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Not One Thin Dime: Republican Health Advisor Says the Uninsured Can Just Go to an Emergency Room

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John Goodman is president of the National Center for Policy Analysis, a conservative think tank. He has proposed a novel solution to the uninsurance crisis. I'll let the Dallas Morning News tell the story:

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.)

Some, um, real reporters tell me that it's not clear Goodman is an official advisor to the McCain campaign. He's apparently part of that cloud of informal advisors who helped produce and market what we know of the McCain health plan. The Wall Street Journal, modestly cited on Goodman's own website, describes him as "the father of medical savings accounts." He's an important Republican on healthcare concerns.

An even more important Republican beat him to it. Here is President Bush from last year:

"The immediate goal is to make sure there are more people on private insurance plans. I mean, people have access to health care in America," he said. "After all, you just go to an emergency room."

The Washington Post's Dan Froomkin aptly called this one "Clueless Quote of the Day."

Let's all stop and wrap our minds around Goodman's comments. Many health policy experts are trying. Their unanimous verdict isn't pretty.

I have noted before that emergency departments (EDs) are increasingly overcrowded, with many in danger of closure. Between 1995 and 2005, ED visits increased by 20 percent, while the number of emergency care facilities declined by 38 percent. Almost every level 1 trauma center is operating at or above capacity. Why is this happening? The crush of uninsured and underinsured people makes these facilities very unprofitable for many hospitals that run them. Many hospitals are actively considering closing their emergency departments.

These problems affect everyone. Median waiting time for emergency care exceeds four hours and is rising. Last year, Edith Rodriguez lay on the floor of the ED waiting room at Los Angeles's Martin Luther King Jr.-Harbor Hospital. She was suffering from a painful abdominal problem. Her boyfriend, trying in vain to get medical attention, became so desperate that he called 911. . The paramedics refused to come, and Rogriguez died an agonizing death from a perforated bowel.

Less egregious tragedies are common. Medical surveys reveal a disconcerting number of ED doctors and nurses with first-hand knowledge of patients death due to delayed care. As Ramon Johnson of the American College of Emergency Physicians told Congress,

Emergency physicians and nurses are dedicated to saving lives. But in a system struggling with the closure of hundreds of emergency departments in the last 10 years because of huge amounts of uncompensated care, and in which ambulance diversions and the 'boarding' of patients in ER hallways for hours and sometimes days at time have become commonplace, we simply can't always get to everyone. And if we can't get to you, we can't save your life.

Goodman (and Bush) are right that the ED has to treat your emergent problem. Of course that hospital can then kick you out once your immediate crisis is addressed. If you are a 58-year-old woman with hypertension and diabetes, no one is under any legal obligation to help you stabilize your blood pressure or to make sure you receive your medications. A hospital is within its legal rights to stabilize you, load you into your car or an ambulance, and ship you off to the county whatever when they don't like your insurance card.

And of course both hospitals can send you a whopping bill and then sue you if you cannot pay. Jonathan Cohn's prizewinning Sick describes Dickensian conditions at the Cook County courthouse. Its docket is clogged with medical debt cases in which hospitals sue low-income patients.

A trainload of studies indicate that uninsured people suffer serious harm because they are less likely to receive preventive care, get blood pressure checks, or fill needed prescriptions. They also receive substandard care.

Given President Bush's comments, Mr. Goodman may be accused of shameless copying. Given Goodman's academic pedigree, I'm not surprised that he adds a little more. Here is Goodman's solution to the healthcare crisis:

"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.

Facts are stupid and embarrassing things. Maybe we can find the same guys to do the census who found no gay people in Iran.

Many people drop their health insurance for the cheaper path of using the ER.

I've heard this someplace before ... but where? Oh yeah: Herbert Hoover: "Many persons left their jobs for the more profitable one of selling apples."

There is a mentality at work here, whereby the comfortable and complacent regard the suffering of others with undue equanimity. You can't afford regular healthcare, but you can always go down to the County Hospital and hibernate in the ER.

One thin dime, indeed.

Update: Jonathan Cohn has been killing this story over at New Republic. And so have many others. Seth Michaels has a great piece. Steve Benen adds that it isn't just Goodman and Bush.

This nonsense is surprisingly common in Republican circles. Last year, Tom DeLay argued, "[N]o American is denied health care in America," because everyone can go to the emergency room. Around the same time, George W. Bush said the same thing: "[P]eople have access to health care in America. After all, you just go to an emergency room." In 2004, then-HHS Secretary Tommy Thompson said our healthcare system "could be defined as universal coverage," because of emergency rooms.

In a way, they're right. If you're sick, there are public hospitals that will treat you.

One might wonder how these public hospitals are supposed to keep the lights on. Goodman and McCain have little to offer on that score, too.