The Plank

Stop Your Whining: Health Care Edition (corrected)

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John Goodman* runs the National Center for Policy Analysis, a conservative think-tank based in Dallas, Texas. So when Dallas Morning News reporter Jason Roberson was reporitng his story on the latest figures on America's uninsured, he decided to dial up Goodman and get a quick reaction. Here's what Roberson reported:

...the numbers
are misleading, said John Goodman, president of the National Center for
Policy Analysis, a right-leaning Dallas-based think tank. Mr. Goodman,
who helped craft Sen. John McCain's health care policy, said anyone
with access to an emergency room effectively has insurance, albeit the
government acts as the payer of last resort. (Hospital emergency rooms
by law cannot turn away a patient in need of immediate care.)

"So
I have a solution. And it will cost not one thin dime," Mr. Goodman
said. "The next president of the United States should sign an executive
order requiring the Census Bureau to cease and desist from describing
any American – even illegal aliens – as uninsured. Instead, the bureau
should categorize people according to the likely source of payment
should they need care.

"So, there you have it. Voila! Problem solved."

Voila indeed. And why stop with health care? Imagine how easily we could solve poverty if we simply stopped measruing income and wealth. And global warming? Pshaw. Just stop measuring atosopheric pollutants and temperature. Really, the possibilities are endless.

Seriously, though, this is one of those days when I really wish I had a few hours to give everybody chapter-and-verse on the multilple problems with that statement. Since I don't--other duties call--I'll be brief. For now.

There is overwhelming statistical evidence that people without health insurance get worse health care. Among the big reasons: They don't get routine preventative care and, when they need speciality care, they have to wait because they're dependent upon overwhelmed charity care providers. Emergency rooms will treat anybody who shows up with a medical condition requiring immediate treatment; the law requires it. But when it comes to regular and follow-up care, which is what a lot of those folks inevitably need, they have to look elsewhere.

And that's to say nothing of the financial problems that uninsurance creates. The law says emergency rooms have to provide treatment. It doesn't say they have to provide treatment at rates patients can afford. So if you're uninsured and show up at the emergency room, yes, you might get the treatment you need. Chances are good you'll also get a bill--a rather large bill, easily into five or even six figures, depending on what you needed. If you can't pay the bill, you'll likely hear from a collection agency, which could result in crushing payment plans, garnished wages, and bankruptcy. 

Of course, this sort of thing also happens to people who never show up in the emergency room, but instead find themselves with serious, even life-threatening diseases, but no way to cover their ongoing medical expenses--either because they have no insurance or because the insurance they do have covers too little.

And don't forget that many of these people are folks with steady jobs and decent paychecks. In other words, they're middle class--or, at least, they used to be before the medical bills hit.

Again, more on this to come.

*Correction: Although the Morning News article reported Goodman as a McCain advisor, the McCain campaign says he is NOT an advisor. That's obviously a big distinction so I've corrected the item, which described Goodman as part of the campaign, as well as the update below. I apologize for the error.

**Update: More from friends Dr. SteveB, Steve Benen, Kevin Drum, Satyam Khanna, and Ezra Klein. Ezra nails the broader political point: This is not some stray comment from some random figure. Goodman is the father of Health Savings Accounts, an idea that many conservatives (including McCain) have long supported. And it's a pretty basic tenet of conservative opinion that the problem of the uninsured is wildly exaggerated and that the bigger problem with health care is that many people have too much insurance. McCain's health care plan--which would likely result in less protection from health care expenses, particularly for those with serious medical problems--is very much in line this thinking, as previously discussed here and here.

--Jonathan Cohn 

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