> maybe a quarter of the people out there in the waiting area don't

That's probably a very low estimate, depending on the ER and region anyway.

The ER is too often used as a general clinic / doctors office, psychiatric ward, or even homeless shelters in many areas. The latter issue with the homeless taking up considerable ER space and hospital beds may be unique to the west coast, where homelessness is far beyond crisis levels.

This is obviously a multifactorial problem at many levels.