Romney: Let Them Eat ERs…

Mitt Romney’s bad week continued, as he was questioned about health policy on 60 Minutes shown Sunday night.

His answer was not just inconsistent with what he has said previously, as the Huffington Post reports. It spotlighted the fact that he doesn’t have anything to “replace” health care reform with after he would “repeal” it as he has promised. It suggested he would be fine with leaving millions of Americans uninsured, and leaving it up to the states–and in particular overstressed emergency rooms–to find a way to deal.

Romney said: “We do provide care for people who don’t have insurance. If someone has a heart attack, they don’t sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care.”

This seriousness of this problem was part of the reason that Republican Governors like Romney and Schwarzenegger in California became interested in a conservative approach to health reform–an individual mandate to get coverage–and which led them, in negotiation with Democratic legislators, toward broader reforms to make coverage available and affordable so that people could meet the mandate.

This answer suggests that Romney, who put his Massachusetts health reform bill in his gubernatorial official portrait, no longer believes health care and the uninsured need to be addressed. But in not offering a solution, it also mis-states the problem.

Even the articles in response don’t point out the main problem with the statement–that Emergency Room use is not a replacement for coverage.
* ERs are only required to stabilize a patient in the case of an emergency. ERs are not required to provide preventative care, or ongoing chronic conditions, or even treatments for cancer or AIDS.
* Whatever care is required, there is no prohibition on sending the uninsured, self-pay patient a bill–and it’s often inflated, and even if not it is usually the biggest bill they will ever receive in their entire life.
* As a result, the uninsured are half as likely to go to the ER than insured patients–and I suspect it is not because they have half as many emergencies.

So yes, the uninsured in the emergency room is a problem–it is the least efficient, most expensive way to provide care; it does strain ERs with visits that should have been done earlier in a non-emergency setting. And yes, unpaid ER bills from the uninsured leave a financial burden on the health system we all rely on, and a “hidden tax” on those who do pay insurance premiums.

But we can’t forget that the uninsured are also likely to go into debt, or bankruptcy, after an ER visit; as a result, they may not get care–even emergency care that they need, resulting in severe financial and medical consequences.

Thankfully, we as a nation have taken key steps, with the Affordable Care Act, to begin to address this issue. But rather than talking about how to advance it further to be more comprehensive, the debate is about repealing it–for folks who don’t have an alternative.

Health Access California promotes quality, affordable health care for all Californians.
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