OCTOBER 15, 2012
Mitt Romney has caught some grief for comments he made about health care last week. It seems to me he deserves a lot more.
As readers know, Romney has called for repealing Obamacare, ending Medicaid as we know it, and changing the tax treatment of health insurance. If he were to win the election and sign these measures into law, tens of millions of Americans will lose health insurance. Not to worry, Romney said during an interview with the Columbus Dispatch, going without insurance isn't that bad:
We don't have a setting across this country where if you don't have insurance, we just say to you, 'Tough luck, you're going to die when you have your heart attack' ... No, you go to the hospital, you get treated, you get care, and it's paid for, either by charity, the government or by the hospital. We don't have people that become ill, who die in their apartment because they don't have insurance.
This preconception, common on the right, is also a misconception. Multiple studies and high-level, independent reviews of these studies have found that people without health insurance are more likely to die from untreated disease. The studies are necessarily messy and, as a result, putting a precise figure on the number of people who die is difficult. But Paul Krugman captures the latest thinking among scholars when he writes that
…going to the emergency room when you’re very sick is no substitute for regular care, especially if you have chronic health problems. When such problems are left untreated — as they often are among uninsured Americans — a trip to the emergency room can all too easily come too late to save a life. …
How many deaths are we talking about? That’s not an easy question to answer, and conservatives love to cite the handful of studies that fail to find clear evidence that insurance saves lives. The overwhelming evidence, however, is that insurance is indeed a lifesaver, and lack of insurance a killer. … there’s no real question that lack of insurance is responsible for thousands, and probably tens of thousands, of excess deaths of Americans each year.
I’ve written about this previously. So have Aaron Carroll, Austin Frakt, Ezra Klein, Sarah Kliff and Harold Pollack. If you want to read through the argument, they’ll walk you back through it. If you want to read the counter-argument, I would suggest Megan McArdle, who makes it as well as anybody (although not, in my opinion, persuasively).
But I’d rather focus on a different point, one lost in this debate. Universal health care isn’t simply about saving lives. It’s also about alleviating misery. When you don’t have health insurance, you start economizing in all the wrong ways. You don’t go the doctor for that nagging pain. You don’t take the medication prescribed for your chronic condition. You don’t get treatment for an injury. Or maybe you just don't get your regular tests and screenings. Best case, if you really do have a problem? You suffer through the pain and, who knows, maybe even get better on your own. Worst case? You end up like one of those people who misses a treatable cancer until it’s too late.
And the misery doesn't have to be physical. Universal health care is, first and foremost, a program to guarantee economic security. It exists to make sure that a chronic condition or a full-blown crisis doesn’t cripple you financially—which is what happens all the time right now, and not just to low-income Americans. Treatment for serious disease can cost tens, even hundreds of thousands of dollars a year, enough to deplete the savings even of middle class families.
In American politics, we’ve come to equate the “safety net” with programs for the poor. But, as the name suggests, it also exists to prevent people from becoming poor in the first place. Maybe that's something Romney never had to contemplate. If so, it's part of the problem.
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(Chart below from the Commonwealth Fund survey of chronically ill patients in seven economically advanced countries.)