Based on his recent comments, it would appear that Republican presidential candidate Mitt Romney supports a radical overhaul of preventative healthcare in America—namely in that he wants to prevent 50 million of us from getting it. Over the past few years, as Republicans were pillorying President Obama for the socialist abomination that is the Affordable Care Act, there has been little chatter from the right as to what they would replace Obamacare with, should it be repealed. Perhaps taking note of the geriatric wrath directed at his running mate Paul Ryan when he attempted to disparage Obamacare at an AARP conference last week, Romney chose the path of least resistance with regards to healthcare while talking with Scott Pelle on 60 Minutes. During the interview, Mr. Romney took umbrage with the idea that there are people in this country without access to healthcare, remarking that, “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.” In other words, the Romney/Ryan healthcare plan for the poorest Americans is to wait until whatever you’re suffering from is just about to kill you, call 911, and pray to God your ambulance is being driven by one of the Duke boys.
Advocating for an ER-based medical system is not new territory for the GOP. Back in 2007, President Bush took time out during a speech in Cleveland to remind the audience that they are never without healthcare because, “after all, you just go to an emergency room.”1 Depending on what your definition of healthcare is, this could be seen as a true statement. In 1986, the federal government passed The Emergency Medical Treatment Active and Labor Act, which was put in place to ensure that no hospital in America could legally refuse treatment of someone if they were suffering from a life-threatening condition. Technically, what Bush and Romney said is correct in that, if you show up to the ER in cardiac arrest or with a .45 bullet lodged in your sternum, they are legally obligated to give you treatment regardless of whether or not you have insurance. An emergency medical condition is defined by the law as involving either a woman who is in active labor, or a health problem so serious that it could be reasonably expected to result in serious harm to bodily organs, serious impairment of bodily functions or death2. Of course, as soon as those potential issues have been stabilized, the hospital can kick your uninsured ass out with a medical bill that makes you wonder if you’d have been better off just staying home and dying in the first place.
The problem with this brilliant piece of policy-making is that the overwhelming majority of our contact with the medical system doesn’t occur when we’re going into septic shock or losing the ability to feel the left sides of our bodies. Emergency room care and health care are not the same thing, as is evidenced by the things that ERs are not required to treat. If you’re uninsured and a diabetic, you can’t simply walk into an emergency room and ask them for insulin or a kidney toxicology screen. Before the ER will take you in for care you need to wait until you’re fading in and out of diabetic coma or in need of dialysis. Basically, any preventative measure that could improve client health, stop disease while it’s still manageable and lower health care costs is off the table in the ER. If you want care, you’ve got to get so sick that they couldn’t really take good long-term care of you if they wanted to.
Mitt Romney knows this. We know that he knows this because his healthcare reform as the Governor of Massachusetts directly reflects the reality of what’s going on in our nation’s hospitals and primary care clinics. Much has been made of the fact that the system devised by Romney during his time as governor is remarkably similar to the nuts and bolts behind Obamacare. In his most recent book, the preemptively angry sounding No Apology, Romney goes through the “collective epiphany of sorts” that spurred on his administration’s efforts at health care reform. As he explains it, they all realized that someone was already paying for the urgent health care of the uninsured and it was up to the state to grab a hold of that money and, “redirect it to help the uninsured buy insurance instead,”3, allowing them to save loads of money.
Romney realized that the state and the healthcare system as a whole could reduce costs and become more efficient by empowering all citizens to utilize primary care and prevent unnecessary and expensive trips to the ER. According to one study, uncompensated care for the uninsured in America cost an estimated $56 billion in 20084. In turn, the majority of that money ends up coming out of the pockets of the average taxpayer as the federal government is forced to pay private hospitals to care for the uninsured. As a result, insurance companies are forced to raise their premiums to keep pace with growing medical costs incurred by the hospitals, and all of us end up paying dearly for it.
From a strictly financial perspective, expanding insurance coverage to all Americans represents the most lucrative decision we can make as a nation with regards to our healthcare. Mitt Romney the businessman knows this. It’s the reason why he put the individual mandate in place with Romneycare in Massachusetts and its the same reason he campaigned on the idea of cutting down on what he dubbed, “free riding” in ER’s when he was running for president in 2008. As recently as 2010, Mitt went on MSNBC’s Morning Joe and advocated helping the uninsured find a way to get coverage as a way to reduce medical costs. He only changed his position now because enough people told him that it’s what he had to do to get elected.
That, ultimately, is the scariest thing about this whole story. We’ve known for some time that the GOP could give two craps about the poor unwashed 47% in his country, but never before have we seen the desperate extent to which Mitt Romney is willing to buy into that contempt to win The White House. Yes, he has advocated tax breaks for the rich and has switched his opinions on abortion and small government. What Romney has done is very similar to what John McCain did when went against everything he stood for as a “maverick” in the 2008 election. There is no denying that Romney and McCain sold their scruples to their handlers and, more importantly, to their backers. The only difference between the two is that McCain once actually believed in bipartisan, independent ideas he used to espouse. You can still see it in the pain lacerating his face when he toes the party line on an issue he used to rail against. With Romney, there is no trace of that pain because he’s never really believed in anything he’s done. Mitt hasn’t flip-flopped because he was never wedded to the original position he flopped from. The only thing Mitt Romney has any conviction and unwavering support for is Mitt Romney. The man is tofu: he has no taste except for the juices he sucks up from the ingredients around him.