Health Care Is Not About Numbers

Romney made news today, at least in the left-of-center blogosphere, with the claim that, “[N]o one in this country dies because they don’t have health insurance” (an assertion I’d argue the former Governor of Massachusetts, a smart and informed man and the father of Romneycare, likely knows to be false). But I don’t think it was the most troubling statement from Romney published today about health insurance and preexisting conditions. That came, instead, during an interview with The Columbus Dispatch in which Romney tried to square the circle of his politically toxic support for repealing Obamacare’s protections for those with preexisting conditions:

Romney, in a meeting with The Dispatch’s editorial board, said those who currently don’t carry insurance would have a chance to make a “choice” to be covered without fear of being denied. But he didn’t specify how long Americans would have to make that choice, or what would happen to those who chose not to be covered and later fell sick.

Romney minimized the harm for Americans left without health insurance.

“We don’t have a setting across this country where if you don’t have insurance, we just say to you, ‘Tough luck, you’re going to die when you have your heart attack,’??” he said as he offered more hints as to what he would put in place of “Obamacare,” which he has pledged to repeal.

For crib notes on why this is a bad idea — assuming one actually cares about helping those with preexisting conditions, present and future — here’s Talking Points Memo’s Sahil Kapur:

What [Romney] didn’t specify: the length of the open-enrollment period. Nor did he say what would happen to sick people who cannot afford the prices set by insurers or those who fall sick — or are born — after the time window lapses.

“If the amnesty ever ends, the problem will just re-emerge,” said Austin Frakt, a health economist at the Boston University School of Public Health. “In part, that will happen because insurance may remain unaffordable without the subsidies that the ACA offers. An individual who can’t afford premiums will cease to have continuous coverage. What’s that person to do after this amnesty ends?”

Tim Jost, a professor of health law at Washington and Lee University, told TPM that covering preexisting conditions isn’t feasible without a mandate to purchase insurance and subsidies for those who can’t afford it — in other words, Obamacare. “If you don’t do those three things [market regulations, subsidies and a mandate] then it’s not going to work,” he said.

A Romney spokesperson did not immediately return a request to elaborate.

There are two explanations I can conjure up in response to Romney’s latest half-baked idea. Neither cast Mitt Romney in a particularly flattering light:

1. He genuinely hopes to do something like this were he to become president and is unaware of the manifold problems with the idea.
2. He knows the idea is a rather bad one, but he also knows it sounds good, it makes him sound less callous and uncaring, and what he’s offered is vague and off-hand enough that, even if he doesn’t carry through with it from the White House, few will notice, remember, or care.

As has been the case for Romney throughout his quixotic, half-decade long quest for the presidency, the GOP nominee’s comments are, while less than ideal from a PR perspective, not out-of-step with his party — even its ostensibly more intellectual, policy-oriented wing. For example, I’d point to this (long) post from Avik Roy, a tangential Romney advisor, on why Mitt’s proposed health care plan is superior to Obamacare. The short version of Roy’s argument is that Obamacare, because it involves regulation, will bankrupt us all; and, moreover, the number of people who are suffering from the preexisting condition syndrome is, relatively speaking, very small:

A Congressional Budget Office study found that, of those who are uninsured, only 3.5 percent were uninsured because their health was too poor to qualify. On the other hand, 71 percent blamed the high cost of insurance for their lack of it. 3.5 percent of 55 million is 1.9 million, or 0.6 percent of the U.S. population. It’s both a big number (1.9 million) and a small number (0.6 percent). If the CBO’s numbers are right, the pre-existing condition problem is one that we should pay attention to, and try to fix, but without making things worse for the other 99.4 percent of the population.

In general, Roy’s not wrong. But his blasé approach to a dysfunction that leaves people with the barbaric choice of maintaining their health or their economic livelihood (often losing both) is, to my eyes, disturbing. It’s a reminder that there are some very fundamental differences between the worldview of liberals and conservatives, differences that have little-to-nothing to do with whether or not one reads Breitbart while the other prefers The Huffington Post.

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