(This is the first in a series on "The Top 10 Misconceptions About Poverty," based on Marie Antoinnette's alleged statement, "Let them eat cake.")
The conversation usually goes something like this:
"Did you know that there are nearly 50 million Americans who don't have health insurance?"
"Yes, I did. But those numbers are inflated. The actual amount is more like 16 million."
"Well, either way, it's too many. Whether it's 5% or 15% of the population, isn't it shameful that so many people in a society as wealthy as ours don't have basic access to health care?"
"What do you mean 'don't have basic access'? Even a homeless person can get health care when they really need it. Emergency rooms are required by law to treat anyone who comes through their doors. It's not like people are dying in the street."
At this point, the conversation invariably devolves into an argument about emergency room statistics, the benefits and savings that come with good primary care, and how much the current system increases everyone else's costs. And anyone who takes a serious look at the situation will know that emergency rooms are not the solution to our health care woes. At best, they're an expensive band-aid - but I won't bore you with the statistical argument here. That's been well-documented in other places.
Instead, I would like to point out the fallacy that is inherent in even attempting to make the emergency room argument. Even if it were a viable solution to the problem of the uninsured, why would someone on the right even suggest it? It goes against the entire conservative philosophy.
The one consistent belief that I have heard expressed by conservatives is "the power of the individual" - the notion that first and foreost, people are responsible for themselves. Self-interest, both at a personal and a corporate level, is the fuel for our economy. They object to a national health care system, and to anything that resembles socialism, because they believe at a fundamental level that it is not the government's role to ensure the people's welfare. The free market, powered by self-interest, is the way to achieve the greatest good for the greatest number of people.
So isn't the argument that the uninsured can use the emergency room for health care antithetical to this conservative philosophy? Because the insured patients that go to a hospital pick up the tab for the uninsured. What could be more socialistic than that? The "haves" are carrying the load for the "have nots."
Wouldn't a more consistent argument from the conservative side be to just tell the uninsured, "Tough. That's what you get for being lazy?" I've heard a few jerks say that, but most conservatives I know are compassionate people and want to do something to help those without access to health care. And most understand how complicated the actual solutions are going to be.
The real problem, then, with saying "let them go to the emergency room" is that it's a lazy answer. It's a way for a conservative to shut down a conversation, instead of digging into the more nuanced layers and issues which might expose some contradiction in their conservative beliefs.
So instead of launchging into a barrage of facts of figures on the impracticality of the ER solution, which will only lead to defensiveness, perhaps the best response is to agree and then take the discussion deeper - to say something like this: "Yes, letting them go to the ER might be something we can do for now. But why don't we talk about some solutions that are feasible for the long term, that don't involve just letting the insured patients pay for the uninsured."
You're not likely to get a ringing endorsement for a national health system out of such a conversation, but you might get past that reflexive and and completely impractical suggestion that the emergency is the solution to our problems.
