One of the most pernicious dysfunctions of the current health care system is that it often puts uninsured people, particularly workers with low and mid-level incomes, in the position of going to emergency rooms for treatment for non-emergency medical problems. This not only puts additional stress on emergency services, it is the least effective way to deliver non-emergency treatment, since ER doctors don’t know patients’ medical histories and rarely have access to their records.

The proper setting for non-emergency care is in the offices of doctors who provide primary care. Formerly known as “family doctors,” these physicians generally see patients on an ongoing basis and are best at diagnosing and prescribing the right treatments. However, doctors almost always require that their patients have some sort of insurance before they’ll take them on.

Emergency rooms are not only least effective and efficient treatment settings for primary care, they are the most expensive. The average ER visit costs $359 — more than double the $129 average cost of a primary care visit. But because hospitals, unlike primary care clinics, are legally bound to treat everyone who shows up, thousands of uninsured people seek primary care treatment in ERs every day, a phenomenon that needlessly adds billions to the overall cost of health care every year.

With a public option — a government insurance plan similar to Medicare, Medicaid and the coverage provided to the military, veterans, members of Congress and federal employees — people who can’t afford insurance now would be covered, and so would have access to primary care. This would not only improve the overall quality of health care and reduce stress on overburdened emergency rooms nationwide, it would eliminate billions in emergency services fees charged to those who can least afford them.

According to a report from the Nationwide Emergency Department Sample released this month, about 6 million uninsured Americans sought treatment in emergency rooms in 2006, the most recent year for which data is available. At $359 per visit, they were billed over $2 billion for emergency services that year.

A Centers for Disease Control study released last year found that among 119.2 million ER visits in 2006, only 15.9 million were classifiable as true emergencies. Conversely, therefore, 86 percent of patients who visited ERs, both insured and uninsured, should have been treated in primary care, urgent care or a similar non-emergency setting.

If 86 percent of the 6 million uninsured ER patients in 2006 — roughly 5 million people — were there for non-emergency treatment, at $359 per ER visit, they were billed about $1.8 billion that could have been spent more effectively on less expensive care.

With a government option, had these 5 million patients gone to primary care providers, at $129 per visit, the government insurance plan would have paid $645 million in doctors’ fees — a savings to the system of $1.15 billion.

Estimates from the Congressional Budget Office (CBO) and other government entities are usually scored over a 10-year period, so if these patients were covered — and assuming (just for grins) that all factors remained constant — the savings of $1.15 billion per year would multiply to $11.5 billion over a decade.

But wait, there’s more. A public option would also eliminate tens of millions of dollars paid by local taxpayers every year to cover defaults on hospital bills by the uninsured.

Medical costs are the number one factor driving bankruptcies these days. In general, when patients default on hospital bills, taxpayers eventually pick up the tab. If the rate of defaults among uninsured patients who use ERs for non-emergency treatment is just 5 percent — meaning that 5 percent of the $1.8 billion is uncollectible — insuring these people would save taxpayers roughly $90 million per year, or $900 million over ten years.

As the debate over health care reform plays out in Washington, we’re hearing a lot from opponents of reform about the cost of government insurance but little in the way of countervailing arguments about savings. While the cost benefit from taking the burden of providing primary care off of the nation’s emergency rooms won’t cover the entire cost of the reformed system, these savings are a strong argument for government insurance and deserve attention.