However troubling it is that UK A&E departments are not meeting government imposed treatment targets, for whatever reason, and however inevitable it is that the media are feasting off this “crisis”, as they call it, the fact is that the long-term future of this service is threatened by forces far more insidious than ones being currently discussed.

Those in the UK who have been led down the ideological garden path of individual responsibility are doomed to pay for their A&E  care, and, I suspect, at a later date, for all their health care. They only need to turn their gaze from the government’s rose-tinted vision of private insurance to the American model, in which the insured co-pay for their treatment. Yes, insurance premiums, unless extremely high, do not cover the full costs of treatment. This is an important point, in that most private health insurance plans taken out by UK citizens in the future will be issued by American insurance companies. In America, both the insured and the uninsured, who are forced to enter into self-pay agreements, are ‘fed’ to debt collection agencies in the event of non-payment of medical bills. In the future, weasel words will be used in the UK to disguise the fact that hospital treatment will gradually become not free. Our Eton lords will introduce a universal insurance scheme, with differrent bands of ‘contribution’, with the lowest ‘contributions’ being deducted from individual social security payments.  They will preach that such pre-payment will mean that you are not charged for care once in hospital – it is free, at the point of delivery. The concept of co-payment (out-of-pocket costs),  will be gradually rolled out, under the guise of individual responsibility – “It is only fair we all chip in, old chap”.

Let me explain quite clearly what our Americanised future holds:

An American emergency emergency room (ER), is usually part of a hospital, and specializes in the acute care of patients who arrive without an appointment. They run alongside ‘urgent care centers’, which offer a cheaper alternative to the ER.  The National Hospital Ambulatory Medical Care Survey estimates that 30%  to 50% of all ER visits are for non-urgent care, such as superficial injuries and upper respiratory infections. The reason that ER’s face a deluge of non-urgent cases is that federal law states emergency departments must treat people regardless of their ability to pay, so ER’s are used as healthcare providers for the uninsured. The uninsured are still liable to pay for treatment, however. They are required to self-pay. Most hospitals offer  plans that allow payments over time. If the bills are not paid, however, they may be handed over to a debt collection agency.

According to Kiplinger’s Personal Finance magazine (2011), the average cost of an ER visit for someone with private health insurance was $933.

The following table compares average costs (2011) of ER treatment to that of urgent care centers.

Allergies: $345 … $97

Acute bronchitis: $595 … $127

Earache: $400 …  $110

Sore throat: $525 … $94

Sinusitis: $617 … $112

Strep throat: $531 …  $111

Upper respiratory infection: $486 … $111

Urinary tract infection: $665 … $110

Treatment at urgent care centers is paid for on a pay-for-what-you-get basis. They have less doctors, and more nurses and ‘physician assistants’. They accept most private health insurance plans, with co-pays averaging between $25-$50. A self-paying individual will usually be asked to make a down payment for the visit, with other charges billed at a later date. If medical debt is not paid, it can be discharged to a debt collection agency. An individual may enter into a plan to consolidate several medical debts (many individuals have multiple debts), into one manageable payment at a lower rate of interest. These urgent care centers can be owned by corporations, and they can be expected to become as prevalent in the UK as they are in America. Their revenue exceeded $13 billion in 2011.

Nearly 8 million Americans have unpaid medical debts. A recent report (, January 15, 2014), stated ‘Medical debt collection is a serious problem affecting millions of Americans. The typical American family of four had total healthcare costs exceeding $22,000 last year, which included out-of-pocket costs of $3,600. This level of out-of-pocket spending outstripped the amount laid out by the average American household on gas for their automobiles … The nation’s out-of-pocket healthcare costs for 2013 are estimated to have totaled $322 billion. This represents a significant amount of debt — debt, which if not paid off in a timely manner, could be sent out to a collection agencyIn fact, millions of medical accounts are sent to collection annually. Medical bills comprise more than half of the accounts in collection, according to research by the Federal Reserve’. Once a debt collection agency becomes involved, the credit rating of the debtor is adversly effected, and those with other unpaid debt, such as students, will find it almost impossible to take out a mortgage. This is the stick waved at people.

Have we all become so blind that we can not see? Or so stupid to believe we will never be ill?

This is the ‘free  market’ which you shuffle to as cattle, and which is as worshipped by New Labour as it is by the Conservatives. You are the solution, not them.

There will be no future crises in A&E, for the cost involved will limit demand.


lenin nightingale 2015











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