Romney Claims That Emergency Rooms Provide Care Misleading To Say The Least...

Gov. Romney, 60 Minutes last night:

“Well, we do provide care for people who don’t have insurance,” he said in an interview with Scott Pelley of CBS’s “60 Minutes” that aired Sunday night. “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.”


Its not the first time a politician has suggested that emergency room care is somehow an adequate system for providing health care. Mississippi Governor Haley Barbour said, "Gov. Haley Barbour (R-MS) says Mississippi doesn’t need Washington’s help with health care reform because “there’s nobody in Mississippi who does not have access to health care. One of the great problems in the conversation is the mis-impression that if you don’t have insurance, you don’t get health care.” 

North Carolina Representative Virginia Foxx feels the same way about her State: 

Rep. Virginia Foxx (R-N.C.) disputes President Obama’s claim that 47 million Americans lack healthcare. “There are no Americans who don’t have healthcare. Everybody in this country has access to healthcare,” she says. “We do have about 7.5 million Americans who want to purchase health insurance who can not afford it,” she says, urging Congress to adopt a new plan for healthcare reform that wouldn’t “destroy what is good about healthcare in this country” and “give the government control of our lives.”

Sigh...

As the Romney campaign attempts to regain its footing over the last 43 days of this election cycle, health care is an issue that almost everyone has to deal with, either directly or indirectly. The issue that many take with Romney's, Barbour's and Foxx's comments is pretty straightforward. To imply that because everyone has access to the emergency room, therefore everyone has "healthcare" is misleading and when its from the case of a former Governor of a State that has implemented health care reform, its willfully deceptive. 

Let's look at the Federal law which requires all hospitals who accepts Medicare or Medicaid (almost all hospitals accepts one or the other.) The law is known as EMTALA or the 1986 Emergency Medical Treatment and Active Labor Act, signed by President Reagan guarantees anyone treatment who is in an "emergent condition." Hospitals are required by federal law to assess you and treat any conditions that warrant emergency treatment. The definition of "emergency medical condition" as described by the www.emtala.com website says:

A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in —
placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy,
serious impairment to bodily functions, or
serious dysfunction of any bodily organ or part, or

With respect to a pregnant woman who is having contractions —
that there is inadequate time to effect a safe transfer to another hospital before delivery, or
that the transfer may pose a threat to the health or safety of the woman or her unborn child."

So, while women in labor can count on being accepted for delivery of their baby, let's not suggest that they can also stroll in and receive pre-natal or post-natal checkups in the ER. It doesn't happen. 

There's any number of medical situations and conditions where the emergency room doesn't provide healthcare. Women can not receive Mammograms or routine gynecological exams via the ER. Adults in their early 50's are not permitted to walk in and receive colonoscopies on demand. Diabetic patients can't be screened for worsening sugar levels or have their meds adjusted until and if they decline into an emergent condition. Hypogylcemic shock and perhaps their feet begin to turn black from poor circulation. As The Incidental Economist Healthcare Blog writes: Emergency care is important, but it’s not the same thing as health care. We know that people with depression require treatment, but in an emergency room we can’t do anything about it until they are ready to commit suicide. We may know that you would benefit from a hip replacement, but until it fractures, there’s not much that will be done in an emergency department. We may know you  have arthritis, or ulcerative colitis, or migraines, or lupus, or hypothyroidism, or any of a host of other disorders, but until they are life threatening – there’s not much we can do for you. (Multiple authors, The Incidental Economist - June 23, 2011)

There are other issues as well that come into play regarding emergency room care. It's been discovered that often ambulance services will drive patients past certain hospitals that aren't friendly to the uninsured. Plus, more and more hospitals are trying to collect co-pays and sometimes more before treating ER patients. Finally, people who do have insurance can't always get into to see their doctor during business hours, which leaves them to after hours clinics or yes, emergency room care. 

Candidate Romney knows a good deal about health care reform from his work with Romneycare in Massachusetts. His comment last night on 60 Minutes was sure to raise a few eyebrows. The Obama campaign was quick to respond today with a political ad using the 60 Minutes segment against Romney. That ad is below, but pay special attention to Romney's comments starting at the :40 second mark through the :50 mark. He was talking about the individual mandate he utilized in Massachusetts, but describes emergency room care in a patently incorrect fashion: 




Entirely free care for which they have no personal responsibility? That's an odd thing to say since no health care is ever free. He knows this. Hospitals try vigorously to collect from patients, often using collection agencies to acquire payment for services rendered. Medical Bills are the main cause behind more than 60% of our total bankruptcies in the US in a 2007 study. Much of what the hospitals or collector's can recover is reimbursed partially, by Medicare, or our tax dollars. 

I understand Mr. Romney is trying to win the Presidency. I might suggest to him that answers like the one he gave last night on this issue probably convince very few people to vote for him that weren't already. What should he have said? I'm certainly no Republican strategist, but I'd have recommended this: 

"Yes, every American has a right to basic health care and I think its the federal government role to assist each State in deciding how best it can provide its citizens with a sensible path to accessing health care."

But, clearly, he didn't say anything whatsoever like what I suggested. Another blown opportunity for Mr. Romney. 


Sources: 

http://tpmdc.talkingpointsmemo.com/2011/04/barbour-says-everyone-in-mississippi-has-access-to-health-care----but-18-are-uninsured.php

http://thinkprogress.org/politics/2009/07/24/52639/foxx-americans-health-care/

http://www.emtala.com/faq.html

http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/09/24/the-emergency-department-is-not-health-insurance/

http://theincidentaleconomist.com/wordpress/when-the-emergency-room-is-your-only-option/

http://articles.cnn.com/2009-06-05/health/bankruptcy.medical.bills_1_medical-bills-bankruptcies-health-insurance?_s=PM:HEALTH