There is no reason at all that our respective agendas about how US healthcare should be run should require me to wait on-site in the hospital, as opposed to in my home at 1AM, or in my hotel room when I get violently ill on a trip.
There will always be cases when people need to use the ER, and there will never be a good reason they shouldn't be able to call ahead for a soft appointment. Everything about the system, from patient routing to triage to hospital staffing, works better with a system like InQuickER in place.
My argument was only with the idea of using surcharges to deal with overcrowding. The reason that ERs are chronically overcrowded is not (generally speaking) because of people getting ill on trips, being in car accidents, or having ear-infected kids. The reason that ERs are overcrowded is the large number of people for whom ERs serve as primary care facilities.
As you (correctly) pointed out, these people probably wouldn't be using InQuickER-like services anyway, so they're not relevant to the question of whether scheduling systems are helpful or not. I think that scheduling systems lke InQuickER definitely could be helpful to patients that use them, and maybe to the ERs themselves... but also that, depending on the specifics of a given ER's catchment area, they won't have much impact on overall crowded-ness, since that's largely due to a segment of the population that won't be using the scheduling system anyway.
Now, if one could find a way to make these people more likely to use the scheduling system, you might see more of an effect.
Of course, I could be completely wrong- IANDNAIHEOHQE (I am not a doctor nor am I a health economist or healthcare quality expert), and when it comes to health care quality interventions (which is what InQuickER basically is) it is not at all uncommon for things to behave in a counter-intuitive manner. That's why solid evaluation of system outcomes is so important. Hopefully the participating hospitals are keeping a close eye on their utilization statistics... for their sake, I hope that the InQuickER people are insisting on it- being able to show a significant change in in-ER waiting time due to their system would be the single best marketing tool that they could possibly hope for.
Adding to the list of things that I could be completely wrong about, my sense of who InQuickER's users are could be dead wrong. Tyler, what are your user demographics like? Do they mirror those of the hospitals that are using the system?
[1] To the extent that emergency room overcrowding is due to people without other health care options (i.e., the un- and under-insured) using ERs as their primary care facilities, surcharges really won't help: by definition, these are people who can't pay for medical care... so adding additional surcharges probably won't have much effect on their ER utilization.