Actually, ERs lose money. Heart programs, women’s programs (childbirth), and surgeries make money. Generally, “proceduralists” (such as surgeons, gastroenterologists, etc.) make money because of the way Medicare billing is set up. It’s more easily quantifiable to bill for a discrete procedure than for treatment of pneumonia. In the case of pneumonia, for example, Medicare pays based on “average” time/resources needed to provide treatment. If the patient stays sicker longer, then the hospital eats the cost (unless they can invent another diagnosis to bill for). I’m not sure exactly what the economics of an ER are, but you have to remember that they get flooded with drunks, homeless, psychotics, and people who aren’t looped well enough into the healthcare system to seek preventive care and consequently use the ER for everything from an earache to the flu. They are forbidden by law to refuse care to anyone and probably eat a lot of costs dealing with non-emergent conditions.