Editore"s Note
Tilting at Windmills

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August 28, 2008

THE REPUBLICAN E.R. PLAN.... John McCain's healthcare plan, by his campaign's own admission, doesn't even try to extend coverage to every American without insurance. We're starting to get a better sense as to why this is.

[John Goodman, president of the National Center for Policy Analysis, a right-leaning Dallas-based think tank] 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 nonsense is surprisingly common in Republican circles. Last year, 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.

In a way, they're right. If you're sick, there are public hospitals that will treat you.

But as is too often the case, conservatives haven't thought through the implications of their argument. First, it's extremely expensive to treat patients this way, and it would be far cheaper, and more effective, to pay for preventative care so that people don't have to wait for a medical emergency to seek treatment.

Second, under this McCain/Bush/DeLay model, sick people with no insurance go to the E.R. for care. They can't pay the bills, and hospitals can't treat sick patients for free, so the costs are passed on to everyone else.

In other words, the man responsible for crafting McCain's healthcare policy effectively described the most inefficient system of socialized medicine ever devised.

Update: 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.

Steve Benen 12:31 PM Permalink | Trackbacks | Comments (90)

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Ummm, any poor person who has ever been to an emergency room (I used to be such a person) realizes that this "insurance" only works after the hospital aggressively goes after the money from you and yours and then sells your debt to a credit agency, thus ruining your chances of Living the American Dream for at least five more years.

Posted by: PJ on August 28, 2008 at 12:34 PM | PERMALINK

Off topic but I just wanted to remind everyone what John "I'm Ready to be President" McCain was doing on the day Katrina hit New Orleans, August 29th, 2005:

http://www.whitehouse.gov/news/releases/2005/08/images/20050829-5_p082905pm-0125-515h.html

That's right, eating cake with George "Helluva Job Brownie" Bush.

Maybe that Twin Cities crack was justified.

Posted by: The Other Ed on August 28, 2008 at 12:35 PM | PERMALINK

Their fans don't look that far ahead. In their thinking, all a Republican need do is say "Solution!", and it actually is the solution to the problem. It's all so simple! Just go to the Emergency Room! Never mind the staffing bulge this would necessitate as everyone without health insurance flocked to the Emergency Rooms of the nation's hospitals - in some cities, the Emergency Department would eventually absorb the hospital in its entirety.

Posted by: Mark on August 28, 2008 at 12:36 PM | PERMALINK

"My friends, there was a time when I didn't have any health care...when I was a prisoner of war in Vietnam."

I'm sorry--I'm just anticipating the response after Obama's team makes hay out of this comment.

Posted by: Lev on August 28, 2008 at 12:36 PM | PERMALINK

There's another key point to keep in mind about emergency rooms, and that is that the "costs are passed on to everyone else" only as a last resort. Hospitals bill the recipients of ER services, whether they have insurance coverage or not (and in the event they don't, they're typically billed at a much higher rate). Hospitals will agressively pursue payment, often leading to financial ruin for the uninsured consumer of ER services.

Posted by: Bob Haskell on August 28, 2008 at 12:39 PM | PERMALINK

You can still be uninsured even though you can go to an emergency room. The E.R. just charges you a large amount of money. This happened to my dad last year. He was sick, went to the E.R. and found out he had a heart problem. They put in a dual-purpose pacemaker/defribulator and sent him a bill for six figures. He ended up declaring bankruptcy. Before this, his credit score was around 800.

The E.R. staff were shocked that a) he worked full time and didn't have health insurance and b) that he gave his real name. I suppose he could have lied, making billing impossible, but that would have made follow-up care and documenting his medical history a bit tricky.

Posted by: Brian G on August 28, 2008 at 12:40 PM | PERMALINK

The number of uninsured went down this month, largely due to a million more people becoming elligible for Medicaid. It boggles my mind that we consider these people "insured", since a little more income will put them back in the uninsured category.

Posted by: Danp on August 28, 2008 at 12:41 PM | PERMALINK

To PJ:

You did it wrong. You go to a state or county hospital without ID and give a fake name.

The ER has to at least stabilize your condition.

See!! That's a health plan if there ever was one.

Posted by: amy on August 28, 2008 at 12:41 PM | PERMALINK

Just call it the "Poor people die of Cancer" program.

You don't go to the emergency room when you have a lump in your breast. Or to get your PSA test, or a colonoscopy, or get that funny mole looked at, and so on.

Posted by: MobiusKlein on August 28, 2008 at 12:42 PM | PERMALINK

Last year I had to bring a family member to the emergency room, for a medical emergency, at 4:30AM. We had to wait in line behind a woman with a toothache and a woman asking about a pregnancy issue. Were these emergencies? At the time, it seemed as if these were just poor people with nowhere else to turn for medical advice and treatment. And our emergency just had to wait. . .

Posted by: RSA on August 28, 2008 at 12:43 PM | PERMALINK

If these "my country firsters" ever had to visit an ER they would see just how overcrowded and overburdened many ERs are. People who do need prompt care for critical emergencies often have to wait longer because of the overcrowded conditions caused by the uninsured who use the ERs for their health care.

Republicans -- if they don't like the problem and it reflects badly on their screwed up policies or lack of policies, they redefine it. But it is still the same old problem, no matter how you name it.

Posted by: lou on August 28, 2008 at 12:43 PM | PERMALINK

This is wonderful. By the same logic, we can end homelessness in one stroke.

You see that spot under the bridge where you sleep? That's your home! Enjoy it, and stop whining.

No, I can't spare any change. Take a bath and get a job. God, I love the free market!

Posted by: thersites on August 28, 2008 at 12:45 PM | PERMALINK

Also off-topic, but hoping it will generate some investigation and perhaps a new thread rather than hijacking this one - Russia just attempted to push a statement through the UN, formally condemning the US airstrike in Afghanistan which killed civilians, and taking pains to note that this has happened before.

It's not likely to succeed, but America is on notice - this is what you can expect every time America steps on its own dick in Afghanistan or Iraq; no more papering it over with a quick statement of denial from the military, but a pointed investigation and a big noise in the international press.

WaPo and the NYT both featured a story today quoting a US Diplomat, who said Russia's recognition of South Ossetia and Abkhazia was the action of a "weak country". This is the pushback, and if the US government truly thinks a resurgent Russia fat on high-octane western cash is weak, it is making yet another big mistake.

Posted by: Mark on August 28, 2008 at 12:46 PM | PERMALINK

So absurd. An asthmatic goes repeatedly to emergency rooms, but gets no actual care, drugs, training etc., unless s/he's in a crisis. That's a denial of the cheapest, most effective kind of care for sure. This costs all of us an immense amount of money.

Posted by: David in NY on August 28, 2008 at 12:48 PM | PERMALINK

"In other words, the man responsible for crafting McCain's healthcare policy effectively described the most inefficient system of socialized medicine ever devised."

Yes! Dems should be hitting this point everywhere they go. The Republican healthcare plan is to send anyone without insurance to the E.R....in other words, the most expensive, inefficient system of socialized medicine ever devised.

Pow!

But that is just the jab that sets up the haymaker! The next line goes something like this: But anyone without insurance who has ever been forced to utilze the E.R. will tell you how quickly the hospital will come after your money and drive you into bankruptcy.

Wammo!

Posted by: independent thinker on August 28, 2008 at 12:51 PM | PERMALINK

This Goodman fella is in the Dallas area - so he knows that eleven of the hospitals in the region are owned by the Frist-controlled Hospital Corporation of America. (see here for map)

HCA has a long history of screwing the government and therefore the taxpayer, and have produced no evidence that they will change their ways because crime pays. They pay the fine and the settlement and turn to a new scheme.

They have also been sued for price gouging - charging individuals five to ten times what they charge an insurance company for an identical service.

I was a shift supervisor in an HCA facility for several years after the company bought out Health Midwest in 2003. I know first hand how they operate, and when I say I know where some of the bodies are buried, in this case it isn't just an expression.

Posted by: Blue Girl on August 28, 2008 at 12:52 PM | PERMALINK

This "healthcare policy" is too stupid for commentary.

Posted by: Winkandanod on August 28, 2008 at 12:53 PM | PERMALINK

A liberal is a conservative who spent four hours on a Sunday afternoon at an emergency room waiting to see a doctor about an urgent, but not immediately-blood-on-the-floor-life-threatening, medical condition.

Attention Democrats: THIS IS A GAFFE.

OK, there's a convention right now, so everyone's busy. But if Democrats do not bring up this statement by McCain's health care advisor AT EVERY OPPORTUNITY from now on, starting with the talk shows this coming Sunday, we can only conclude that they aren't serious about winning.

Posted by: Basilisc on August 28, 2008 at 12:54 PM | PERMALINK

------------------------

Anyone think they can get chemotherapy in the ER?

-----------------------------------

Posted by: eightnine2718281828mu5 on August 28, 2008 at 12:55 PM | PERMALINK

Forgive my two year old rant:

I HATE REPUBLICANS! I HATE REPUBLICANS! I HATE REPUBLICANS! I HATE REPUBLICANS! I HATE REPUBLICANS! I HATE REPUBLICANS! I HATE REPUBLICANS! I HATE REPUBLICANS! I HATE REPUBLICANS! I HATE REPUBLICANS! I HATE REPUBLICANS! I HATE REPUBLICANS!

Ok, I feel better now.

Let's mention that:

- ER's won't cover cancer, will they?

- ER's won't do mammograms (perhaps if you tell them your breasts hurt or something), right?

- ER's won't cover anything routine, without cause, right?

This is absolute bullshit and it infuriates me that they can even be so callous about their hatred of regular Americans.

And what was said earlier about ruining someone's credit, further eroding their health due to concerns about cost and care, possible garnishment of wages which further impacts ability to live at all (hello! FOOD!), they don't go to the government first. It is a last result and it will always be uglly for the person who had to go to an ER for rudimentary care.

Have I mentioned that I HATE REPUBLICANS?

Posted by: MsJoanne on August 28, 2008 at 12:55 PM | PERMALINK

I hope the Rethugs keep this up, because Americans can see that when it comes to health care solutions... they got nothing.

Barack should do a tour of ERs, and see how well the Republican plan would work. Interview the staff, the patients, and the brass.

Posted by: Racer X on August 28, 2008 at 12:56 PM | PERMALINK

"In a way, they're right. If you're sick, there are public hospitals that will treat you."

No, they are wrong.

If you are merely sick, say with fairly early cancer, heart disease, etc hospitals may well turn you away.

If you are acutely ill they will probably treat you.

HUGE difference, even before we get to the "probably".

Posted by: JeffF on August 28, 2008 at 12:57 PM | PERMALINK

That's not 'insurance.' That's theft.

People are stealing service from the hospital they can't afford and when a creditor can't recoup the hospital's loss, the cost is passed on to people who can pay or do have insurance.

Does the fault lie with the person who can't afford insurance or proper care or with the 'let them eat cake' Republicans who'd just as soon let them die as extend a governing hand?

I'm going with option B.

Posted by: doubtful on August 28, 2008 at 1:00 PM | PERMALINK

"are there no prisons? and the union workhouses, are they still in operation?"

ebenezer mcsame

Posted by: mellowjohn on August 28, 2008 at 1:07 PM | PERMALINK

As mentioned upthread, hospitals WILL bill you, even if you don't have insurance. And ER's are only required to get you to a stable condition, ie, treat emergencies. If you've got a long-term illness, they will not treat you for that illness, although they may treat immediate symptoms.

I'm not even sure that the government acts as a payer of last resort. I don't know what provisions the government provides to hospitals for non-payment of ER services. There may well be some. But as far as I know, hospitals write off the loss and jack up everyone else's prices. I don't think the government reimburses them for anything.

Anyone who says "The uninsured can just use emergency rooms" shouldn't even be involved in the health care debate.

Posted by: Royko on August 28, 2008 at 1:12 PM | PERMALINK

Ever since Reagan made compassion passe', these jokers cannot approach any social problem seriously. Therefore "solutions" like this seem perfectly plausible. Or it could just be plain and simple ratfucking.

Posted by: Stooleo on August 28, 2008 at 1:12 PM | PERMALINK

The most inefficient system of socialized medicine ever devised is also the most profitable. In capitialist societies profits are more important than people's well being.

Posted by: Tommy on August 28, 2008 at 1:13 PM | PERMALINK

I dunno. Maybe it IS the start of the solution.

Once we consider these people insured by the government as a last resort, maybe these modern day Maries Antoinette will take an interest in avoiding the high cost of ER care.

They're actually accepting responsibility for people's health care. I'm not sure they understand the repercussions of their admission that the taxpayer is footing the bill.

Posted by: toowearyforoutrage on August 28, 2008 at 1:14 PM | PERMALINK

I want to echo what Blue Girl just said. I can only afford a health savings account coupled with a high deductible insurance policy. Recently after a hard day remodeling I became dehydrated and suffered severe cramps. An ambulance was called I was taken to an HCA facility. I was fine before the ambulance arrived at the hospital but everybody wanted to make sure that I was OK. I received a "bill" from HCA which was a shocker. The initial HCA bill was enough to choke a horse. The insurance company "negotiated" and my final bill (insurance payment plus my deductible) was about 1/4th of the initial bill.

Even a health savings account coupled with high deductible insurance is better than going to the emergency room naked.

Posted by: Ron Byers on August 28, 2008 at 1:16 PM | PERMALINK

A few years ago I had to go to the ER for an infected splinter in my finger. After 15 minutes, the doctor prescribed me some antibiotics. The cost? $2200.00. I'm not kidding. I could pay it, but people without insurance are massively overcharged. And we have to pay it.

Posted by: fostert on August 28, 2008 at 1:17 PM | PERMALINK

If you've seen the news clips of hospitals in L.A. literally dumping homeless and elderly patients onto the skid row sidewalks, you know that hospitals don't "treat" poor patients. They may put a band-aid on a wound, but they're looking to get rid of the patient as soon as they can.

Posted by: Rosali on August 28, 2008 at 1:18 PM | PERMALINK

Make no mistake: Goodman knows precisely how absurd it is to suggest that ER care is somehow a substitute for the continuity of care available through a good primary care provider. He just doesn't give a damn.

As someone upthread mentioned, the Dems need to hammer this one home.

Posted by: JM on August 28, 2008 at 1:20 PM | PERMALINK

A nit to pick, but would there not be an uproar if an Obama confidant included "illegal aliens" with Americans? From the quote:
"equiring the Census Bureau to cease and desist from describing any American -- even illegal aliens -- as uninsured"...

There you have it. Shouldn't Dems be out there saying how McCain considers "illegals" to be Americans?

Posted by: anonymous on August 28, 2008 at 1:21 PM | PERMALINK

A nit to pick, but would there not be an uproar if an Obama confidant included "illegal aliens" with Americans? From the quote:
"...requiring the Census Bureau to cease and desist from describing any American -- even illegal aliens -- as uninsured...".

There you have it. Shouldn't Dems be out there saying how McCain considers "illegals" to be Americans?

Posted by: anonymous on August 28, 2008 at 1:22 PM | PERMALINK

Ron, I know which facility you were taken to and have worked a few shifts in the lab in that facility. There was a fine levied for "unbundling" lab tests - that is how you turn a $60 metabolic panel into a thousand dollar bill. They kept doing it to the uninsured even after medicare busted 'em for it. There is a down side to HIPPA - makes it almost impossible for the patients to find one another and file a class action suit.

Posted by: Blue Girl on August 28, 2008 at 1:26 PM | PERMALINK

What an extraordinary statement. It really cements the image of "caring Republicans". Good lord.

With statements like this:

1. I am amazed that anyone making less than $250k thinks that McCain is a viable choice.

2. Republicans have finally shown their true colors - that they are made up of religious nuts and rich folks who can give a collective-f*ck about anyone but themselves.

Posted by: inthewoods on August 28, 2008 at 1:28 PM | PERMALINK

As I was explaining to someone yesterday, there are a whole lot of downsides to HIPAA, which isn't the magic solution it gets billed as.

Posted by: shortstop on August 28, 2008 at 1:30 PM | PERMALINK

If you are indigent and have no need for credit this strategy may work--though then you probably qualify for Medicaid. If you have assets and/or a need to borrow this is a good way to lose your credit rating and be endlessly hassled by debt collectors.

No they can't turn you away but they don't have to provide the care without charge.

Guess who is paying for all this "free" care--the other patients of the institution and their insurers. Quite a system we have!

Posted by: Cycledoc on August 28, 2008 at 1:37 PM | PERMALINK

This should become an ad and McCain should be hit with this silliness over and over again. The problem is the statement is so stupid on so many levels I am not sure where you hit McCain first. Heartlessness, waste of health care dollars, etc. Where should we go. I like the idea that the heartless approach wastes health care dollars.

If this guy really is McCain's top health care adviser it is clear the McCain camp is clueless on the issue.

Posted by: Ron Byers on August 28, 2008 at 1:41 PM | PERMALINK

"In other words, the man responsible for crafting McCain's healthcare policy effectively described the most inefficient system of socialized medicine ever devised."

Can you point to any examples of efficient systems of socialized medicine as a basis for comparsion?

Posted by: Chicounsel on August 28, 2008 at 1:44 PM | PERMALINK
In a way, they're right.

An ER can't turn anyone away because of inability to pay, it can, however, turn them away after an exam without any treatment because they aren't in need of stabilization, which is all an ER is obligated to do; they'll just tell you to see a regular doctor, and if you don't have one might give you the address of a clinic that treats indigents.

Posted by: cmdicely on August 28, 2008 at 1:53 PM | PERMALINK

This makes me so angry I can hardly see straight. Half the people listening to this shit (low-information Republican voters, I'm looking at you, you mentally lazy assholes) don't even realize that you have to be completely indigent to qualify for Medicaid or most state programs; otherwise, as people have pointed out above, you can lose everything you have and wreck your credit paying the emergency room bills. I know someone who died extremely prematurely and painfully because he couldn't afford treatment, especially emergency room treatment, and he couldn't bring himself to give up every cent of his meager assets in order to throw himself at the mercy of the state--he would have had to go on general assistance to get the Medicaid.

It isn't going to be long until every person in America knows someone like this. Then will these people fucking get it?

Add to that the inefficiency and staggering costs of doing health care this way, and the needless suffering coming from the lack of preventive care available in ERs, and the stupidity burns like acid.

Posted by: shortstop on August 28, 2008 at 1:54 PM | PERMALINK

Where does that leave someone like me with a pre-existing condition? I have crohns, a very expensive disease to treat. Because of it, I would be denied coverage with any health insuruer. I'm Canadian and my work insurance covers the perscription drugs, so thankfully I don't have to worry. But my condition is one that is becoming more and more common in the US as well.

Sure, people like me could just suck it up and wait for the large intestine to explode so we could finally get some treatment at the ER, and maybe we'd even survive the toxic shock without too much long term damage. But unless we get actual treatment for our conditions (and I extend this to all people with chronic illness far worse then what I have, the Cancer's, the AID's and other life taking illness), this is not health care. And the fact that these people think it is says so much about their warped minds then anything else I can think of.

Posted by: Kevin on August 28, 2008 at 2:00 PM | PERMALINK

So ... instead of actually fixing the problem, his solution is just to define it out of existence?

Typical GOP.

I hope Goodman loses his job and insurance, has all his money stolen, and then gets some terminal illness. He'll see how great the ER is then. Asshole.

I know, I know ... very shrill and unhinged.

But for people who talk about a "Culture of Life," they sure don't seem to give a shit if their policies lead to hundreds of thousands of American deaths, do they?

Posted by: Mark D on August 28, 2008 at 2:03 PM | PERMALINK

So ... instead of actually fixing the problem, his solution is just to define it out of existence?

Typical GOP.

I hope Goodman loses his job and insurance, has all his money stolen, and then gets some terminal illness. He'll see how great the ER is then. Asshole.

I know, I know ... very shrill and unhinged.

But for people who talk about a "Culture of Life," they sure don't seem to give a shit if their policies lead to hundreds of thousands of American deaths, do they?

Posted by: Mark D on August 28, 2008 at 2:03 PM | PERMALINK

Whoa ... how the hell did that double post? That never happens around here.

Sorry about that -- wasn't trying to do a Swan impression or anything ...

Posted by: Mark D on August 28, 2008 at 2:05 PM | PERMALINK

Can you point to any examples of efficient systems of socialized medicine as a basis for comparsion?

The VA - before Iraq wrecked it because they haven't increased funding and staffing to accommodate the influx of new veterans needing services.

Posted by: Blue Girl on August 28, 2008 at 2:05 PM | PERMALINK

Can you point to any examples of efficient systems of socialized medicine as a basis for comparsion?

Japan's.

Posted by: Gregory on August 28, 2008 at 2:08 PM | PERMALINK

The media should repeatedly question McCain about whether he agrees with this until he either repudiates it (which he won't), agrees with it (throw me into that briar patch), or blows his cool. Democrats should begin to mock McCain about this in their stump speeches. This seems to be a gift to Obama. He and the Democrats should use it.

Posted by: Hanan Kolko on August 28, 2008 at 2:09 PM | PERMALINK

"But as is too often the case, conservatives haven't thought through the implications of their argument."

You could have stopped after "..conservatives haven't thought".

At least it's consistent with the dietary advice provided in the Rethuglican health care plan: "Let them eat cake."

Posted by: Uncle Jeffy on August 28, 2008 at 2:09 PM | PERMALINK

"An ER can't turn anyone away because of inability to pay, it can, however, turn them away after an exam without any treatment because they aren't in need of stabilization"

That's true but it gets even worse. My brother came into an ER several years ago complaining about his appendix hurting. They took an X-ray without any dye (dumb, I know) and told him he was fine. He reiterated that his appendix really hurt and they replied that if he had appendicitis, he would be in too much pain to walk. So, they sent him home, and his appendix burst 5 hours later. So instead of getting $5,000 dollars worth of treatment, he needed $130,000 worth of treatment. And had to pay it. Of course, he said the magic word ("malpractice"), and his bill was reduced to $50,000.

Posted by: fostert on August 28, 2008 at 2:16 PM | PERMALINK

"But as is too often the case, conservatives haven't thought through the implications of their argument."

I think they know exactly what they are doing, which is to prevent the reform of a system that works well for them. Republicans serve the business community, and the health care business is doing extremely well. They like it this way. That ER proposal isn't meant seriously. It's just one way of distracting us from the issue. Here we are arguing the merits of a non solution that they threw out so we'd argue about it and forget what we're supposed to be doing. To top it all off, they know the media will take whatever they throw out and turn it into a he said/she said pointless, futile debate.

And remember, money wasted doesn't disappear - it goes into somebody's pocket. And if it winds up in a rich man's pocket, well, then that's good, isn't it?

Posted by: on August 28, 2008 at 2:26 PM | PERMALINK

"But as is too often the case, conservatives haven't thought through the implications of their argument."

I think they know exactly what they are doing, which is to prevent the reform of a system that works well for them. Republicans serve the business community, and the health care business is doing extremely well. They like it this way. That ER proposal isn't meant seriously. It's just one way of distracting us from the issue. Here we are arguing the merits of a non solution that they threw out so we'd argue about it and forget what we're supposed to be doing. To top it all off, they know the media will take whatever they throw out and turn it into a he said/she said pointless, futile debate.

And remember, money wasted doesn't disappear - it goes into somebody's pocket. And if it winds up in a rich man's pocket, well, then that's good, isn't it?

Posted by: hark on August 28, 2008 at 2:26 PM | PERMALINK

The VA - before Iraq wrecked it because they haven't increased funding and staffing to accommodate the influx of new veterans needing services.

Posted by: Blue Girl on August 28, 2008 at 2:05 PM |

The VA exists because it is proper for the government to completely pay for the health care needs of those who volunteered to wear the uniform and with their service and sacrifice keep our all lazy asses free and secure.

Tell me, what have the uninsured and especially the illegal aliens who fall into that category ever done for our country that would justify spending public money in order to provide them with any health care at all?

Posted by: Chicounsel on August 28, 2008 at 2:39 PM | PERMALINK

The E.R. staff were shocked...that he gave his real name.

The medical system will force a two tiered identity system on the lower classes. An identity one is born with, used for taxes, education and credit, and an identity one receives health care for.

Posted by: Tommy on August 28, 2008 at 2:41 PM | PERMALINK

Tell me, what have the uninsured... ever done for our country that would justify spending public money in order to provide them with any health care at all?

Sen. McCain and other Republican candidates should tell the uninsured their labor is not valued enough to provide them with health care or other public goods. In McCain's nomination acceptance speech he should look into the camera and tell millions of Americans their contributions to society are not good enough to earn them the chance to see a doctor if they become sick.

McCain and Repubicans need to inform those without health insurance they need to work harder or become more patriotic and die for the good of the nation.

Posted by: Brojo on August 28, 2008 at 2:50 PM | PERMALINK

Brojo to chicounsel -

pwned!

Posted by: BuzzMon on August 28, 2008 at 2:54 PM | PERMALINK

"The VA exists because it is proper for the government to completely pay for the health care needs of those who volunteered to wear the uniform and with their service and sacrifice keep our all lazy asses free and secure."

So how do you feel about a candidate - aka McCain - that proposes rationing healthcare for veterans?

http://www.armytimes.com/news/2008/07/military_mccain_healthcare_072208/

Or how do you feel about his repeated votes against veterans across the board - here's an example:

"During a March 2005 Senate budget debate, McCain voted to kill an amendment that would have "increase[d] veterans medical care by $2.8 billion in 2006." That amendment lacked an assured funding stream, but lest one mistake this incident for a maverick's stance against budget-busting, there's more. Just a year later McCain voted against an amendment that would have "increase[d] Veterans medical services funding by $1.5 billion in FY 2007 to be paid for by closing corporate tax loopholes." Two days after it failed, he voted to kill "an assured stream of funding for veterans' health care that [would] take into account the annual changes in the veterans' population and inflation to be paid for by restoring the pre-2001 top rate for income over $1 million, closing corporate tax loopholes and delaying tax cuts for the wealthy." That amendment died quietly, forty-six to fifty-four."

http://www.thenation.com/doc/20080602/beutler

Republicans, and McCain specifically, talk a lot about honoring our soldiers, but have repeated shown that they will not. This is why he gets such low grades from major Vet organizations.

Posted by: inthewoods on August 28, 2008 at 2:59 PM | PERMALINK

What has McCain done to deserve his health insurance? Graduating at the bottom of his class at Annapolis? Crashing 5 planes? Bombing brown people from a safe altitude? Befriending a bunch of corrupt real estate developer in AZ? Divorcing his sick wife to marry a beer heiress? Cheating on said beer heiress with lobbyists several decades his junior?

Posted by: anon on August 28, 2008 at 3:02 PM | PERMALINK

*

Posted by: mhr on August 28, 2008 at 3:08 PM | PERMALINK

Tell me, what have the uninsured and especially the illegal aliens who fall into that category ever done for our country that would justify spending public money in order to provide them with any health care at all?

First of all, you can take your notion of some kind of two-tier citizenship, with veterans somehow more deserving of the fruits of citizenship than mere civilians, and stuff it in the garbage along with your copy of Starhsip Troopers, you facist jackass.

Second of all, uninsured people drive this economy, producing and consuming goods and services, including health care. Many working people don't have company provided health care, and our stupidly inefficient systems -- far more inefficient than any socialized system the more civilized industrialized nations enjoy -- are unaffordable even to middle class families. So you can take your notion of lacking health insurance as some kind of indicator of second class citizenship and cram that straight up your facist ass, you disgusting worm.

Moreover, as a civilized and democratic nation, we're perfectly capable of choosing to extend government paid health care to all Americans, just as we do veterans and the elderly. They deserve it, you reprehensible vomitous mass, because they're members of a decent and civilized society, one which even, to its great cost, tolerates the presence of authoritarians fools and scoundrels like you.

Shame on you, Chicounsel.

Posted by: Gregory on August 28, 2008 at 3:10 PM | PERMALINK

Algebra lesson:

If RTT = Republican Think Tank

RTT = Oxymoron

John Goodman = RTT - oxy

Posted by: Prup (aka Jim Benton) on August 28, 2008 at 3:11 PM | PERMALINK

Housing is important- you get the drift.

You know, mhr, you've convinced me. The government should stop subsidizing housing in any way -- including eliminating mortgage decudtions, guaranteeing bank deposits and eliminating Federally guaranteed loans. That'll sure eliminate roadblocks to prosperity and result in a booming middle class!

The irony of nihilist authoritarians like mhr complaining about Cuba when their idea of an ideal state is Somalia boggles the mind, though it's always amusing to be reminded of conservatives' ridiculous obsession with Communism.

Jackass.

Posted by: Gregory on August 28, 2008 at 3:15 PM | PERMALINK

Gotta love "Compassionate Conservatives" like Chicounsel and mhr.

People are sick? Let them go bankrupt or die!

People are hungry? Let them starve!

People are homeless? Let them freeze to death or die of heat exhaustion!

I mean, imagine just how horrific it would be if our nation actually took care of those in need -- you know, did something as stupid as take care of the sick and infirm, feeding the hungry, sheltering the homeless.

I mean, no good Christian (as all good GOPers claim to be) would ever, EVER let that happen. I mean, it's not like Jesus ever made it a point to help the sick or the poor or anything.

Oh, wait a second ...

Posted by: Mark D on August 28, 2008 at 3:17 PM | PERMALINK

Maybe the Republicans are trying to resurrect the "Welfare Queen." Here, the freeloading is about health care instead of food stamps but the strategy appears the same: stir up resentment in working-class people who are merely struggling to get by, against those who have even less.

Posted by: Katie on August 28, 2008 at 3:22 PM | PERMALINK
People are sick? Let them go bankrupt or die!

People are hungry? Let them starve!

People are homeless? Let them freeze to death or die of heat exhaustion!

Hey, isn't that what Jesus said to do?

Posted by: Gregory on August 28, 2008 at 3:33 PM | PERMALINK
People are sick? Let them go bankrupt or die!

People are hungry? Let them starve!

People are homeless? Let them freeze to death or die of heat exhaustion!

Hey, isn't that what Jesus said to do?

Posted by: Gregory on August 28, 2008 at 3:40 PM | PERMALINK

Ya, and if we just start calling the underside of bridges houses, we can eliminate the homeless people. What a fricken genius.
__________________

"Tell me, what have the uninsured and especially the illegal aliens who fall into that category ever done for our country that would justify spending public money in order to provide them with any health care at all?" - Chicounsel

If you could stop hating the poor and realize that by the time an non-emergency issue hits the emergency room, the costs are exponential and whether you like it or not, we, the insured tax payers are paying for it. So I don't have an issue doing the moral thing and making sure someone with a simple infection gets cured with a doctors visit and some antibiotics. Because if that infection goes untreated, we are probably going to pay for a surgical removal of the infected limb. It's a win, win, it's cheaper and it's the right thing to do.

The problem of course is the republicans who would rather spend more money and be a total jackass just so someone, somewhere, sometime doesn't get what they perceive as a free lunch.

That guy in the field picking watermelons probably works 10 times harder then you, so using your rational, he should get 10 times the health coverage, no ?? I am a Veteran and since you like the two tear system, do I deserve more of the American dream then you ??

How can you tell a republican ? Easy, they love social programs until the very second they feel like they are putting in more then they are receiving.

Posted by: ScottW on August 28, 2008 at 3:47 PM | PERMALINK

Another point I haven't yet seen made in this thread is that public hospitals are paid for by taxes raised at the county level, e.g. Cook County Hospital. The federal government has little or nothing to do with operating them, and if they are poorly run, the county government is a convenient scapegoat.

Posted by: gotoL on August 28, 2008 at 3:52 PM | PERMALINK

Tell me, what have the uninsured and especially the illegal aliens who fall into that category ever done for our country

Have you eaten a meal in the past decade?

You have them to thank for it.

Posted by: Bob Loblaw on August 28, 2008 at 3:59 PM | PERMALINK

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 for 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 or what is advocated by Democrats such as Obama.

Posted by: Ron Chusid on August 28, 2008 at 4:23 PM | PERMALINK

Because if that infection goes untreated, we are probably going to pay for a surgical removal of the infected limb.

Or -- and here's where, as usual, Chicounsel's reflexive Republicanism leads to bad public policy -- the infected person can spread that infection to others.

Posted by: Gregory on August 28, 2008 at 4:28 PM | PERMALINK

Tell me, what have the uninsured and especially the illegal aliens who fall into that category ever done for our country that would justify spending public money in order to provide them with any health care at all?

Even if as a typical Republican all sense of good and right and fellow-feeling is absent, you'd think that some basic self-interest in wanting to prevent the spread of infectious diseases -- diseases which could, after all, infect him -- would motivate him. But no -- the desire to punish the poor is stronger even than his own desire to save his own life. Impressive in its pathology.

Posted by: Stefan on August 28, 2008 at 5:11 PM | PERMALINK

Some wag once described Puritanism as the haunting regret that someone, somewhere, was having a good time.

In a similar sense, I think we can describe conservatism as the haunting regret that someone, somewhere, is being cared for.

Posted by: Stefan on August 28, 2008 at 5:13 PM | PERMALINK

I'm afraid that healthcare is one of those issues that's not going to be seriously addressed until the aftermath of a crisis, probably some epidemic of a highly infectious disease - avian flu, maybe, or tuberculosis - that overwhelms emergency rooms and makes it unsafe to go out in public. That is, when inadequate healthcare interferes with business.

Posted by: allbetsareoff on August 28, 2008 at 6:24 PM | PERMALINK

It should be mentioned that medical bills are the chief cause of personal bankuptcy in the United States. And like the man said, offering the ER as the insurance of last resort passes the expenses on to the people who can pay for the services while running the expenses up to a point where bankruptcy is likely. McCain is trying to pass the lack of a program off as a program, and his ditto heads will be happy to go along.

Let us not lose sight of the fact that this is a system filled with inequities and unnecessary losses.

Posted by: frank logan on August 28, 2008 at 7:41 PM | PERMALINK

John McCain got excellent free socialized medical care as a POW which saved his limbs and probably his life from a Communist nurse who still remembers him

Posted by: andy on August 28, 2008 at 9:12 PM | PERMALINK

I should probably know better....but I'm about to wade into a hornet's nest. Hey, somebody's got to present the other side. Here goes.

Yes, what Goodman said is ridiculous. He hasn't been what we call in my business, "media trained." In other words, don't say anything you wouldn't want to see in print. No doubt, he's wishing someone had given him that little nugget before a reporter from the Dallas Morning News called him up yesterday.

But this blog does an injustice in not reporting the rest of his (still foolish, but somewhat rational) quote. Here, I'll help:

"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.

To his point, to say this person is uninsured, or that person is insured, lacks nuance. It lacks context and most of all it doesn't address the problem.

Everyone on this blog agrees health care in the country is a problem. Ok, what good does the Census Bureau's stats do to fix that problem?

Zippidy Do Dah, Nada.

So here's what the Goodman's of the world say. Rather than take a number and hold it out there as some measure of insurance versus uninsurance, instead let's look at funding and find better ways to fund health care.

Instead what happens is people look at insurance numbers versus uninsured numbers, and equate it to care. But that isn't accurate. Health insurance is not health care. Currently, our system relies on the insurance system, mostly due to inertia, but this is the very heart of the problem. All that is being funded is a middle man. This is a problem and it doesn't address the real bugaboos in the system: One, how to make health care more affordable. Two, how to make sure there's enough health care providers to cover 300 million people.

Allow me to provide seom context for why health care is "expensive" in the US:

Employers are the primary provider of coverage. This prevents the creation of a national pool in which we can group all 300 million people into the US to defray the costs among the sick and the healthy. Rather, we are left to defray the costs across the gainfully employed, under 65.

In this plan, insurance companies then put a bunch of garbage into the plan which is far from necessary. Coverage for acupuncture, invitro fertilization, male erectile dysfunction are by no means preventive in nature yet they are included in many health care plans because they are lucrative.

Employees have little option to opt out of unnecessary coverage options listed above. What is needed is a national pool of insurance providers with options that allow people to purchase the amount of health insurance they need. But...

State regulations protect state health insurance providers rather than open a national market for health insurance. Yet, it's not all the state's fault...

Health insurance agencies, refuse payment to hospitals because hospitals often time inflate the cost of treatment. Hospitals inflate the cost of treatment because of the reasons listed below...

1. We place a huge emphasis on end of life care so people can die with "dignity." This will sound cold-hearted, but, is this the best use of health care costs? Sorry, sometimes we have to make the tough decisions, but we are prevented from making these decisions because of...

The tort bar. The tort bar extracts huge sums of money from doctors by using props (read: sick kids) in a court room to illicit an emotional response from jurors. These awards having no bearing, whatsoever on a doctor's incompetence. To pay for these grossly inflated awards, doctors take out hefty malpractice insurance, which they then pass on to the insurance companies, which refuse to pay for doctor services because they say the treatment costs too much.

Doctors, fearing malpractice lawsuits, run redundant tests, and often times unnecessary tests. This moves care beyond preventive for health, but preventitive for lawsuits.

So to Goodman's whole point, let's actually collect stats that are worth something. Let's look at why people elect not to purchase insurance. Let's look at how people pay for health care. Let's look at where those funds come from and what's the best means of transferring funds to pay for these services.

His delivery was off the mark, but why can't we work torward a solution rather than spend our energy posting comments like "I hate Republicans?"

Posted by: Eric Hazard on August 28, 2008 at 9:15 PM | PERMALINK

Why can't those people just call the doctor to come when they need him? Why would they want to sit in a doctor's office (or ER), sharing everyone else's germs? I don't have any health insurance either and it's never been a problem...

Posted by: CindyAntoinette on August 28, 2008 at 9:40 PM | PERMALINK
If you're sick, there are public hospitals that will treat you.

Not if you are non-emergent.

Posted by: Casey on August 28, 2008 at 11:17 PM | PERMALINK

Eric Hazard wrote: "Everyone on this blog agrees health care in the country is a problem. Ok, what good does the Census Bureau's stats do to fix that problem?"

They help make the case that there is a problem that needs to be fixed.

The question of how to fix the health care system was basicly settled during the Democratic primary, at least if you hope for anything to be done over the next four years. We are going with the Obama plan rather than the Edwards or Clinton plans.

What remains to be seen is whether the system will be changed, or whether the insurance industry and the Republicans will be able to preserve the status quo.

When a Republican like Goodman suggests that the Census Bureau statistics which Democrats use to make a case for reforming the health care system are "worthless," it's reasonable to suppose that the reason he is doing it is to make a case for retaining the status quo.

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