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For years, Republican leaders including President George W. Bush, former House Minority Leader Tom Delay and current Senate Minority Leader Mitch McConnell have insisted that "no American is denied health care in America" because "you just go to an emergency room."  Apparently, Minnesota Governor and 2012 White House Republican hopeful Tim Pawlenty didn't read the memo on the GOP's emergency room health care plan.

On Monday, the man who calls himself T-Paw told Fox News' Greta Van Susteren (around the 2:30 mark in the video above) that he favors the repeal of federal mandates requiring emergency rooms to provide treatment regardless of patients' insurance or ability to pay.  While ignoring the resulting body count, Pawlenty explained how his cost-cutting measure would work:

"One thing you could do is change the federal law so that not every ER is required to treat everybody who comes in door even if they have a minor condition. They should be --If you have a minor condition, rather than being at the really expensive ER, you should be at the primary care clinic."

When Van Susteren asked about the scenario when "you come in with chest pains, and like, you get horrible chest pains," T-Paw countered, "You have to do a little triage. That's for sure."

What is also certain is that hundreds of thousands of Americans end up in the emergency room each year precisely because they can't afford access to a primary care provider.

And if Tim Pawlenty read page 1 of the Republican playbook, he would have learned that the reliance on overcrowded, inefficient emergency rooms isn't a bug in the GOP health care program, it's a feature.

During a July 2007 visit to Cleveland, President Bush unveiled the Republican emergency room cure for the ills of the U.S. health care system. Rejecting the expansion of the successful - and even more popular - State Children's Health Insurance Program (S-CHIP), Bush assured Americans that there was no crisis in medical coverage:

"I mean, people have access to health care in America. After all, you just go to an emergency room."

In November that year, indicted former House majority leader Tom Delay took Bush's health care clown show overseas. Speaking in the UK, Delay announced:

"By the way, there's no one denied health care in America. There are 47 million people who don't have health insurance, but no American is denied health care in America."

The GOP's Emergency Room Health Care Plan also reemerged during the 2008 election. It was repackaged by the architect of John McCain's health care proposals, John Goodman. No one in the United States is uninsured, Goodman, pronounced, because Americans have access to emergency room care. As the Dallas Morning News reported:

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."

And as the health care reform debate heated up last year, the #1 Republican in the Senate led the charge.  While repeatedly decrying Democratic reform initiatives he insisted "denies, delays, or rations health care," Mitch McConnell told David Gregory on Meet the Press that Americans "don't go without health care":

GREGORY: Do you think it's a moral issue that 47 million Americans go without health insurance?

McCONNELL: Well, they don't go without health care. It's not the most efficient way to provide it. As we know, the doctors in the hospitals are sworn to provide health care. We all agree it is not the most efficient way to provide health care to find somebody only in the emergency room and then pass those costs on to those who are paying for insurance. So it is important, I think, to reduce the number of uninsured. The question is, what is the best way to do that?

McConnell's GOP colleagues were quick to propagate the talking point.  In July, Rep. Virginia Foxx (R-NC) announced, "There are no Americans who don't have healthcare. Everybody in this country has access to healthcare."  Rep. Paul Broun, her Republican ally from Georgia, concurred in a response to a constituent:

"People who have depression, who have chronic diseases in this country...can always get care in this country by going to the emergency room."

Sadly, even that Republican strategy is rapidly being overrun by the events on the ground.

As it turns out, a convergence of disturbing trends - 50 million uninsured, 25 million more underinsured, one in five American postponing needed care and medical costs driving over 60% of personal bankruptcies and an aging population - are having a cascading effect on waiting times and treatment at American emergency rooms.

While high-profile cases of the deaths of untreated ER patients in Los Angeles and New York put a face on the crisis, a 2006 report by the Institute of Medicine revealed that U.S. emergency rooms can barely cope with the volume of patients in the best of circumstances, let alone in the wake of crises such as a terrorist attack or flu epidemic:

The study cited three contributing problems to the rise in emergency room visits: the aging of the baby boomers, the growing number of uninsured and underinsured patients, and the lack of access to primary care physicians.

The report found that 114 million people, including 30 million children, visited emergency rooms in 2003, compared with 90 million visits a decade ago. In that same period, the number of U.S. hospitals decreased by 703, the number of emergency rooms decreased by 425, and the total number of hospital beds dropped by 198,000, mainly because of the trend toward cheaper outpatient care, according to the report.

In 2008, a Congressional panel looked into the ability of the nation's emergency rooms to handle a terrorist attack on the scale of the 2004 Madrid bombings which killed 177 people and injured more than 2,000.  The results were unsettling, including in Tim Pawlenty's home state of Minnesota:

None of the 34 U.S. hospitals surveyed earlier this year had the emergency space needed to handle a similar number of casualties. The results showed Hennepin County Medical Center in Minneapolis had five treatment spaces open in the emergency room. There were three beds available in the intensive care unit.

Defending his draconian plan to ration Medicare through complete privatization of the system serving 46 million American seniors, Wisconsin Rep. Paul Ryan recently argued:

"Rationing happens today! The question is who will do it? The government? Or you, your doctor and your family?"

Ryan, of course, omitted the real gatekeeper, the private insurance companies.  But as he made clear this week in calling for an end to the Republicans' talking point about emergency rooms meaning no one is denied access to health care in America, Governor Tim Pawlenty seems more than willing to play that role himself.

** Crossposted at Perrspectives **

Originally posted to Jon Perr on Fri Feb 26, 2010 at 10:59 AM PST.

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Comment Preferences

    •  Pawlenty's approach clearly leads to the (3+ / 0-)
      Recommended by:
      BlackSheep1, DaleA, whaddaya

      idea of ER's for the well insured (hmmm,maybe they could put a barcode on your insurance card to scan before the doors open)only.Which seems to be where all this GOP rhetoric is going.Yesterday's summit showed they just don't believe healthcare is a right.Full-stop.They think it is a luxury.

      "George RR Martin is not your bitch" ~~ Neil Gaiman

      by tardis10 on Fri Feb 26, 2010 at 11:11:20 AM PST

      [ Parent ]

      •  Hold up (1+ / 0-)
        Recommended by:

        The Democrats hold up a BLANK PIECE OF PAPER AND SAY---SO _THIS IS THE REPUBLICAN PLAN FOR YOUR HEALTHCARE--- Wonder how the 30 million  uninsured and the 45,000  who will die this year feel about this!!??

  •  Come Back When You Have Pneumonia (5+ / 0-)
    Recommended by:
    DaleA, slippytoad, eXtina, fl1972, tardis10

    So we will refuse to treat people until their condition becomes expensive to treat.


  •  here's what makes my head explode (6+ / 0-)

    Reading quote after quote, you realize that they make it sound as if you walk into the ER and walk out, all cured and happy.  

    You get a bill.  If you own a modest home like we do, that trip the ER and any illness or accident that brought you there will strip you of your house, garnish your wages, bankrupt you.  You are billed for those services, and they are astronomical if you are not insured.  (I think Illinois just passed a law where the hospitals can't charge you more than they charge the insured.  A small step).  

    Even people who I think of as intelligent, think it's free for anyone.  Unbelievable.  

  •  T-Paw is a non-starter for 2010 (1+ / 0-)
    Recommended by:
    Not much appeal beyond the land of Bachmania.

    Mark Sanford vacations in Argentina but John Ensign prefers the Hamptons.

    by mojave mike on Fri Feb 26, 2010 at 11:16:10 AM PST

  •  ER's and the Massachusetts Model (2+ / 0-)
    Recommended by:
    DaleA, tardis10

    It is worth noting that one of the things that made the Massachusetts model possible was that the state was already spending $1 billion a year to pay for the uninsured's use of emergency rooms.

    When the state put in place its insurance mandate, that $1 billion could be applied to subsidies for lower income residents.

    Of course, T-Paw has nothing like that in mind.

  •  There are all sorts of conditions that can not (6+ / 0-)

    be treated in an ER. Cancer is one. Diabetes is another. Anything that requires constant monitoring can not be treated in an ER. This total disconnect from how medicine works is beyond stupid.

  •  Diabetics (1+ / 0-)
    Recommended by:

    Can go to the ER if their sugar gets really high.

    But the ER won't send them home with insulin (which can cost $150-$600 a month depending on how much you need) or metformin tablets (which can cost $25 for a months' supply) or blood pressure medication (which seems to readily go along with Type II) or test strips (which are $1 each and could cost you $90 for a months' supply).

    Not only that, but even if they could the ER won't have an endocrinologist on hand to determine a correct course of treatment or educate the diabetic on how to track their diet.  

    Going to the ER with diabetes over and over again is what I would expect at the end stage of the disease.  After the third or fourth visit I'm sure the complications of blindness, gangrene in the feet or other extremities, or kidney failure would be the main complaint, and after that just fuckin' death.

    Now, that's just from my experience as a sufferer of the disease -- I know how absurd it is to imagine getting long-term treatment at the fuckin' ER.  Other chronic conditions are also equally absurd to imagine as an ER treatment.

    These guys are FUCKIN' clueless.

    "You have no interest in helping me do my job and I have no interest in helping you do yours" - Rep Geoff Simpson to wingnut radio host.

    by slippytoad on Fri Feb 26, 2010 at 01:50:24 PM PST

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