Agreed the ER is the single most expensive place to get healthcare.
Have you read Elisabeth Rosenthal’s “An American Sickness”? I think misuse of ERs is a problem, but think the bigger problem is that health care has transitioned from the public good it was in my childhood, into a system in which every piece is seeking to extract the maximum revenue from (or more precisely from third party payers on behalf of) each patient. That’s like Wall Street. Even my well known, national, “nonprofit” HMO has sold out to upcoding and bullshit billing.
The jerk who bought a pharmaceutical company and increased the price of its product by orders of magnitude, purely to get a financial win, was just the tip of the iceberg. My utter inability to find out the price of a good or service before I’ve committed to purchase it is part of the problem. Having been with this HMO since every interaction cost exactly one dollar 30 years ago, being hit with surprise $500 copays twice in the last five years was telling. But it’s every physician visit, every procedure or lab test, every pharmaceutical, every hospital charge which are now managed to maximize marginal revenue (this is a technical term from economics for the behavior of a monopolist) rather than for the economic efficiency through competition which is the hallmark of the capitalist system.
Just as Toyota came in and unseated the fat dumb and happy US auto oligopoly in the 1970s (with a higher quality product, produced more efficiently, at a lower price), and just as the southeast asian supply chain with its ruthless efficiency drove the price of a PC from $2500 to $600 between 1995 and 2005*, and just as Wal-Mart with its brutally efficient supply chain and distribution put a lot of retailers out of business, it’s time for a brutally efficient competitor to enter the US medical scene, and force efficiencies throughout the entire supply and distribution chain. We need to be laying the political/policy groundwork now to allow this hypothetical competitor a place, rather than letting its entrenched “competitors” attack the medical licenses of its people, its facility licenses, and its ability to accept Medicare payments once they become cornered animals as they realize they’re about to be put out of business.
 * A well written story about the brutal efficiency brought to the PC industry can be found at https://www.linkedin.com/pulse/day-everything-changed-compaq-sean-burke/ . (I spent my career in the computer server / storage / data center network industry.)