Something else to consider: hospitals(ERs) are forced to treat whatever walks through the door, regardless of if they have insurance or means to pay the bill. When a significant portion of your clients can not pay the bill, like every other sector in business, guess who it gets passed on to? That's correct, those who can pay. Just like taxpayers that pay the cost for many that can't, won't or don't pay taxes, but still draw the benefits.
I will give you an example. A middle aged man walks into the ER complaining of abdominal pain. He has no insurance and is a self pay customer. His ER work up includes lab draws, abdominal imaging, some IV fluids, perhaps some Zofran for nausea. Imaging reveals he has a perforated bowel and needs emergent surgery. The surgery crew is called in, his surgery is completed and he is admitted inpatient to Med/Surg unit for 3 days post op recovery antibiotics, IV fluids, etc. The ER bills, coupled with his surgery and inpatient bills is substantial as anyone who has been hospitalized well knows. But this gentleman isnt going to pay because he cant. Even if he had Medicare or Medicaid, the reimbursement would barely be a break even for the hospital. If our pt in the scenario complains about any aspect of his visit, reimbursement becomes even less. So who eats this substantial bill? The hospital, ER physicians group and Surgeons group. The same folks that have to pay staff, maintain equipment, building and all the expenses it takes to maintain a facility, not the least of which is insurance of several varieties (fire, malpractice, etc.)
In the above scenario, if the surgery was determined to be non emergent, then the hospital only has to eat the ER work up(still a good chunk of cash) because as an ambulatory or scheduled inpatient procedure, the hospital can collect some payment before the procedure or decline to provide service if payment arrangements can not be made.
I am here to testify, as someone who manages a mid level hospital after normal business hours, this type of scenario occurs very regularly. Small hospitals are closing or consolidating across the nation, mid levels are consolidating or fighting for their existence, even the large operations aren't churning out a tremendous profit in many cases.
These types of occurrences eventually are written off as losses because of inability to collect. No successful business can function for long taking losses.
Just something to consider.