Death by Ideology
By PAUL KRUGMAN
Published: October 14, 2012
Mitt Romney doesn’t see dead people. But that’s only because he doesn’t want to see them; if he did, he’d have to acknowledge the ugly reality of what will happen if he and Paul Ryan get their way on health care.
Fred R. Conrad/The New York Times
Last week, speaking to The Columbus Dispatch, Mr. Romney declared that nobody in America dies because he or she is uninsured: “We don’t have people that become ill, who die in their apartment because they don’t have insurance.” This followed on an earlier remark by Mr. Romney — echoing an infamous statement by none other than George W. Bush — in which he insisted that emergency rooms provide essential health care to the uninsured.
These are remarkable statements. They clearly demonstrate that Mr. Romney has no idea what life (and death) are like for those less fortunate than himself.
Even the idea that everyone gets urgent care when needed from emergency rooms is false. Yes, hospitals are required by law to treat people in dire need, whether or not they can pay. But that care isn’t free — on the contrary, if you go to an emergency room you will be billed, and the size of that bill can be shockingly high. Some people can’t or won’t pay, but fear of huge bills can deter the uninsured from visiting the emergency room even when they should. And sometimes they die as a result.
More important, going to the emergency room when you’re very sick is no substitute for regular care, especially if you have chronic health problems. When such problems are left untreated — as they often are among uninsured Americans — a trip to the emergency room can all too easily come too late to save a life.
So the reality, to which Mr. Romney is somehow blind, is that many people in America really do die every year because they don’t have health insurance.
How many deaths are we talking about? That’s not an easy question to answer, and conservatives love to cite the handful of studies that fail to find clear evidence that insurance saves lives. The overwhelming evidence, however, is that insurance is indeed a lifesaver, and lack of insurance a killer. For example, states that expand their Medicaid coverage, and hence provide health insurance to more people, consistently show a significant drop in mortality compared with neighboring states that don’t expand coverage.
And surely the fact that the United States is the only major advanced nation without some form of universal health care is at least part of the reason life expectancy is much lower in America than in Canada or Western Europe.
So there’s no real question that lack of insurance is responsible for thousands, and probably tens of thousands, of excess deaths of Americans each year. But that’s not a fact Mr. Romney wants to admit, because he and his running mate want to repeal Obamacare and slash funding for Medicaid — actions that would take insurance away from some 45 million nonelderly Americans, causing thousands of people to suffer premature death. And their longer-term plans to convert Medicare into Vouchercare would deprive many seniors of adequate coverage, too, leading to still more unnecessary mortality.
Oh, about the voucher thing: In his debate with Vice President Biden, Mr. Ryan was actually the first one to mention vouchers, attempting to rule the term out of bounds. Indeed, it’s apparently the party line on the right that anyone using the word “voucher” to describe a health policy in which you’re given a fixed sum to apply to health insurance is a liar, not to mention a big meanie.
Among the lying liars, then, is the guy who, in 2009, described the Ryan plan as a matter of “converting Medicare into a defined contribution sort of voucher system.” Oh, wait — that was Paul Ryan himself.
And what if the vouchers — for that’s what they are — turned out not to be large enough to pay for adequate insurance? Then those who couldn’t afford to top up the vouchers sufficiently — a group that would include many, and probably most, older Americans — would be left with inadequate insurance, insurance that exposed them to severe financial hardship if they got sick, sometimes left them unable to afford crucial care, and yes, sometimes led to their early death.
So let’s be brutally honest here. The Romney-Ryan position on health care is that many millions of Americans must be denied health insurance, and millions more deprived of the security Medicare now provides, in order to save money. At the same time, of course, Mr. Romney and Mr. Ryan are proposing trillions of dollars in tax cuts for the wealthy. So a literal description of their plan is that they want to expose many Americans to financial insecurity, and let some of them die, so that a handful of already wealthy people can have a higher after-tax income.
It’s not a pretty picture — and you can see why Mr. Romney chooses not to see it.