Romney’s Wrong: Lack of Health Insurance is Killing Us
In a recent 60 Minutes interview, presidential candidate Mitt Romney suggested the uninsured population in the United States doesn’t need health insurance to access medical care. Romney said, “We do provide care for people who don't have insurance… If someone has a heart attack, they don't sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care.
What Romney overlooked is that care to which he’s referring—emergency room care—doesn’t come cheap. The average emergency room bill came to $1,381 in 2011. That’s a bill the uninsured are expected to pay, and if they can’t, everyone else pays for it when the hospital offsets the loss by charging more from those who can pay.
But Romney’s comment misses the larger point by treating emergency rooms as simply another means of delivering care. In reality, emergency rooms should serve as the last line of defense, not as the primary care facility for a segment of the population. Behaving as though the uninsured have an alternative but sufficient means of health care delivery is simply irrational.
The data clearly demonstrate the uninsured receive inferior care. In their 2012 study Dying for Coverage, Families USA reports, “Across the nation, 26,100 people between the ages of 25 and 64 died prematurely due to a lack of health coverage in 2010. That works out to… 72 people who died prematurely every day.” Of those, 193 were Minnesotans.
Cost concerns make uninsured adults over three and a half times as likely to forgo preventive care and six times as likely to go without needed care. A separate study of ICU patients in Pennsylvania found the uninsured receive less aggressive care and have a higher likelihood of mortality compared to the insured visiting the same ICUs. And the problem isn’t just limited to adults—uninsured children who are hospitalized are twice as likely to die from their injuries, less likely to receive expensive treatment, and are sent home earlier.
Not only are the uninsured receiving inferior care, but they have to pay more for it: Without a health insurer to negotiate a lower payment rate, the uninsured are often billed more than 2.5 times the cost of services billed to a health insurer. Forced to pay more for a lesser product, it’s no wonder the uninsured are 25% more likely to die prematurely.
Furthermore, inferior care for the uninsured doesn’t just hurt them—it hurts everyone. Sarah Kliff reports that in areas with more uninsured patients, even those with insurance receive worse care, as hospitals are forced to spend more on uncompensated care and have less to spend on staff and equipment. She writes, “[I]f uninsurance were eliminated, there would be 3 to 5 percent fewer deaths among those who already had coverage” (emphasis mine).
If the Affordable Care Act continues on its path to full implementation, then the number of uninsured will shrink significantly in 2014, thanks to the expansion of Medicaid, the issuing of health insurance subsidies, and the enforcement of the individual mandate. That will mean better health outcomes for those presently uninsured—but it will also mean better health outcomes for everyone else.