The GOP’s emergency-room argument lives

THE GOP’S EMERGENCY-ROOM ARGUMENT LIVES…. I’d hoped we would hear the argument much less after the Affordable Care Act became law, but the notion that the uninsured can just rely on emergency rooms hasn’t gone away quite yet.

Here, for example, was Virginia Gov. Bob McDonnell (R) on Fox News the other day:

“The fact is a lot of people that don’t have insurance are getting [care] right now. They’re not denied in the emergency rooms. They’re generally not denied by doctors. It’s not a pretty system, but the idea that people are not getting health care particularly for critical needs is just — is just not the case.”

This is strikingly wrong. For one thing, doctors in private practice nationwide tend to take on patients with insurance. For another, all McDonnell has to do is spend a few minutes at a free clinic someday to realize all kinds of families in need go without much-needed care every day, in Virginia and elsewhere.

But it’s that darn emergency-room argument that needs the most help.

Let’s set the record straight. It’s true that under the previous system — before the Affordable Care Act passed — if you’re uninsured and get sick, there are public hospitals that will treat you. But it’s extremely expensive to treat patients this way, and it would be far cheaper, and more medically effective, to pay for preventative care so that people don’t have to wait for a medical emergency to seek treatment.

For that matter, when sick people with no insurance go to the E.R. for care, they often can’t pay their bills. Since hospitals can’t treat sick patients for free, the costs are passed on to everyone else.

In other words, it’s the most inefficient system of socialized medicine ever devised.

And yet, Republicans keep praising it. McDonnell was repeating this talking point over the weekend, but he’s hardly alone. Rep. Steve King (R-Iowa) was touting it late last year, and Sen. Jim DeMint (R-S.C.) was thinking along the same lines a month prior. In July ’09, Senate Minority Leader Mitch McConnell was asked about the 47 million Americans who go without health insurance, McConnell replied, “Well, they don’t go without health care,” because they can just go to the emergency room.

In 2008, the conservative who shaped John McCain’s health care policy said anyone with access to an emergency room effectively has insurance. The year before, Tom DeLay argued, “[N]o American is denied health care in America,” because everyone can go to the emergency room. Around the same time, George W. Bush said the same thing: “[P]eople have access to health care in America. After all, you just go to an emergency room.” In 2004, then-HHS Secretary Tommy Thompson said our healthcare system “could be defined as universal coverage,” because of emergency rooms.

It’s a dumb argument. That it’s been a staple of Republican rhetoric for so long only adds insult to injury.

Update: Aaron Carroll has a related post on this, which emphasizes a few points I’d overlooked. Worth a read.