For the second time in three weeks, GOP presidential candidate Mitt Romney echoed George W. Bush, Tom Delay, Mitch McConnell, Paul Broun and other Republicans pretending that "people have access to health care in America. After all, you just go to an emergency room." But in claiming "We don't have people that become ill, who die in their apartment because they don't have insurance," Romney isn't just ignoring studies from Families USA, the Urban Institute and Harvard Medical School which put the unnecessary death toll for the uninsured as high as 45,000 a year. As it turns out, Mitt Romney wants to add over 45 million more Americans to the ranks of those without health insurance even as emergency rooms are vanishing around the country.
Last year, the New York Times revealed the magnitude of the Republicans' ER farce in an analysis of U.S. emergency room capacity.
Urban and suburban areas have lost a quarter of their hospital emergency departments over the last 20 years, according to the study, in The Journal of the American Medical Association. In 1990, there were 2,446 hospitals with emergency departments in nonrural areas. That number dropped to 1,779 in 2009, even as the total number of emergency room visits nationwide increased by roughly 35 percent.As it turns out, studies have been warning for years that America's overflowing emergency rooms do not have the capacity, staffing or funding to be the health care solution of last resort. 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:
Emergency departments were most likely to have closed if they served large numbers of the poor, were at commercially operated hospitals, were in hospitals with skimpy profit margins or operated in highly competitive markets, the researchers found...
Emergency rooms at commercially operated hospitals and those with low profit margins were almost twice as likely as other hospitals to close, Dr. Hsia and her colleagues found. So-called safety-net hospitals that serve disproportionate numbers of Medicaid patients and hospitals serving a large share of the poor were 40 percent more likely to close.
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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.
And that's in the best of times; the forecast for the worst of times is grimmer still. A March 2008 study from the House Oversight and Government Reform showed an American ER system woefully unprepared to handle a "predictable surprise" of a terrorist attack on the scale of the 2004 Madrid bombing:
The results of the survey show that none of the hospitals surveyed in the seven cities had sufficient emergency care capacity to respond to an attack generating the number of casualties that occurred in Madrid. The Level I trauma centers surveyed had no room in their emergency rooms to treat a sudden influx of victims. They had virtually no free intensive care unit beds within their hospital complex. And they did not have enough regular inpatient beds to handle the less severely injured victims. The shortage of capacity was particularly acute in Los Angeles and Washington, D.C.(Just last week, the Times explained how commercial clinics like those from Continuum Health Partners are trying to capitalize on recent hospitals closures in cities like New York. Meanwhile in Florida, the ER's at mega-chain HCA are profiting by bilking Medicare patients while erecting barriers to serving the uninsured. Ironically, HCA was acquired in 2009 by three private equity firms including--you guessed it--Bain Capital.)
Leave aside for the moment that U.S. emergency room capacity is shrinking or the percentage of uninsured in Massachusetts is 2 percent compared to almost 30 in Texas. To secure the Republican nomination, Mitt Romney adopted the Republicans' emergency room health care plan. So what if 50 million people would remain uninsured, another 25 million underinsured resulting in 45,000 unnecessary deaths a year even as a fifth of Americans defer needed care and over 60 percent of personal bankruptcies are related to medical costs? As Mitt Romney said of his intent to repeal Obamacare in March:
"If I'm the godfather of this thing, then it gives me the right to kill it."Even if, it turns out, Americans are literally dying to get it.