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Dr Gillian Schmitz former ACEP president and current vice chair of education at Naval Medical Center San Diego, examines emergency medicine's financial crisis and its consequences. She identifies the fundamental contradiction in how America treats emergency care as a universal right while funding it as a privilege, creating an unsustainable system where nearly 70% of ED patients don't cover their care costs.

• Former ACEP president with extensive experience in civilian and military emergency medicine
• Healthcare in America faces a fundamental conflict between right vs privilege approaches
• Nearly 70% of emergency department patients don't pay the full cost of care
• Insurance companies making billions while avoiding fair payment for emergency services
• Boarding and overcrowding have reached dangerous levels affecting patient safety
• Physician groups facing consolidation as independent practice becomes financially nonviable
• Potential solutions include better insurance accountability and reconsidering funding models
• Some physicians consider unionization and collective action as necessary steps
• Media portrayal through shows like ”The Pit” helps public understand emergency medicine challenges

We need the public to understand how emergency care is funded – or not funded – and the impact of this unfunded mandate on the entire healthcare system. Without addressing the root cause, boarding, violence, and consolidation will continue to worsen.

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