The tremendous problem lies in the catch-all standard that really is no longer our "emergency" room. Triage should be used to separate emergency room use and normal treatment. If people who came to the emergency room were rated (not a lot of thought here, just example purposes) as follows:
Class I Patients who require minor treatment and can be exited in a short period of time.
Class II Patients whose injuries require immediate life sustaining measures.
Class III Patients for whom definitive treatment can be delayed without loss of life or limb.
Class IV Patients requiring such extensive care beyond medical personnel capability and time.
Then, Class I patients could be helped quickly/cheaply and moved on and out;
Class II is my definition of who emergency room care is for and why "mandated" care came into existence;
Class III patients should be turned away or admitted with payment;
Class IV patients (self-explanatory) - if they're going to die and don't have money to pay for extreme measures, no treatment is necessary. We'll all die eventually.
I realize that allowing Class III patients to turn into Class II or Class IV patients would be sad, but a percentage of Class III would seek treatment elsewhere or get better. Unless you've spent much time in the waiting room, you wouldn't believe the number of people who are there for colds, hang-overs, drug seeking, and plain old family doctor problems. The emergency room has become the regular doctor for a huge population of people.