You, sir, are incorrect: an open letter to Mitt Romney

by Adrianna McIntyre

“We don’t have a setting across this country where if you don’t have insurance, we just say to you, ‘Tough luck, you’re going to die when you have your heart attack.’ No, you go to the hospital, you get treated, you get care, and it’s paid for, either by charity, the government or by the hospital. We don’t have people that become ill, who die in their apartment because they don’t have insurance.”

Mitt Romney, 10/11/2012

Dearest Willard,

A friend was kind enough to direct me to this piece detailing some of your recent comments on health care. I understand that ThinkProgress isn’t exactly a bastion of bipartisan objectivity, but they provided enough context for me feel comfortable telling you this: you, sir, are incorrect. I get that you’re on something of a tight schedule, what with this “election” business, so allow me to be brief:

People do die for lack of insurance. Hey now, I get what you were trying to say when you talked to The Columbus Dispatch–maybe, despite that last sentence, you were talking specifically about ER walk-ins suffering from heart attacks; yep, hospitals are obligated by law to treat them. As a politician, you’re entitled to choose your words carefully. And as a persnickety twenty-something, I’m entitled to call you out on it.

Anyways, here’s the problem: people are going to take from your comment that emergency rooms serve as an effective medical safety net, which means individuals don’t die as a consequence of being uninsured. Let’s ignore the argument over how expensive it is to treat the ER as a safety net (been there, done that, gotten the bill). Let’s just talk about the people who are dying, and–humor me–let’s talk data: according to a recent study in the American Journal of Public Health, 45,000 Americans die as a consequence of being uninsured every year. This correlates to a 40% increased risk of death, compared to the privately insured. A different study published in the New England Journal of Medicine this past July estimated that Medicaid expansions in Arizona, Maine, and New York resulted in a 6.1% reduction in mortality. So, in an expansion of 500,000 people, 2,840 deaths were prevented per year. Previous studies found similar reductions in mortality among infants (8.5%) and children (5.1%) after Medicaid was expanded in the 1980s.

So you see, there’s actually pretty broad academic consensus that people die in their apartments because they don’t have health insurance. Furthermore,

Hospitals are only obligated to provide care in immediately life-threatening situations and (surprise!) patients can legally be charged for it. It’s true that many hospitals provide uncompensated care; they treat individuals and absorb (or shift) the costs of that care. Hospitals that see a high number of uninsured have financial incentives to do so–for now–as they receive disproportionate-share (DSH) payments. But insofar as legal obligation goes, hospitals only need to stabilize patients whose lives are in immediate danger (like with that heart attack you mentioned, or a case of appendicitis). You know when you do get told “tough luck” in the ER? If you’re uninsured and find out from an emergency room visit that you have cancer. Also, nothing in EMTALA–that law that requires hospitals to provide emergent care–precludes hospitals from charging patients for that care. Just click through a few of those links when you have a chance.

I do my best not to wax political on this blog, but I hear you made a similar argument while talking to Scott Pelley on 60 Minutes a few weeks ago. I just thought someone ought to point out the factual flaws in your rhetoric–in case you’re receptive.

Sincerely yours,

Adrianna McIntyre
professionally persnickety twenty-something

Adrianna works in clinical research and is a graduate student in public policy & public health at the University of Michigan. Follow her on Twitter @onceuponA.


5 thoughts on “You, sir, are incorrect: an open letter to Mitt Romney

  1. Frank Clinton Lee says:

    Adrianna, It sounds like you have some good statistics to support your position. My suggestion is that you finish grad school, leave academia, and step into the real world. Work in a hospital ER and see the abuse, treatment, and uncompensated that occurs repeatedly every single day.

    • Hi Frank,

      Thanks for your comment. I actually do work in a hospital—not in patient care (I don’t have medical training, nor is that the focus of my graduate studies), but I work within the hospital system that currently provides the highest proportion of uncompensated care in the state of Michigan. I understand that there is a lot of uncompensated treatment happening at hospitals and clinics nationwide, and that many providers admirably make it part of their institutional mission.

      Unfortunately, data indicates that even with charity care, people die because they are uninsured. I’m happy to let politicians argue their own views on how (or if) to change that status quo, but I’d like to see them have that argument armed with the facts.

  2. […] Shorter Romney: All of you folks about to gain insurance thanks to the Affordable Care Act don't really need it because it's not as though you'll die without it. Which is, of course, very much untrue. […]

  3. […] Shorter Romney: All of you folks about to gain insurance thanks to the Affordable Care Act don’t really need it because it’s not as though you’ll die without it. Which is, of course, very much untrue. […]

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