Slate's Medical Examiner struck a chord examining the why people go to the E.R. when they shouldn't. It's the site's most emailed story this week, and begins the discussion by dispelling some conventional wisdom that it's only the supposed E.R. abuser clogging out system and raising our costs:

The oft-repeated claim is that if we can just find a way to get the abusers out of the E.R. waiting rooms, we'd eliminate many of the high costs associated with health care in the United States.

The problem is that this story of the healthy, cavalier, uninsured E.R. abuser is largely a myth. E.R. use by the uninsured is not wrecking health care. In fact, the uninsured don't even use the E.R. any more often than those with insurance do. And now, a new study shows that the increased use of the E.R. over the past decade (119 million U.S. visits in 2006, to be precise, compared with 67 million in 1996) is actually driven by more visits from insured, middle-class patients who usually get their care from a doctor's office. So, the real question is: Why is everybody, insured and uninsured, coming to the E.R. in droves? The answer is about economics. The ways in which health information is shared and incentives aligned, for both patients and doctors, are driving the uninsured and insured alike to line up in the E.R. for medical care.

The piece goes on to look at how financial incentives for both patients and doctors contribute to the current crisis, and makes some suggestions like better access to primary care and improved management of patient flow. It's a nice overview of an issue we've written frequently about before (We don't think the uninsured are irrelevant—they are a factor in ER overuse. But it's not the whole story). You can hear more about it this Friday at New America's event: Health Care Quality: A Reform Issue for Every American—which will feature a variety of experts including, our own physician advisor, Guy Clifton, M.D., as well as Brent Asplin, M.D., MPH, the head of the Emergency Department of Regions Hospital, St. Paul, MN, and an expert on patient flow.