The problem is that at 1am, with whatever horrible pain prompts you to drag yourself, or your child, to seek out medical care, your ONLY option is often an ER.

It's not about how amazing ERs are and therefore expensive. It's about horrible allocation of resources across the entire system. If you don't have insurance, guess what, the ER becomes your clinic. If your child is screaming in pain at 2am with an ear ache, guess what, urgent care is closed, you have to go to the ER.

From personal experience, people will go to an ER knowing full well it's not life threatening and don't need the full services, knowing full well it's going to cost them a small fortune. But they just can't reasonably wait 6-12 hours to get treatment. Would you let your 3 year-old scream in agony until the next day because that's what time the Urgent care re-opens, so an MD cay say "Yup, that's an ear infection, here's your script, off you go"? It's a silly system that doesn't provide reasonable options to such common occurrences. People should dam well complain about it until there are better options.