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It's not so much what Mitt Romney said about whether the government should guarantee people health care in his interview on CBS's 60 Minutes Sunday that has health care policy types buzzing. It's how that compares to what he has said before.
To back up a bit, Scott Pelley asked the former Massachusetts governor if he thinks "the government has a responsibility to provide health care to the 50 million Americans who don't have it today?"
"Well, 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 — and die. We pick them up in an ambulance, and take them to the hospital and give them care. And different states have different ways of providing for that care."
That was basically Romney's way of saying that people who don't have insurance can always go to the hospital emergency room.
Yet in 2010, in an appearance on MSNBC, Romney said almost exactly the opposite: "It doesn't make a lot of sense for us to have millions and millions of people who have no health insurance and yet who can go to the emergency room and get entirely free care for which they have no responsibility," he said at the time.
That's because back then, Romney was defending the Massachusetts law he signed as governor. It's the one that requires most people to either have health insurance or pay a fine — just like the federal law he now vows to repeal.
He used even more colorful language back in 2007, talking to Fox News host Glenn Beck. "When they show up at the hospital, they get care; they get free care paid for by you and me," he said. "If that's not a form of socialism, I don't know what is."
But in addition to flip-flopping, Romney is missing a key fact about the uninsured and emergency room care, says health policy professor Harold Pollack of the University of Chicago. Just because hospitals are required to see patients in the emergency room doesn't mean that care is required to be free.
"The emergency room is perfectly entitled to send you a whopping bill," said Pollack. "And there are many people across America who are facing significant financial problems from serious bills that they've received for emergency care."
It's only when the uninsured don't — or can't — pay those bills that the costs come back to the taxpayers. Pollack also says Democrats and Republicans largely agree that emergency rooms are wholly inappropriate places for most people to get health care.
"It's just about the least cost-effective way you can get your medical care. And we also have really damaged the institution of emergency department care by expecting it to take on these burdens it's not really designed to assume — to provide primary care to low-income people," he said.
Romney is always quick to say he still supports the law he signed in Massachusetts. He simply doesn't want to require other states to do the same thing. But one of the continuing ironies of his health care position is that it was hundreds of millions of federal dollars that made the Massachusetts health law feasible. Under a Romney administration, other states likely wouldn't get a similar chance.