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." But while Mitt Romney reminded Joe Scarborough that the funds Massachusetts used to pay to meet that federal requirement made the Bay State's near-universal health care program possible, his 2012 GOP White House rival Tim Pawlenty wants to eliminate the law altogether.
The 2006 Massachusetts health care reform that now covers 97% of residents was made possible not only by the commonwealth's already low rate of uninsured. As it turned out, the state was already paying $1 billion a year to fund emergency room treatment for those without insurance coverage. And those dollars helped provide the subsidies for lower-income residents when Massachusetts put its insurance mandate into place.
And that, former Governor Mitt Romney told the crew on MSNBC's Morning Joe, is what enabled the universal coverage there he supported:
"Oh, sure. Look, it doesn't make a lot of sense for us to have millions and millions of people who have no health insurance and yet who can go to the emergency room and get entirely free care for which they have no responsibility, particularly if they are people who have sufficient means to pay their own way.
And so we said, look, we've got an idea. Let's take all the money we've been spending to give out free care, paying hospitals to provide free care, and let's use those same dollars to help people who can't afford it buy insurance."
But as he made clear last week, Minnesota Governor Tim Pawlenty has a different idea.
The man who calls himself T-Paw told Fox News' Greta Van Susteren (around the 2:30 mark in the video) 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.
"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. Meanwhile, Mitt Romney wants to deny to Americans nationwide what he helped Massachusetts provides its residents. But if Romney wants to bar the gate to coverage for millions of people, Governor Tim Pawlenty wants to close the doors to the emergency room altogether.