Yeah, you're totally right. Running an ER has huge fixed costs. Running an ER will inevitably have huge fixed costs because emergencies are, by definition, unex

Yeah, you're totally right. Running an ER has huge fixed costs. Running an ER will inevitably have huge fixed costs because emergencies are, by definition, unexpected so they have to be ready for anything. In most of the developed world those fixed costs are amortized over everyone, in the form of government subsidies of one sort or another. It's like the police or the fire department; everyone chips in some, via taxes, to keep the service running whether they currently need it or not. In America, however, we amortize them over everyone who comes into the ER. That's good for the guy who never needs medical attention: he gets all the peace of mind of having state of the art care a phone call away for free. It's good for the lady who rolls in at 3am with a gunshot wound: she gets her very elaborate lifesaving care for only a few percent over the marginal costs. It really sucks, though, for the guy with a dislocated thumb: he's forced to either massively cross-subsidize both the other patients or to forgo necessary but relatively simple care because of the huge expense. That guy doesn't need to believe the system should be free to have a valid complaint that he, personally, is getting screwed over by it.