PLANK SEPTEMBER 24, 2012
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Fifty million Americans have no health insurance. Does government have an obligation to help them? The answer is no, Mitt Romney suggested during a “60 Minutes” interview that aired on Sunday, in part because people can already get care through emergency rooms:
We do provide care for people who don’t have insurance, people—we—if someone has a heart attack, they don’t sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care.
That statement isn’t untrue. But it leaves out an awful lot. ERs are great if you need urgent help with a major medical problem: You’ve had a heart attack, you’ve been in an accident, whatever. And, yes, hospitals will generally treat you regardless of insurance status, if only because the law requires it. As a condition of accepting Medicare money, hospitals must provide stabilizing or life-saving treatment. But they will not provide basic, ongoing care. They will charge a lot of money for their services. In many cases they will do their best to collect on outstanding bills, even if that means using techniques that even the retail industry eschews as overly harsh. And sometimes, as Sarah Kliff notes today, hospitals find ways to avoid providing care in the first place.
Romney is not the first conservative to make this argument. George W. Bush did it all the time. But Romney, of all people, knows better. While he was governor of Massachusetts, promoting his plan to make health insurance available to all residents, he argued that ERs were a lousy way to provide care—not just because they were expensive and necessarily episodic, but also because taxpayers and payers of private insurance premiums ended up paying indirectly for those services. Here was Romney on MSNBC’s “Morning Joe,” less than two years ago, speaking to Mike Barnicle:
BARNICLE: Do you believe in universal coverage?
ROMNEY: Oh sure. Look, it doesn’t make a lot of sense for us to have millions and millions of people who have no health insurance and yet who can go to the emergency room and get entirely free care for which you have no responsibility. Particularly if they are people who have sufficient means to pay their own way.
(h/t Amanda Terkel and Sam Stein of Huffington Post)
The two statements are not contradictory. It’s possible to believe simultaneously that ERs provide care to everybody who needs it and that they are an inefficient, expensive way to do that. But the Romney who made that statement in 2010 was making the case for having government do more to cover the uninsured, while the Romney who made that statement yesterday was making the case for having government do less.
And that’s really the most important point of all. Remember, Romney doesn’t simply want to repeal the Affordable Care Act, effectively taking health insurance away from 30 million people who, starting in 2014, are likely to get it from the law. He also wants to end Medicaid, making cuts that would leave between 14 and 27 million additional people without insurance. And he wants to change the tax treatment of employer health benefits, in ways that could make coverage more expensive or harder to get.
Romney’s strategy for health care isn’t “repeal and replace,” as he sometimes likes to say. It’s “repeal and reverse,” as my colleague Ed Kilgore has called it. And it'd leave the ERs even more inundated than they are now.
follow me on twitter @CitizenCohn
15 comments
The Obama campaign ad writes itself. This will allow them to include the video of George W. Bush and Mitt Romney saying the exact same thing. Whereas they usually avoid playing up GWB for fear that people might accuse them of bringing up the past instead of their own record and blaming other people for the worst economic crisis since the 1930s, this is a legit way to pair Romney with Bush and it's idiotic campaign strategy* for Romney. The people in Boston must have facepalmed, especially since he's invested so much in not completely repudiating Romneycare. *Clever campaign strategy is to the same thing (as the policy hasn't changed) but in different words (to forestall the brainless comparison). This is what Romney does with his tax policy, for instance.
- chaitless
September 24, 2012 at 10:42am
47% of Americans are moochers who do not deserve health care. When they sicken and die, it is their just reward for their laziness and lack of ability, their unwillingness to "take responsibility" for their own lives by moving to Somalia. The 53% don't need them anyway. Whatever can be done to hasten the departure of the 47% from this earth should be done. At the very least, we ought not assist them to remain here any longer than absolutely necessary.
- roidubouloi
September 24, 2012 at 10:45am
Cohn makes a good point that is often overlooked: while in contrast to countries like China or Namibia where if you lack $$$ and are sick unto death, you're fucked, it is indeed the case that everyone in America gets top quality hospital care including ICU care and urgent surgery regardless of their ability to pay, and the thing is, when they can't pay--as they often cannot--the rest of us foot the bill anyway. There is no free lunch.
- AaronW
September 24, 2012 at 11:30am
So the flag-carrier for the party of individual responsibility actually argued that individual irreponsibility - not buying insurance - should be rewarded by cost-free ER care. And the taxpayer who foots the bill should not have any say in the matter (that is, to mandate the individual to buy insurance). The party of economic determinism has not the first clue of basic economics principles: externalities and cost-based choice. I think what you are seeing here, like the 47%, is another instances of the Right-wing feeback loop distorting not only voter perception but political discourse. Seattle here has been pushing this "poor people get ER" idea for years, without any idea of the costs, both for those receiving ER and the society at large, both in direct outlays and actual failure of preventative public health policy. And now we have Romney parotting it. Should be interesting to hear him make the same statement in the debates. And Obama? "Governor Romney suggests that 47 million Americans use the ER as their primary care facilities. Much like most of his economic prescriptions, that's just bad arithmetic. If you have the flu, a visit to a primary care physician costs $50; to the ER, $3000. Who pays? More important, a primary care physician could get you on a healthy diet so you don't have the heart attack in the first place. This is why we insist on primary care coverage. Not just for health, but for fiscal sanity."
- icarus-r
September 24, 2012 at 11:52am
And let's not forget that, in addition to bteing expensive and inefficient, ER treatment of the uninsured imposes a significant hidden tax on the rest of us. As with all sorts of external costs that the "job creators" blithely impose upon society (environmental ones being the most obvious), supposedly free-market conservatives have a real penchant for ignoring that pesky little fact about the absence of free lunches. This is just one more example.
- EDLWOLF@ALUMNI.BROWN.EDU
September 24, 2012 at 12:02pm
Somalia! Our model state! President Romney of Somalia, home of the free, land of the brave pirates, where people Take Responsibility To Fend For Themselves, is truly exceptional. We weed out the weak, the sick, the dependent, the lazy - they die like flies in the streets and THAT is how Jesus meant it to be! If we need money in Somalia, we go out and get it. Much like the exemplary Bain Capital, we don't wait around for government handouts that keep us in A Hammock of Dependency. No! We go out and take it by God. We take tankers, freighters, fishing boats, passenger liners and it pays! Courage and initiative are rewarded, not punished! Take note, moochers. Arise and be free!
- Sophia
September 24, 2012 at 12:27pm
Seriously? Again he parrots conservative talking points, which contradict stuff he said only a few years ago? It's still true, that the more we learn about Romney, and the more specifics he tells us about his plans, the worse he and his plans appear for America. He's Bush-II all over again. Sure, over-all, he denies he's Bush-II. Then, when he gets to specifics, he sounds exactly like Bush-II. Ah, well, I just hope he can keep this up until November.
- AllanL5
September 24, 2012 at 12:29pm
I think maybe we are buying into the "go to the ER and get care" as if it were true. You cannot get Avonex for MS in the emergency room. Nor can you get chemo for breast cancer, or statins to keep a heart attack at bay. You can't get state of the art customized radiation treatments for brain or other kinds of cancer. You can't get glaucoma treatment, or treatment for high blood pressure (unless you're currently having a heart attack or stroke, and then not ongoing care). We need to quit pretending that the ER provides adequate care to uninsured people. It does not. That is not its mission.
- ReganaD
September 24, 2012 at 12:32pm
What Regana said: you cannot get MOST medical care in an emergency room. All you can get is stabilization in an emergency, or urgent care for something like a fulminant infection. Everything else, you either have insurance or deep pockets. A member of my family makes a good example: she has required about $100K of surgery to save her eyesight in the past 18 months. Absent our good employer paid policy, that $100K would have been out of pocket expense (in fact we paid about $12K out of pocket for deductibles and co-insurance - we have a a high deductible policy with HSA), or she'd be blind. Now, we'd have survived that $100K hit. Absent insurance, a family with a median income, some mortgage debt, and maybe some kids in college, would be pushed absolutely against the wall, if not bankrupted, by something like that. Or they'd have a person go blind, removed from the work force and permanently disabled. That's what Romney/Ryan thinks working and middle class Americans deserve.
- IowaBeauty
September 24, 2012 at 12:57pm
Chaitless writes: "The Obama campaign ad writes itself. This will allow them to include the video of George W. Bush and Mitt Romney saying the exact same thing." Absolutely. I can clearly remember, so am reasonably sure many others can as well, W saying that healthcare is no problem, because the uninsured can simply go to an ER when in need of care. Hope this is fully exploited, it is a priceless opportunity.
- Haole45
September 24, 2012 at 2:02pm
Iowa's right. You get stabilized in the ER period, they will treat an EMERGENCY but you can't get serious care for a chronic illness let alone the kind of surgery she's talking about. These people are willing to let us go blind - or die - my god. What kind of "human beings" are these?
- Sophia
September 24, 2012 at 3:46pm
AllanL5: "It's still true, that the more we learn about Romney, and the more specifics he tells us about his plans, the worse he and his plans appear for America. He's Bush-II all over again. Sure, over-all, he denies he's Bush-II. Then, when he gets to specifics, he sounds exactly like Bush-II." Actually, while I basically agree with you, in key respects Mitt is even worse than George. Yes, he's certainly smarter and not nearly as lazy. But on immigration and development assistance to combat HIV/AIDS, Bush was better. And more generally, as stupid and hypocritical as Bush was, he at least preached the notion that we should look out for others. Romney has promoted the Ayn Rand ideology of everyone for themselves. Does he really believe it, or is he just so craven that he'll say it if he thinks it will get him donations and votes? I'm not certain. But that's not the point anymore. If elected, Romney will govern as a wing nut and fill his administration with them, regardless of what's in his heart (if he has one).
- Thunderroad
September 25, 2012 at 12:42am
Just heard a sound clip on NPR of Romney, back in 2010, explaining how the uninsured's relying on the ER for basic healthcare does not make medical or economic sense. It was a well-thought out statement, logical, reasonable, even compassionate. So,this latest etch-a-flop on the roleof the ER in our "safety net" shows that he goes whichever way the political wind blows. He must be the most transparently unprincipled politician I've ever seen in my lifetime, one who can reverse a previously held position with neck-snapping speed. He will literally say anything, adopt any extreme policy position, if he thinks that is how to get the needed votes to get elected. But I sense that this has become so obvious to the public at large, that he is probably past the point of having the credibility necessary to win a majority of the electoral vote.
- Haole45
September 25, 2012 at 12:37pm
aaronw writes: "it is indeed the case that everyone in America gets top quality hospital care including ICU care and urgent surgery regardless of their ability to pay, and the thing is, when they can't pay--as they often cannot--the rest of us foot the bill anyway. " Put into perspective, though, the number is actually fairly small. The LATimes reported in 2012 the figure was $56B of ER care for the uninsured in 2008. The same article notes 5% of patients in CA lacked coverage. For comparison, medical malpractice liability is a $55B/year problem according to Reuters (administrative cost, payments, lawyer fees). So, roughly the ER problem is the same size as the malpractice problem. The NYT reports the combined profits of the 5 biggest for-profit insurers was $11.7B. So, the ER and malpractice problems are quite a bit larger than the insurer profits. Now, to put this into perspective, our annual spend on health care is north of $2T. And today we learn Kaiser reports the cost for employer provided family coverage rose $3K from 2008 to 2012. And the premiums climbed faster during Obama's time in office than Bush. REcall Obama claimed we'd see a $2500 drop in family premiums. There isn't a thing in ACA that will move the needle on costs. With expanded services and expanded coverage, we have not yet begun to see the final cost arrive on ACA. This will continue to swell like a rotting carcass baking in the sun.
- seattleeng
September 25, 2012 at 4:30pm
seatteng: "There isn't a thing in ACA that will move the needle on costs." Simply not true. There's the IPAB, a board that will have the authority to make changes in Medicare to achieve specified savings that do not affect coverage or benefits, unless overruled by Congress. There are a host of pilot programs, including those that do not operate on a fee-for-service basis. Many analysts think that the CBO underestimated potential savings in the ACA because it deemed the programs not sufficiently concrete. That may be a wise assumption, but there's a decent chance that at least some of the programs will be successful and more widely adopted. So yes, the ACA did not contain as much cost containment as many would have liked. But that doesn't mean that "there isn't a thing" that would "move the needle." Instead, it's a long-awaited and much needed start. Getting back to the subject of the post, Romney has not offered anything close to a viable alternative. His ER comment hardly advances the discussion.
- dsimon
September 26, 2012 at 5:50pm