This is an interesting riff off my blog post. What struck me about the particular hospital I visited in Munich was not that they were better at efficient triag

This is an interesting riff off my blog post. What struck me about the particular hospital I visited in Munich was not that they were better at efficient triage or pipelining incoming cases, but that it had no queueing facility. There was no waiting room at all (unless you count a few empty chairs in the hallway). I suspect the real reason we have such bad ER wait times in the US (3 hours and 42 minutes mean waiting time according to a Press Ganey study from 2006) is that for many Americans the ER is the go-to care provider. It's the provider of last resort for people who don't have insurance, or who simply don't have a primary care doctor. And even for people who do have insurance, there's a whole culture around going to the ER that's ingrained in many people. As a Canadian looking from the outside in, the author of this post seems to think that the US health care system is a brutally capitalistic free market, and that it may leave some poor people without care but that supply will meet demand in some predictable way. However, many of the people who show up at the ER are deeply unprofitable for the hospital to care for, and yet the hospital is legally required to treat them. (Though the hospital probably makes up for these losses with insured people in serious distress, making the ER profitable overall.) The US health care system is not a free market, it's a tangled mess where patients, doctors and hospitals have no ability to control costs and are often motivated in the wrong directions. So it probably won't work to try to explain its behaviors from first principles.