Even if you give some people health insurance they may not take advantage of it by establishing a relationship with a primary care provider, which theoretically could help avoid inappropriate emergency room use and even prevent some hospitalizations, although the research does not yet support that theory. The researchers used a primary care program given to low-income people by a Virginia University medical center as a test bed for whether providing them with incentives (i.e., cash) would increase use of primary care. (HA Article) Note that this program is paid for by the taxpayers. The researchers randomized people to a $50, a $25 or no incentive to go to a primary care clinician. They also made a comparison to a group that did not participate in the experiment at all. 77% of those in the $50 incentive group and 74% in the $25 incentive group saw a primary care provider in the first six months after enrollment, compared to 61% not in the experiment and 68% who were in the study but given a zero incentive. Seems like a pretty small gain and the authors did no work to see if in fact this made a difference in ER use or avoidable hospitalizations. And if this became a regular feature of this and other programs of free health care, it means more government outlays and more taxes for someone to pay.
It is obviously likely beneficial for people to see a primary care doctor regularly to identify potential health issues and to maintain treatment of ongoing health concerns. But this is part of a very disturbing pattern where people who actually work hard have increasingly expensive, high-cost sharing health insurance and are paying a lot of taxes to give free, no cost-sharing coverage to many others who simply don’t want to work or make an effort to be responsible for themselves. So now, not only are we giving them free coverage, but we are going to pay them to use it. That is great public policy. Here is a better idea; show some individual responsibility in your health behaviors or lose that gold-plated coverage.