The Dallas Morning News should have known better than to run a news story last week that was essentially an op-ed for John Goodman, who heads the conservative National Center for Policy Analysis, a Dallas-based outfit that, over the past fifteen years, has been highly influential in setting the nation’s health policy agenda. The Center first championed medical savings accounts (MSAs), which morphed into HSAs, health savings accounts that combine a savings element with a high deductible policy—you know, the ones where you have to spend $5,000 or $10,000 on medical bills before the insurer pays a dime. In one of its own publications, the Center boasted that, between 1990 and 2004 (right after Congress approved HSAs), it had given 250 presentations on the subject in every state and published more than forty studies, backgrounders, and analyses, as well as placing op-eds in the Wall Street Journal and the Washington Times.
You’d think that the Morning News would have investigated this before turning its story on the latest census figures into another way for Goodman to whitewash numbers that, once again, showed Texas as the state with the highest proportion of its population uninsured. While he was at it, Goodman gave a new twist to a familiar theme: that people can always go to an emergency room and get free care because the government is the payer of last resort. Goodman was saying only those who don’t get care are uninsured, because everyone who needs care is effectively insured through some program. The paper noted parenthetically that, by law, hospitals cannot refuse a patient who needs immediate care. So what’s really the problem?
Goodman’s solution, according to the paper, is to require the Census Bureau to stop describing people as uninsured and, instead, categorize them by the source of payment when care is required. That would put an end to what Goodman called “worthless statistics that people fling around in vacuous editorials and pointless debates.” More important, that would diminish the number of people officially “uninsured” and take the heat off Republicans, who aren’t keen on health reform in the first place.
Of course, some context could have explained what’s really happening in Texas emergency rooms: people who have no source of payment are turned away after their condition is stabilized, and often go without follow-up care or treatment for chronic illnesses, and don’t have money to pay for prescriptions they are given. The paper could have reported that people go to the ER because they can’t find primary care doctors who will treat them—because they have nowhere else to turn. It could have said that ER care is not free, that hospitals bill for their services—whether or not you can pay.
Instead, the reporter rang up an analyst from the Center for Public Policy Priorities, a liberal group in Austin, who didn’t effectively counter Goodman’s argument. Instead of addressing Goodman’s “solution,” she said that people without insurance are less likely to seek care, and when they do, the cost to the health system is greater. No kidding.
The paper identified Goodman as a McCain adviser, and his comments spread quickly to the health care blogosphere, including a post on the CBS News blog that challenged the Census data: “But according to an advisor of Sen. John McCain who helped craft the Republican candidate’s health care policy, those numbers are misleading.” The post went on: “In fact, says John Goodman, president of the National Center for Policy Analysis, the number of uninsured Americans is basically zero, since anyone who can get to a hospital emergency room can get medical attention, with the government footing the bill. CBS blog readers might believe that Goodman was on to something.
Jonathan Cohn at The New Republic addressed the substance of Goodman’s remarks, but got into a who-ha about whether Goodman was or is currently a McCain adviser. The New York Times columnist Paul Krugman mentioned the myth of free ER care and argued that, even if Goodman is not an adviser, “it’s a good bet that Mr. McCain’s inner circle shares Mr. Goodman’s views.”