John McCain's Health Care Adviser: "There Are No Uninsured."

Today, the Dallas Morning News again pointed out how far behind Texas is from the rest of the country when it comes to health care. As I've argued before, this is because of the extensive privatization of health care in Texas which throws people out to fend for themselves in the "free market," resulting in more uninsured than the rest of the nation.

John Goodman, president of the National Center for Policy Analysis, thinks the numbers put out by the Census highlighting Texas' plight are "misleading:"

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. Voila! Problem solved."

That's right. John Goodman's solution to the health care crisis in America is to change the definition of "uninsured" so that magically, everyone is insured.

Goodman couldn't be more wrong in his analysis. Using the emergency room for health care is just about the worst thing you can do, both from a cost and health perspective. DrSteveB over at the PNHP blog has a great breakdown of the health arguments that's I'll sum up:

1. There are about 22,000 deaths per year due to lack of health insurance and 11 million Americans with chronic physical illnesses are not getting the medical care they need because they don't have health insurance.
2. Hospitals are getting killed financially in part because of the dumping of care into emergency rooms. They are closing ERs all over the country because of this. Meanwhile wait times in the ER are up even for the critically ill.

Add to that the fact that using emergency rooms for basic care is three to four times more expensive than going to your doctor.

All this ads up to a health care policy - championed by John Goodman - that is intent on privatizing the profits and socializing the risk.

By eliminating employer-based health care, taxing the benefits, and making us all fend for ourselves on the "free market," Goodman's plan (and the health insurance industry's, in case you forgot) allows the health insurance industry to snap up wealth, young, and healthy people as customers - people who rarely get sick or who can afford to pay the bills - thus making the insurance industry a ton of money. And the uninsured (who, according to Goodman are actually insured, we just don't know it) can just go to the emergency room, sticking hospitals or the state with the bill.

The insurance industry gets all the profits. And we get all the costs. That is what these kinds of plans are designed to do.

Here's what Richard Kirsch, our National Campaign Director, had to say about John Goodman's plan:

Mr. Goodman's solution for fixing our broken health care system is to rebrand its failings? Wow. That's not only glaring evidence of a man grossly insensitive and misinformed but also frighteningly telling as to what we can expect should someone like Mr. Goodman have a say in developing the future of health care in this country.

What we need the next President and Congress to do is make real health care reform the first order of business in 2009. We not only need to cover the uninsured, but we also need quality, affordable health care we all can count on. We need a public plan so that we are no longer at the mercy of private insurance. And we need government to act as a watchdog - setting and enforcing rules on the unregulated, bureaucratic insurance industry that continues to insist on putting profits before people's health.

Oh, and here's another reason why nobody should be listening to John Goodman's ideas on health care. In July, at the National Center for Policy Analysis's "Freedom Fest Health Care Debate," Goodman laid down this gem:

Here is the variation in life expectancy among ethnic and racial groups in the United States and as you can see, it's all over the map. [...] but doctors just don't control our over eating, over smoking, and shoot outs in the hood.

Don't believe me? It's on tape! Here's the audio.

There you have it. The racist John Goodman thinks nobody in America is uninsured, and that a perfectly good solution for our health care crisis is for people to simply show up at the emergency room when they get sick enough. Why anybody takes this guy seriously is beyond me.

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Comments

[Anoka]

I am an RN who works for community mental health in a rural area. Most of the people I see are uninsured or underinsured who get medical treatment in the ER or go to the community free clinic that is staffed by volunteer physicians and nurses. This service delivery, while excellent for acute conditions, is not adequate for persons who need ongoing treatment for chronic conditions. It is heartbreaking to see people fall through the cracks because of no insurance or inadequate insurance to pay for on-going care. Ideas like John Goodmans just perpetuates the myth that our health care system can take care of everyone equally. When will health care become a right for all?

[jadegypsy]

The ER is not medical care, its emergency care and limited to immediate needs. Example: if you go to the ER because your blood glucose is 600 and symptomatic, you will recieve immediate ermergent care. However, if you are uninsured, you can expect either no follow-up care or a referral to a clinic. At the clinic, you will need to prove need, and you probably earn too much to qualify for their services. You go home without treatment, your diabetes is not monitored and within a few years you become a major burden on our medical and disability system because you now have kidney failure, blindness, peripheral neuopathy and a host of problems which medicaid will have to cover. Because your 10 or 12 dollar an hour job offer no or unaffordable insursnce, your income is too high for public assistance and you are left to struggle on your own. In 1971, i made minimum wage-on that income I supported myself and child, bought a house, owned a car, paid insurance, Now, minimum wage has increased 3 or 4 fold, but that same house has increased 100 fold, the car 10 fold, insurance 7 or 8 fold, etc. Only those whose income has kept up with the increases can afford all of todays needs. I believe we are rapidly slipping toward third world lives. Lives without adequate medical care, decent housing, affordable food, transportation and utilities. Our politicians need to be aware many hard working people need care.

[nurse1980]

This is truly sad that our leadership, Sen. McCain, has individuals surrounding him with a mindset that is so far out of contact with what is occurring in the lives of people they are aspiring to represent. There is a major difference between preventative care and emergency care, even the goals are different. Mr. Goodman's statements are a notice to the world of what he sees the value of healthcare to be. Is this his answer to regular check ups or screenings? This is the advise that McCain is listing to!

[Mauszuppe]

Once when a patient came to the E.R. he was seen by a triage nurse, who sorted out the emergent, the urgent and the not so serious patients and had them seen in that order.
AFTER they were treated, they submitted their insurance or payment information.
The last two times I went to the E.R., I was told to "sit; stay." Then, when a clerk had the time, they recorded every last bit of fiscal information, after which I was again told: "Sit! Stay!." Eventually I had vitals taken and was seen by some sort of Doctor who seemed totally involved in getting the chart done so that it would record every proper procedure - whether it was actually done or not, so the paperwork would reflect an armor against predatory attorneys.
I don't think I shall ever again go to a hospital. A friend's brother recently went in for an open-heart procedure. It was quite successful, but he died there of MRSA.*
I am so old I can remember hospitals where you found tile and Lysol - before carpet and carpetbagging bookkeepers and lawyers. In spite of all the marvelous technical inventions and new kinds of studies, I suspect that the patient may have fared better in the "olden days" - and was, for sure, better cared for as a human being

*Methycillin Resistant Staphylococcus Aureus - one of the Hospital acquired infections

[henryl]

More like THERE ARE NO INSURED. I was forttunate enough to have famly health insurance, and when my six-year-old daughter was diagnosed with cancer, I had to pay for her radiatiion treatments out of my pocket. I was turned over to a collection agency. The insurance company left us hanging, so even if you have health insurance, you're not protected. No small footnote here is that, thank God, my daughter is doing very well and is healthy.

Since then, I've gone on disability with multiple sclerosis, my wife has divorced me and in three years my COBRA health insurance stops. Medicaire will not begin to pay for the daily injections I have to take. Not a sob story; everyone has prloblems, and I consider myself extremely fortunate in many ways.

But no one who believes healthcare is in good shape in this country should be our president.

[lep]

John Goodman's remarks are appalling. That he is advising McCain on his health care policy is terrifying. I am a social worker at a children's hospital, working mostly with families of kids with diabetes. Every week we are contacted by patient families without insurance, or unadequate insurance coverage. Diabetes is an expensive disease to treat, but complications are way more expensive both in dollars and loss of quality of life. And they are preventable with access to insulin and preventive medical care. The same applies to so many other conditions. The ER cannot provide preventive care. Health care is a human right and everyone needs health insurance -- the ER is not health insurance! And as others have said, hospitals cannot keep absorbing these expenses. And people shouldn't be forced into foreclosure and bankruptcy over medical bills.

[bluezkattx]

I guess those 45,000 uninsured folk will be surprised to read that they really do have insurance... I have to say as an RN who came to Texas from Canada almost 20 years ago I have seen the US system from both sides. My room mate is uninsured and we spent 18 hours in the county ER when she had a fall and broke her shoulder. That room was full of people who had no option but to go to the ER due to lack of insurance... some had been there 24 hours or more. If they'd had insurance half of them could have gone to a Primary Care Physician, been assessed and treated in less than 2 hours depending on their reason for seeking help.
"Mr. Goodman... said anyone with access to an emergency room effectively has insurance, albeit the government acts as the payer of last resort. "
My first encounter with the consequences of having no insurance came when I worked as a Dialysis nurse at that same hospital on first arriving in Texas. I had a patient, 37 years old, who'd had both legs, and part of his right arm amputated due to letting a respiratory infection go untreated for over a week... he had no insurance and couldn't justify using money needed to feed his young family to pay for a "Doc-in-the-Box"...
I guess according to Mr Goodman, that constitutes "good" health care coverage?

[debjones]

I am appalled by Goodman's statements-as a health care professional and as a human being. Regardless of what Mr. Goodman thinks, affordable health care affects all socioeconomic and racial groups. Middle class America is struggling with deductibles and copayments as well as the less fortunate. Telling people to go to the ER, they have to take care you does not help with long term solutions. You can't get a transplant or a bypass operation in an emergency room. We are already dealing with the rising cost of food, gas, etc. Why should we bankrupt hospitals and travel 50 miles further? Let's pray that Mr. Goodman and his team become truly informed on the issues in healthcare.

[kkcoo]

I was recently in Canada and was helping a young woman attemping to get c Cerebral Palsy person in a glider plane, he was so anxious to fly that he would have let us "stuff him in" He was extremly spastic and having a CP grandaughter, I asked if he had a Baclafen pump. She replied, we are trying to get him one but they are expensive and we have to wait at least 2 years to get one, The young man was 22 years old. I ask if they had used Botox and was given the same answer except.....was told this was too expensive to use. My grandaughter has been able to have both. If her insurance had not paid Shriners Crippled Children's Hospital would have done it free. They do not have that in Canada. I have been an ER nurse like you for 25 years, and yes, our health system needs revamped, but our hospital has never turned away a patient even when the situation was a clear abuse of the system. I am now retired and work PTOC at a County Health Clinic. There are provisions made for all children thru the local Children's Hospital but many parents are too lazy or too unconcerned to follow thru with the care for their children . Don 't blame our government totally for our problems. A great many of them are a result of our own personal irresponsibilty. An RN

[bluezkattx]

I wonder what Province your acquaintance was from as the health care plans vary from Province to Province. The Shriner's have a presence in Canada as well as the US. It may be that she was unaware of their programs or the availability of assistance.
I say this as a former Canadian nurse who still has family living in Canada who are receiving benefits that I can't get for my Medicare patients here in Texas.

[Pegeen]

As an Advanced Practice Nurse in an emergency department, I feel I need to comment on Mr. Goodman's ignorant remarks. Ignorant because I am sure he has excellent health insurance and doesn't know how 45 million uninsured working people obtain health care.
Yes we do provide some primary care in our ED - immunizations, care for dental problems, blood pressure screening, health care for the mentally ill who have not seen a regular physician in years, to name just a very few things we provide. We grumble sometimes about seeing these patients, but underneath it all, we know we are providing a service that is not available to them, even though we have to eat the cost.
Especially compelling are the little children, living in poverty yet so bright and full of optimisim before they grow up to see the despair their family has in trying to provide for them.

[BKJ]

As an RN with over 30 years working in hospitals and clinics, I see uninsured every day. Sometmes it's irresponsibilty, but most people don't have resources to spend on a "maybe" expense("Maybe I'll get sick or in an accident and need to pay"), in favor of paying for the immediate -electricity, food, rent, etc. Using the ER is not only expensive, it doesn't help people manage anything but the acute problem of the day. no help preventing heart attack, diabetic complications, etc. We see patients every day who don't have recommended tests or take their medicines because of cost. My own adult son, uninsured after a layoff, needs back surgery. Lucky for him, he has parents who are willing to sacrifice to help him get the surgery he needs. Many people have no backup, and if something else happens, who knows who will help my son after we're tapped out? It's a disgrace that we don't have at least a base plan available for every American.

[baw4782]

Goodman's idea of using the ER for health care would create a disaster if EVERYONE dropped the expensive insurance they might have and EVERYONE who didn't have insurance used only the ER. I myself carry insurance with a high deductable ($5000) which doesn't pay for office visits etc. I am fortunate to be able to do this right now if I do have a major event--but who knows about tomorrow. I know of working families that have dropped their insurance and hope for the best. It is a shame that this country which has so much treats us like this. The insurance companies dictate what kind of care we can have or NOT have. The hospitals would be overwhelmed and it would all come crashing down.

[BetsyRN]

McCain's healthcare plan will free employers from subsidizing healthcare, thus cutting a huge corporate cost, when employees realize they will be taxed on the benefit. There is no incentive for employers to pass this cost savings from benefit reduction on to employees in the form of higher wages, resulting in higher corporate profit.
The McCain healthcare tax rebates will be about one third the cost of policies workers will then have to shop for themselves and their families, assuming they are in perfect health and young. Any worker with a pre-existing condition, chronic problem, mental health disorder, or any condition requiring treatment will either be unattractive to insurance companies to cover or will have sky-high premiums to maintain.
John Goodman's suggestion will I fear become policy as the only way to hide the inevitable millions of American workers now unable to afford health insurance will be to deny the problem exists. Of course when hospitals start to close because the majority cannot pay, and ER visits have waiting times measured in days instead of hours, the American public might wake up.
The McCain healthcare plan is a disaster for America and the only winners will be the corporate heads who live outside the USA and can enjoy the windfall profits without having to see the carnage.
Oh and by the way Mr. Goodman, McCain will need to provide government funding for all the hospitals, doctors offices and clinics whose admission forms erroneously now identify patients as uninsured.

[jpkilzcancer]

Obviously Goodman and McCain have no idea how 99% of the US population live. I have been an RN for 14 years working in an urban low socioeconomic area. Our ER is already overflowing, a pt recently told me about his 11 hour wait for care while he vomited blood throughout that time. We cannot blame the hospital staff. Hospitals are having to eat the cost of those ER visits by the un and underinsured. Cuts are being made in staffing requiring nurses to care for multiple patients in unsafe ratios. After I complained to a manager about not having time to bathe my patients I was told that baths are not necessary care. Our health care system is crumbling. I currently work with cancer patients and have to watch families decide whether or not to treat their loved one or go bankrupt paying for prescriptions, radiation and chemotherapy. These are people who have worked hard their entire lives. It is sickening. We have the best technology medicine has to offer but no one can afford to use it.

[wolfgangmo]

You are wrong. The IMPORTANT people can afford all the care they want. It is, after all, subsidized by the rest of us.

[OregonRN-for40years]

John Goodman's illogical advice r/t reclassifying insured persons in America according to source of payment bears uncanny similarity to another Republican President's suggestion 20 years ago that reclassification of ketchup and pickles as "vegetables" for school lunch menus would save money. We all know what bad outcomes can and did occur when the basic premise for this argument was dismissed as a non-issue - we got poorly nourished and overweight kids. If John McCain relies on such poorly informed advisors about health policy, there will be serious national health problems that may never be fixed. Get an expert in health care economics for an advisor.
Having worked for many years with uninsured persons with acute communicable diseases, I know that the present system of health care funding does not allow for timely treatment of infectious diseases unless there is impending death, or alternativelyt if the person comes to an appointment with cash in hand to pay for treatment. The use of insurance companies that operate for profit does not keep the best interests of patients in mind when making decisions about accepting or cancelling enrollees, and about limitations of coverage.