t have a good plan, it's worse."

So the doctor from Brazil lied about his symptoms to jump the queue. Talking with a friend who is an ER nurse, I heard that this is all too common. She explained that when the EKG results came back, she knew when the patient lied. It occurred to me to wonder how many EKGs ordered up in the ER result from lies. I wonder how much the excessive waits in ERs add to our medical costs. She told me the average wait in her ER is four hours.

And it turns out that eating often worsens the problems for the patients who need surgery. Since they cannot have surgery on a full stomach, they must wait even longer for treatment.

Obviously, one cannot generalize from the poor behavior of one Brazilian doctor; but my friend the ER nurse confirms that people often lie about symptoms to avoid the long wait for service. To put the situation in terms an academic economist might understand, the situation in ERs across the country represents a market failure. For a simple person like myself, I worry about how we allocate scarce resources. I worry about undermining the social contract that enables queues to operate effectively in the first place. I worry about the care my children and grandchildren will get in a world where it’s every man for himself.

Opponents of National Health Insurance often argue that any workable plan will result in rationing healthcare. Such an argument assumes two things: first, that rationing is a bad thing; and second, that we don’t already have rationing. The second assumption is patently false; the "facts on the ground" show that health care is already rationed in this country. The real question is, do we want to ration health care intelligently and with foresight; or shall we have an ad hoc hodgepodge of de facto rationing lurching forward into the future?

Next: the highway as a queue.

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