An Emergency Room is not “health insurance”

Except that John McCain’s health care policy advisor thinks it is. (emphasis mine)

But the numbers [of uninsured Americans] 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.”

Yup! Let them eat cake! Or, instead, let them get eye care, dental care, preventive care, vaccinations, medications, and treatment for disease before it becomes life-threatening … at the ER! Yeah, that makes a whole lot of sense.

According to Mr. Goodman, only people who are denied care are truly uninsured – everyone who gets care is effectively insured by some mechanism. “So instead of producing worthless statistics that people fling around in vacuous editorials and pointless debates, the Census Bureau should produce meaningful numbers, identifying all of the sources of funds people will draw on if they need medical care,” he said.

Um … those who are denied care are uncared for. Not uninsured — which means not having health insurance. 

Now, granted, Goodman (and McCain) don’t actually seem to be saying that people should just get their health care at the ER. But understanding that people don’t have insurance to take care of stuff that is short of disastrous isn’t a “worthless statistic” — ER care is not just a “payer of last resort” (the emphasis on who’s ponying up for the money is telling), it’s simply not adequate or suitable to keep people healthy, just to (after sitting in the waiting room a dozen hours) deal with emergencies. It’s certainly of value to identify who’s picking up the tab — but that’s a secondary statistic (and, conveniently, a lot less embarrassing than identifying folk as “uninsured”).

Goodwin, by the way, is the one touting the McCain plan (he helped draw up) to remove the tax-exemption on employer contributions to health insurance (but, remember, that’s not a tax increase).

Of course, this is fully in line with President Bush’s belief that the ER is a fine source of primary medical care: “I mean, people have access to health care in America. After all, you just go to an emergency room.” 

Perhaps next time Sen. McCain needs to have some skin biopsied to look for cancer, he can just have the limo drop him off at the ER for the afternoon.