Some ER service problems are an outgrowth of our health-care system. Many Americans with no health insurance use emergency rooms as their primary source of treatment. The uninsured crowd into ERs hoping to get care that they can’t get, or can’t afford, anywhere else.

The report also recognizes that emergency rooms are the only place most people, insured or not, can go at night or on weekends. Unlike some European countries, the U.S. doesn’t have a reliable system of after-hours care. To take the strain off emergency rooms, we need medical facilities where patients can get treatment during off-hours. That will be a longer, tougher fix and depends on the involvement of community health clinics and flexible medical practices willing to provide after-hours care.

Many of you have written to Consumers Union to tell us about your ER experiences. We’ve heard the good and the bad: dedicated and hardworking staff members who toil in a system that can be dysfunctional, the endless waits, the failure to treat excruciating pain, poor-quality care, sky-high costs, and even preventable death.

From your stories and the report, it is clear we need a way to measure ER quality more comprehensibly so that the public and policymakers can quantify differences. Publicly rating ambulance services and ERs for wait times and for differences in care among racial and ethnic groups will push hospitals to put more effort into this first line of critical health care.