Fifty million Americans have no health insurance. Does government have an obligation to help them? The answer is no, Mitt Romney suggested during a “60 Minutes” interview that aired on Sunday, in part because people can already get care through emergency rooms:

We do provide care for people who don’t have insurance, people—we—if someone has a heart attack, they don’t sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care.

That statement isn’t untrue. But it leaves out an awful lot. ERs are great if you need urgent help with a major medical problem: You’ve had a heart attack, you’ve been in an accident, whatever. And, yes, hospitals will generally treat you regardless of insurance status, if only because the law requires it. As a condition of accepting Medicare money, hospitals must provide stabilizing or life-saving treatment. But they will not provide basic, ongoing care. They will charge a lot of money for their services. In many cases they will do their best to collect on outstanding bills, even if that means using techniques that even the retail industry eschews as overly harsh. And sometimes, as Sarah Kliff notes today, hospitals find ways to avoid providing care in the first place.

Romney is not the first conservative to make this argument. George W. Bush did it all the time. But Romney, of all people, knows better. While he was governor of Massachusetts, promoting his plan to make health insurance available to all residents, he argued that ERs were a lousy way to provide care—not just because they were expensive and necessarily episodic, but also because taxpayers and payers of private insurance premiums ended up paying indirectly for those services. Here was Romney on MSNBC’s “Morning Joe,” less than two years ago, speaking to Mike Barnicle:

BARNICLE: Do you believe in universal coverage?
ROMNEY: Oh sure. Look, 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 you have no responsibility. Particularly if they are people who have sufficient means to pay their own way.

(h/t Amanda Terkel and Sam Stein of Huffington Post)

The two statements are not contradictory. It’s possible to believe simultaneously that ERs provide care to everybody who needs it and that they are an inefficient, expensive way to do that. But the Romney who made that statement in 2010 was making the case for having government do more to cover the uninsured, while the Romney who made that statement yesterday was making the case for having government do less.

And that’s really the most important point of all. Remember, Romney doesn’t simply want to repeal the Affordable Care Act, effectively taking health insurance away from 30 million people who, starting in 2014, are likely to get it from the law. He also wants to end Medicaid, making cuts that would leave between 14 and 27 million additional people without insurance. And he wants to change the tax treatment of employer health benefits, in ways that could make coverage more expensive or harder to get.

Romney’s strategy for health care isn’t “repeal and replace,” as he sometimes likes to say. It’s “repeal and reverse,” as my colleague Ed Kilgore has called it. And it'd leave the ERs even more inundated than they are now.

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