During an interview that aired Sunday night on CBS's "60 Minutes", Republican presidential candidate Mitt Romney talked about emergency rooms as a solution for the uninsured.
“If someone has a heart attack, they don’t sit in their apartment and die," he said. "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's different from 2006, when Romney used to talk about emergency rooms as the problem. Massachusetts had just passed its universal coverage law that was meant, among other things, to move care out of emergency rooms, where costs are higher, and into primary care offices.
Romney wrote a Wall Street Journal op-ed in 2006, shortly after the law passed, arguing that emergency care for those without coverage drove up costs for everyone who did have insurance.
"By law, emergency care cannot be withheld," he wrote. "Why pay for something you can get free? Of course, while it maybe free for them, everyone else ends up paying the bill, either in higher insurance premiums or taxes."
The problem Romney refers to here is that of uncompensated care, the medical bills from doctors and hospitals that go unpaid. A Kaiser Family Foundation found that state and federal government spent $34.9 billion on uncompensated care in 2004.
Some costs likely get shifted to private consumers, too. A 2008 paper in the journal Health Affairs estimates that as much as 1.7 percent of private health insurance premiums are used to offset the cost of uncompensated care.
The fact that emergency room care tends to be more expensive than that delivered in other settings exacerbates this problem. Uncompensated care bills for the emergency room are higher than they would be for, say, an unpaid bill in a family physician's office. Romney got at that problem in a separate Boston Globe op-ed, in 2004, when he was pitching his health reform plan.
"One way our insurers and our state health programs will be able to provide care at a lower cost is by directing patients towards the most effective and efficient care," he wrote. "A sore throat can be diagnosed and treated by a physician at an emergency room, but the cost varies quiet dramatically."
The data backs this up: Government data shows that the average emergency department visit cost $922 in 2008. The average office visit, meanwhile, came in at $199. Here's another way to put it: Emergency room visits accounted for 4.4 percent of doctor visits but 14.4 percent of doctor visit costs.
Some of this is certainly due to the fact emergency rooms see more complex conditions. But separate research does suggest that there are higher charges for primary care delivered in an emergency room.
Romney is right when he says there's a federal law that requires all emergency rooms to accept uninsured patients (how that gets applied on the ground, however, is another story). He was also right back in the 2000s, too, when he suggested that emergency rooms are expensive places to deliver health care.