Driving through Southeast Texas toward Louisiana over the Christmas holiday, I was startled by the number of private "emergency care facilities" that had sprung up in strip malls from Beaumont to Baytown (a suburb of Houston).

My parents informed me that these free-standing emergency rooms---unaffiliated with any hospital, private or public---were the fastest way to get emergency care: way faster than sitting around in a hospital emergency room for hours, next to people suffering God-knows-what, until the triage nurse decides you're next. In contrast, they told me, private emergency rooms guaranteed that patients would be seen in 45 minutes or less---a tempting prospect for those of us who've spent hours waiting in emergency rooms with broken bones, acute stomach pain, or other illnesses that are deemed less bad than the person next to us.

My folks, in other words, are, fans, and I see why: As someone with health insurance, I'd choose to be seen immediately in a clean, modern, close-by facility over an interminable wait in a filthy hospital any day.

The problem, though, is that these private clinics only treat those with insurance or those who have the means to pay for care out-of-pocket; those who can't are relegated to traditional public emergency rooms, which are obligated by law to care for patients regardless of their ability to pay.[pullquote]The flood of new, often uninsured, psychiatric patients is competing with record numbers of uninsured medical patients.[/pullquote]

Two things (in addition my trip across East Texas) brought those weird suburban clinics to mind. First, the Washington Post's Wonkblog reported today on some of the problems posed by so-called retail clinics---institutions similar to private emergency rooms where patients can be seen more quickly and cheaply than at traditional doctors' offices.

Leaving aside the issue of quality of care (which, according to most accounts, is apparently as good or better than that at regular doctors'), there's the question of information: What if you go to a retail clinic inside Wal-Mart and get treatment or new medication but fail to report it to your primary care physician? That doctor is now handicapped by limited information that could lead him or her to prescribe dangerous medication, suggest risky or redundant treatment, or worse.

The second, and more alarming, bit of news related to retail emergency rooms comes via today's Atlantic: As states (like Washington) slash care for mentally ill and clinically depressed patients, emergency rooms are being inundated with psychiatric emergencies---people who have attempted suicide or have severe depression or psychosis. This flood of new, often uninsured, psychiatric patients is competing with record numbers of uninsured medical patients, those who wait until their problems become acute before seeking treatment.

I fear that the proliferation of for-profit, private emergency facilities, combined with increased demand for emergency services from the indigent and uninsured, will result in a two-tiered health care system: Effective, fast, affordable care for the wealthy and well-insured, and overcrowded, dingy, cash-strapped hospital wards for those who lack health insurance or the ability to pay what the market dictates.