Get Thee To An ER

It’s rare that Mitt Romney gets cornered into answering questions about what his agenda would mean for regular folks, and that’s particularly true with that la-la-la-I-can’t-hear-you category of domestic policy, health care. But it happened yesterday on 60 Minutes, when Scott Pelley pressed Romney on what will happen to people without health insurance if Obamacare is repealed. No problem!

We do provide care for people who don’t have insurance, people—we—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.

As TNR’s Jonathan Cohn promptly noted, this is pretty damn close to a “let ’em eat cake” response:

That statement isn’t untrue. But it leaves out an awful lot. ERs are great if you need urgent help with a major medical problem: You’ve had a heart attack, you’ve been in an accident, whatever. And, yes, hospitals will generally treat you regardless of insurance status, if only because the law requires it. As a condition of accepting Medicare money, hospitals must provide stabilizing or life-saving treatment. But they will not provide basic, ongoing care. They will charge a lot of money for their services. In many cases they will do their best to collect on outstanding bills, even if that means using techniques that even the retail industry eschews as overly harsh. And sometimes, as Sarah Kliff notes today, hospitals find ways to avoid providing care in the first place.

And as Jon also notes, Mitt Romney is entirely aware of these facts, because the cost and inadequacy of ER care was a big part of the rationale for Romneycare.

But the health system Mitt Romney is committed to creating now is a lot worse than the situation he faced in Massachusetts, thanks to his promised deep cuts to Medicaid; an interstate insurance sales proposal that would gut state health insurance regulation; and another proposal to undermine employer-based coverage.

No wonder the slippery dude has found a thousand reasons not to get below the slogan level in promoting his policy agenda. The Mitt Romney of the very recent past would be a pretty strong witness for the prosecution.

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Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.