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COLUMNISTS
TODAY'S STORIES
28.08.2008
Stop Your Whining: Health Care Edition (Corrected)

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 

Posted: Thursday, August 28, 2008 12:34 PM with 14 comment(s)

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drdannyu said:

Soooo, women should go to the emergency room for the pap smears?  We'll be vaccinating children there?  Or chemo?  We'll be providing ER chemo?

This may be the stupidest thing I've ever read.  This man is an adviser to John McCain?  Are they sure they didn't accidentally interview the guy that used to be on "Roseanne"?  (Though, truth be told, he's probably too smart to say anything as stupid as this.)

August 28, 2008 1:08 PM

Rhubarbs said:

This would be a lot more persuasive if the guy were willing to forego insurance himself and rely on emergency-room care for his and his own family's care.

Similarly with Kathryn Jean Lopez's call to repeal the 19th Amendment:

corner.nationalreview.com/post

As soon as she announces her own voluntary commitment to stop voting, then we can take her seriously.

All arguments like this need to be met first with the question of whether one would accept the proffered "solution" for oneself. If not, then we really don't have to debate them on the merits, do we?

August 28, 2008 1:18 PM

tomeg said:

drdann, it may be stupid, which is but a consideration, not a flaw. It is, however, ideologically correct (IC) which is what counts, and only counts, with IC conservatives. No?

August 28, 2008 1:25 PM

WoodyBombay said:

Dr. Dan,

Maybe you've forgotten, but John McCain spent five-and-a-half years in a box in Vietnam and he didn't have access to an emergency room at all!

This fits right in with the Phil Gramm "nation of whiners" strategy McCain's campaign is employing. It's too bad there's no audio of this: "So, there you have it. Voila! Problem solved."

(Also, Jonathan, that link to the DMN isn't working.)

August 28, 2008 1:26 PM

kevincollins said:

Oh. My. Goodness. You know, when Bush said exactly the same thing as Goodman several months ago, I was very disappointed that he wasn't properly taken to task for that elitist, ignorant statement. I for one am a prime example of Bush's sunshine-in-the-ER nonsense: I was admitted to the ER at midnight because of a kidney stone (I knew that's what it was because I'd had one about 14 years prior, and you certainly know what it is, I tell ya) and was discharged 3 hours later with a bill of just over $6800; I was only working 15-20 hours a week, and told them from the get-go that I had no insurance, yet this didn't stop them from giving more than a few expensive tests. Now my credit is ruined, collection agencies seeking me out, and this was for 3 hours in the ER.

When will it get through everyone's head that preventive treatment is the key to lowering health-care costs because that'll put a big reduction in catastrophic ER visits? Why do so many of these low-income toe-the-line Bushies sit idly by an accept this kind of crapola from Bush's mouth?

August 28, 2008 1:33 PM

cleavet said:

Can we start calling them "conservative group-think tanks"?

August 28, 2008 1:41 PM

drdannyu said:

I...wow.  Every time I think of this clown's comments, my throat begins to close up.  We'll now be doing surgery in the ER!  (I know that they do it on the show, but that show has as much to do with real medicine as "American Idol" has to do with theology.)  Worried about that mole?  ER!  Irritable bowels?!  ER!!  Baby has colic?  ER!!!!  Back pain?  Nasal congestion?  Crying for no reason?  ER!  ER!!  ER!!

And you can default on the bill, because as a last resort the government will pay!  Or you can sell your house!  Or go without heat!!!!  OR FOOD!

ARRGHHHHHHHHHHHH!!  How can ANYONE listen to this man?  He sounds too dumb to find his own ass with both hands and a mirror.  McCain listens to THIS MAN??!  Jethro Clampett was busy?

August 28, 2008 1:43 PM

icarusr said:

Is there a tape of this interview?  They should be running this, plus the "nation of whiners", throughout the Republican convention.  Better yet - where is Ratner? - this should be part of the "proud of my ignorance" routine.

This is the curious thing.  Why is it that the Bush/McCain administration is looking and sounding increasingly like the Ahmadinejad administration in Iran?  Iran's Minister of Social Welfare announced two months ago that the Government will not collect and publish data on the poverty line. (This, after release of information indicating that by the most optimistic standard, some twenty percent of Iranians live under the poverty line, even as the country's oil revenues have gone up twenty-fold over the past three years.)  "What do these numbers prove? Nothing at all, they're just numbers."  No more data on poverty, no more poverty, problem solved.  

And so it is with the McCain Health Care Plan: "Stop asking if you're insured, and the problem is solved."  The ad writes itself; so does the joke.  Leno?  Colbert?

August 28, 2008 1:46 PM

cleavet said:

My sympathies, Kevin. I took my wife to the ER for a kidney stone about six weeks ago. No treatment was required (she had already passed the stone) and no tests were performed but it still cost us a cool thousand bucks. We have insurance, but it's one of those fraudulent high-deductible plans.

Good luck with your situation.

August 28, 2008 1:50 PM

icarusr said:

kevin: just don't tick the box on the Census, and the problem is solved, voilà.

August 28, 2008 1:55 PM

icarusr said:

"conservative group-think tanks" - excellent suggestion.  BUT, even "groupthink" implies some sort of thinking.  I think Orwell had the right idea: simplification of language: Conservative Unthinktanks.

August 28, 2008 1:57 PM

adaglas said:

Jeez Dan, you sound a bit stressed.  You should probably hit the ER, pronto.

August 28, 2008 1:58 PM

drdannyu said:

I have just changed the sign outside my office from "Pediatrics" to "ER," in the hopes for increased funding under a McCain administration.

August 28, 2008 2:19 PM

The Plank said:

The saga of John McCain and his official views on health care just keeps getting more interesting. As

August 28, 2008 4:02 PM