The McCain Campaign’s Solution To Increasing Number of Uninsured

Evidence that the McCain campaign has absolutely no answer to the health care crisis can be seen in this report in The Dallas Morning News in which a McCain adviser attempts to dispute the significance of statistics showing a jump in the number of uninsured in Texas:

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.”

This is wrong on so many levels. It is true that an Emergency Room cannot turn anyone away. That does not mean that those utilizing an Emergency Room in this manner will not be charged. ER’s are far more expensive than other out-patient facilities, and those who are already forced to pay for their insurance out of their own pocket will have even larger bills.

Often such charges wind up going uncollected and ultimately result in the government paying more. The taxpayers wind up covering the uninsured, but in an inefficient and more costly manner. Rather than allowing such cost shifting to increase the costs of Medicare and Medicaid, it would be more efficient to apply the funds towards less costly out-patient care.

Even if there was no problem in paying for such use of the Emergency Room, this would be a poor substitute for health insurance. While ER’s do wind up providing more primary care than they should, they are not prepared to provide long term care of chronic disease or to provided preventative care. Receiving treatment from an Emergency Room is no substitute for having insurance coverage. You cannot make the problem of the uninsured go away by ordering the census bureau to stop counting them.

Update: Steve Benen points out similar problems with the McCain plan, but unfortunately makes the mistake made by many liberal bloggers with the counter-example he provides:

Of course, if we take McCain’s policy advisor at his word, and build a “socialized medicine” system around public hospitals, there’s a perfectly good model to follow: it’s called the VA system.

The McCain campaign looks very foolish for proposing ER’s as a solution for the uninsured. Unfortunately liberal bloggers who repeatedly link to this study risk looking almost as foolish. Studies of health care quality are very primitive at this point and mainly measure the ability of a health care system to input data into a computer system while revealing little of substance about actual care. The VA comes out looking good here due to its computer system, not due to the care they provide.

The risk here is that those who are aware of the very serious flaws in the VA system will realize that this is a poor model for health care nationally. If liberal bloggers who have no first hand knowledge of health care promote the VA as a model they run the risk of increasing opposition to Democratic plans among those who are aware of the VA’s deficiencies.

Neither ER’s or the VA provide a good model of either of what is desirable for a national health care policy or what is advocated by Democrats such as Obama.

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1 Comment

  1. 1
    battlebob says:

    I have heard the emergency room argument before.  If you have a problem, go to the emegency room.
    That removes PCPs from the chronic and longterm care needed for many ilnesses.
    Forget about testing for cancers.  I am alive because testing discovered a rare, fast-going cancer.  Without a routine wellness exam, it never would have been detected.
    McCain ignores the fact that emergency room care is the most expensive care.  People without insurance go there when they have an issue; not for premptive problem testing.
    Republicans have never believed in early detection of medical issues; even though most of the wealthy ones are alive because of prostate, heart, breast, colon, cervical tests for early problem detection.
    One of my coworkers is facing prostste issues as his PSA is rising.  As a person who said go to the hospital, I chided him for getting wasteful tests.  Just go to the hospital when he starts peeing or pooping blood, or when his lymph nodes look like golf balls.  It is ok for him do deny other life.

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