Uncomfortable truths

For a while now, there's been a backlash against those Americans without health insurance - people implying that they just don't want it - that they refuse to be insured - and that they therefore don't deserve our sympathy. But even when faced with actual people who desperately want it and can't afford it - or aren't able to buy it at all - many folks still manage to downplay the problem. Take for example John Goodman, one-time (if not still) McCain campaign adviser and health-care policy writer, was recently quoted as saying that, actually, there are no uninsured people in America.

But 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. Voilà! Problem solved."

Well, for a certain value of "solved", I suppose.

Paul Krugman points out, with my emphasis:

The truth, of course, is that visiting the emergency room in a medical crisis is no substitute for regular care. Furthermore, while a hospital will treat you whether or not you can pay, it will also bill you — and the bill won’t be waived unless you’re destitute. As a result, uninsured working Americans avoid visiting emergency rooms if at all possible, because they’re terrified by the potential cost: medical expenses are one of the prime causes of personal bankruptcy.

Another truth is that emergency rooms are for, well, emergencies. Try going to one for preventative care, or pre-natal care. Try going to one for a hip replacement.

Another truth is that when 45 million people use emergency rooms for non-emergency care it overwhelms the medical system. Hospitals provide millions of dollars in uncompensated care (no wonder they sue) and go under. Emergency rooms are so crowded that patients wait hours to be seen (if they're seen at all). Doctors, nurses, and technicians are overworked. For-profit hospitals begin dumping uninsured patients to non-profit ones (just as private schools can dump the problem students back into the public schools).

And people die.

And yet another truth is, that's not some wild, off-sides notion by a "maverick" who's "no longer" a McCain adviser. It's essentially GOP thinking. After all, President Bush said the same thing when he was asked last year:

"I mean, people have access to health care in America. After all, you just go to an emergency room."

Also last year, Tom DeLay said:

“By the way, there’s no one denied health care in America. There are 47 million people who don’t have health insurance, but no American is denied health care in America."

In 2004, then-HHS Secretary Tommy Thompson said

"Even if you don't have health insurance, you are still taken care of in America. That certainly could be defined as universal coverage."

It's what they really think.