Defining misfortune down

Anyone who can get to an ER has health coverage, says the guy who invented the Health Savings Accounts that are the centerpiece of McCain’s health care plan. So the real number of uninsured is zero.

The guy who invented the “health savings accounts” that are the center of the McCain health care plan (such as it is) has a simple idea for dealing with the crisis of the uninsured: define it out of existence. If you can get to the emergency room, you can get health care, he says, so everyone has health coverage. The only problem is that we’re counting wrong:

I have a solution. And it will cost not one thin dime. The next president of the United States should sign an executive order requiring the Census Bureau to cease and desist from describing any American — even illegal aliens — as uninsured. Instead, the bureau should categorize people according to the likely source of payment should they need care. So, there you have it. Voila! Problem solved.

Of course, substantively this is insane on more levels than you can count:

1. It’s not true that the ER has to give you care of you show up. They’re legally allowed to show you the door if you’re capable of walking through it, and many do.

2. If you do get ER treatment and you’re poor, the hospital charges it to the “unpaid care” account and shifts those costs to everyone who does have health insurance, or charges it to Medicaid if you have Medicaid. In other words, as Steve Benen says, this is the world’s dumbest and most expensive form of socialized medicine. (Steve also points out that Republicans have been saying this sh*t for years, and getting away with it.)

3. But if you aren’t poor but are uninsured &#8212 if you lost your health coverage when you lost your job, or you’re self-employed and have a pre-existing condition that makes you uninsurable, or you work for Wal-Mart and don’t get health benefits with your job &#8212 then the availability of ER care doesn’t solve your problem, which is that you can afford health care or the rent but not both.

Still, the principle of solving all our problems by changing the way we count is an inspired one. Call it (after Pat Moynihan) “defining misfortune down.”

* Don’t count anyone as crippled who can get around in a wheelchair.

* Don’t count anyone as blind who has a seeing-eye dog.

* Don’t count anyone as homeless who has a place to sleep under the bridge.

* Don’t count anyone as an orphan who has a foster home.

* Don’t count anyone as unemployed who can dumpster-dive for used soda cans.

Those are some really big problems with really cheap solutions. I think we’re on to something here.

Update The news story linked to above describes Goodman as having “helped craft Sen. John McCain’s health care policy” and a “McCain adviser.” Apparently the McCain folks are denying it. But Goodman described himself as “an unpaid adviser to the McCain campaign” in the author note under this WSJ piece he wrote less than a month ago, and back then the McCainiacs weren’t denying it.

The headline of that piece is interesting: “McCain Is the Radical on Health Reform.” A radical conservative, an extremist, and a hothead: is this man fit to be Commander-in-Chief?

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: