Voila

This is, obviously, idiotic ? though in an almost charming, movement conservative Tourette's sort of way ? but one wonders who Goodman thinks is going to be the payer of last resort for non-emergency care? Santa Claus?

Absolutely, it's idiotic, but it at least has the virtue of honesty. This is the inevitable result of a Republican health care "policy" that's forced to lie prostrate before the altar of free-market ideology. I'm just not aware of any other Republicans who've been as open about the consequences for anyone who can't afford insurance.

I have no idea who he thinks is going to pay for that emergency care, but I guarantee you that he has every intention of hanging the debt around the poor suckers on gurneys lining your local emergency room.

He doesn't believe in non-emergency care for poor people. If you're not within an hour or two of dying you don't need a doctor.

Meant to add: Voila!

This is largely being tagged as a policy statement of overflow the emergency rooms when you're sick. (Never mind that you still often get BILLS for that service if you're not insured.)

But I think it more indicative of the doublespeak/Ministry of Truth approach to GOP policy. Bad Facts? Pesky statistics? Well just prohibit various agencies from collecting those stats. If we don't have those stats then clearly we don't have a problem.

For instance: Prohibit the census bureau from counting people as homeless. Rather, designate them as living at the nearest shelter. And viola, we have no homeless in America.

Like most of McCain's "advisors", Goodman really does not know what the hell is is talking about. Except for limited circumstances, such as Medicaid payments for childbirth, "the government" does not pay for emergency care for the uninsured/unable to pay. It gets written off and becomes part of the cost charged to the insurance company and, most egregiously, as an inflated "book rate" to those without insurance but with too much money (i.e., one step above subsistence) to declare bankruptcy under the revised law. This is why big business is getting behind health care reform - unlike the Rethuglican think tankers, at least they have some concept that at some point, someone has to pay the bills.

Even better:

Why don't we just issue an executive order saying that there are no sick poor people -- alive or dead are the only possible categories.

Voila!

But what you don't seem to know, Kevin, is that McCain knows what it's like to life without access to an emergency room. He spent 5 years in a place where there were no emergency rooms. So um... So there!

Ah, not true! According to the late, great David Hackworth:

Yet in McCain's own words just four days after being captured, he admits he violated the U.S. Code of Conduct by telling his captors "O.K, I'll give you military information if you will take me to the hospital."

A Vietnam vet detractor says, "He received the nation's third highest award, the Silver Star, for treason. He provided aid and comfort to the enemy!"

Sounds like he health care while he was over there after all.

Most of the people I know who work in hospital administration have been trying for years to get people with non-emergency situations NOT to use ERs. They establish community clinics to which people get directed. They do almost anything they can think of.

Because ERs are (1) very costly and (2) very inefficient at providing non-emergency care. They can also be fairly dangerous places, because a fair number of the people being treated in big-city ERs are there after, um, interactions with the police. So there are people standing around with loaded weapons.

So any, even jocular, reference to increased use of ERs as a means of medical treatment betrays such a fundamental misunderstanding of how the health care system works, that it boggles the mind.

ER's are also not "free" to the patient. I have a friend, now retired, who became seriously ill while she was temporarily unemployed. She went to the ER, was admitted and treated for free. When she recovered she found a new job -- and the hospital sent her a bill, which she had to make arrangements to pay.

I have no idea who he thinks is going to pay for that emergency care, but I guarantee you that he has every intention of hanging the debt around the poor suckers on gurneys lining your local emergency room.

That's where it already is. These idiots pretend that people who use emergency rooms don't get the bills. Yes, as Marc in Denver notes, most of the bills eventually get shifted to the rest of us, but not before the patient is chased to the gates of hell in an attempt to extract payment. So credit gets ruined, meager savings accounts get emptied, houses and cars and every other kind of asset is lost--and all for a system that doesn't even provide preventive care. Try to get diabetes counseling or prenatal care or cancer treatment in an ER. Sorry--come back when your leg needs amputating, you're in labor or you're ready for the late Stage 4 morphine cocktail. We can make you comfortable while you die.

I just went on an insane rant about this over at Benen's, and I'm mad enough that I'll repeat it here: too many people do not get that your choices are being able to afford private insurance, getting it from your employer or declaring yourself totally indigent to get Medicaid. That last choice means you can't work, you turn over every cent and asset you have to the state, and you go on general assistance. WTF is wrong with this country?

Shortstop hit the nail on the head succinctly:

These idiots pretend that people who use emergency rooms don't get the bills. Yes, as Marc in Denver notes, most of the bills eventually get shifted to the rest of us, but not before the patient is chased to the gates of hell in an attempt to extract payment. So credit gets ruined, meager savings accounts get emptied, houses and cars and every other kind of asset is lost.

And in the process, the bill for everyone is inflated to cover the cost of chasing the deadbeat to the gates of hell; and as it sits unpaid 18% annual interest is tacked on every month, piling on more unproductive expense to the "cost of healthcare."

In our usual Democratic focus on the people who suffer – which is good but, unfortunately, not always the most politically effective in a nation where we were taught all too recently that "greed is good" and "government is the problem" – we forget that the primary functional purpose of a rational healthcare system is to make sure the people who do the work taking care of anyone know in advance they will get paid within a reasonable period of time. Not only will that timely reminder help draw healthcare providers to support a rational system – or at least neutralize them as political opposition in the election and afterwards – but it will help start to give content ordinary people can relate to when we rattle off the usual mantra, "wasteful administrative costs." On this score, how about adding in getting rid of the search for and sometimes prolonged labor-intensive battles over pre-existing conditions, and getting rid of or massively reducing the delay-causing finger-pointing exercise of coordination of conflicting benefits?

The circle of hell in which this guy should end up is an emergency room -- where we can all be sure he's never been. With crazy people, dirty people, sniffling people, bleeding people, crying people, very old people, very young people, no chairs left, and waits may not be the famous 4 hours that turns conservatives into single-payer advocates -- they might be 8, or 12. People _die_ in emergency rooms in my benighted city.

Tonight I wish Richardson or Gore would mention this story as well as the Gramm statements. McCain has quite a knack for picking advisors.

The worst thing is, it's not even true. I work in payroll and hospitals will (and do) seek court orders to garnish people's wages for bills. So while everyone is guaranteed emergency medical care they still have to pay for it, even if they're too poor to cough up the money at the ER entrance. And that doesn't fit my definition of insurance at all.