The New Republic

Is the emergency room an adequate substitute for health insurance, as an expert who has advised the McCain campaign recently suggested? Not according to the American College of Emergency Physicians. Here's the statement they just issued:

Washington, D.C. — The American College of Emergency Physicians (ACEP) today lambasted McCain health policy advisor John Goodman’s assertion that anyone with access to an emergency department effectively has health insurance, and called his logic flawed and his statement irresponsible toward all patients, insured and uninsured alike.

“The Centers for Disease Control and Prevention’s latest report showed visits to emergency departments climbed 32 percent over a ten-year period, and there is no sign that this trend is slowing,” said Dr. Linda Lawrence, president of ACEP.  “Emergency departments are the nation’s health care safety net, but that net is breaking under the load, in part because so much of the care goes uncompensated.  To suggest that there are no uninsured patients is to cast a blind eye toward the needs of all emergency patients, insured or not, who are waiting longer and longer for care, sometimes with deadly consequences.”

“We urge the McCain campaign to rethink the reckless suggestion by Mr. Goodman that the tragedy of uninsured patients can be erased by the magic of emergency departments,” said Dr. Lawrence.  “Emergency physicians can and do perform miracles every day, but taking on the full-time,  medical care for 46 million uninsured Americans is one miracle even we cannot perform.  Access to care in the emergency department is no substitute for the comprehensive health care reform policy that should be at the heart of the platform of any presidential campaign.”

Like any lobbying group, ACEP has some self-serving agendas--namely, protecting the incomes of emergency room physicians. And, to be fair, the studies on emergency room overcrowding are a bit ambiguous over how big a role the uninsured play in that problem.

It's also worth acknowledging that, in some cases, people really do have too much insurance for their own good. A smart system of insurance cost-sharing--one that was progressive and that protected the seriously ill--would actually make a lot of sense.

But that's not what Goodman has advocated. And that's not what McCain has proposed.

As I've written previously in TNR, clawing back insurance coverage in the way McCain advocates would do so in a clumsy, severe way that would leave some of the most medically needy people without the insruance they need. That would land many of them in emergency rooms when they need medical care. And nobody with even a cursory knowledge of the literature--or even the slightest first-hand experience in an emergency room setting--would suggest this sort of E.R. use is adequate.

To its credit, the McCain campaign has now officially disavowed Goodman's statement, saying that McCain "believes that addressing the
problem of the nation’s uninsured is one of our most pressing national
priorities." They also stressed that Goodman no longer advises the campaign--and that he was never more than an informal, volunteer advisor. In other words, they're saying Goodman wasn't a central figure in drawing up the plan, which is perfectly plausible. But that doesn't change the McCain health care plan, which is every bit as "reckless" as the E.R. docs suggest.

--Jonathan Cohn 

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