Bil­ly Koehler died on March 7, 2009, for lack of health insur­ance. Mitt Rom­ney said on Oct. 10, 2012, that’s impossible.

Romney, a quarter-billionaire born with a silver foot in his mouth, has shielded himself from the world in which America’s many Billy Koehlers exist. Their paths don’t naturally cross.

The Repub­li­can nom­i­nee for pres­i­dent told The Colum­bus Dis­patch news­pa­per last week:

​“We don’t have peo­ple that become ill, who die in their apart­ment because they don’t have insurance.”

Tech­ni­cal­ly, that’s true of Bil­ly Koehler. He didn’t die in his apart­ment. He died in his car. Koehler suf­fered car­diac arrest and per­ished slumped over his steer­ing wheel at a stop sign in Pitts­burgh because he didn’t have health insur­ance and didn’t have $60,000 to replace his implant­ed defibrillator.

Rom­ney, a quar­ter-bil­lion­aire born with a sil­ver foot in his mouth, has shield­ed him­self from the world in which America’s many Bil­ly Koehlers exist. Their paths don’t nat­u­ral­ly cross. Bil­ly Koehlers don’t hang out with Romney’s NASCAR own­er pals. Bil­ly Koehlers don’t dis­par­age the nation’s elder­ly and impov­er­ished at fundrais­ers in the homes of pri­vate equi­ty moguls. FDR and JFK made an effort to under­stand the joys and hard­ships of the non-rich. But Rom­ney hasn’t. And that’s why he so care­less­ly called America’s Bil­ly Koehlers a delib­er­ate­ly depen­dent under­class, albeit one com­pris­ing 47 per­cent of all cit­i­zens. Because Rom­ney knows noth­ing of the lives of the nation’s Bil­ly Koehlers, the Repub­li­can nom­i­nee can dis­miss their med­ical predica­ments as nonex­is­tent and assure wealthy donors he won’t ​“wor­ry about those peo­ple.”

Rom­ney told the Colum­bus news­pa­per that no one needs to wor­ry about those lack­ing health insur­ance because fed­er­al law requires hos­pi­tals to treat emer­gency cases:

​“We don’t have a set­ting across this coun­try where if you don’t have insur­ance, we say to you, ​‘Tough luck, you’re going to die when you have your heart attack.”

He continued:

​“No, you go to the hos­pi­tal; you get treat­ed; you get care, and it’s paid for, either by char­i­ty, the gov­ern­ment or by the hospital.”

Log­i­cal­ly, then, the solu­tion would be for no one to buy insur­ance. Why both­er? Hos­pi­tals must treat and bill some­one else, accord­ing to Romney.

But it doesn’t work that way. The late Bil­ly Koehler is an exam­ple of how it actu­al­ly oper­ates – how it fails to work for 26,100 to 45,000 Amer­i­cans who die each year for lack of insurance.

Billy’s sis­ter, Georgeanne Koehler, a retired hos­pi­tal work­er and mem­ber of the Ser­vice Employ­ees Inter­na­tion­al Union, told his sto­ry at ral­lies for pas­sage of Oba­macare, tak­ing with her an emp­ty chair in his mem­o­ry. She cel­e­brat­ed the law’s pas­sage in 2010, par­tic­u­lar­ly its pro­vi­sion for­bid­ding insur­ance com­pa­nies from deny­ing cov­er­age to those with pre-exist­ing con­di­tions. That might have saved her brother.

Bil­ly was just 39 when he suf­fered his first car­diac arrest. An elec­tron­ics tech­ni­cian, he had health insur­ance through his employ­er, and that paid for surgery to implant a defib­ril­la­tor. Still, over the years, Bil­ly spent his entire $25,000 in pen­sion sav­ings on med­ical bills that insur­ance did not pay.

In 2003, Bil­ly lost his job and his health insur­ance when the com­pa­ny he worked for closed. He tried to get anoth­er job with health insur­ance but could not. He tried to buy health cov­er­age pri­vate­ly, but every insur­er in Penn­syl­va­nia denied his request because of his pre-exist­ing heart con­di­tion. He didn’t qual­i­fy for Med­ic­aid because he earned slight­ly too much mon­ey in his new job as a piz­za deliv­ery driver.

While at work on Dec. 14, 2007, he col­lapsed in the piz­za shop. He sur­vived, but a car­di­ol­o­gist told him that his defib­ril­la­tor need­ed to be replaced. Because Bil­ly had no insur­ance, the doc­tor required pay­ment up front.

Romney’s right about one thing. The hos­pi­tal treat­ed Bil­ly as an emer­gency car­diac arrest vic­tim. But the hos­pi­tal emer­gency room wasn’t required to give him surgery to replace the defib­ril­la­tor. And nei­ther Bil­ly, nor his sis­ter, had $60,000 to pay for it out of pocket.

Less than two years lat­er, as Bil­ly drove home from work, he suf­fered car­diac arrest again. And he died. For lack of health insurance.

Under Oba­macare, insur­ers can’t deny cov­er­age to peo­ple like Bil­ly because of pre-exist­ing con­di­tions. Oba­macare also estab­lished high-risk pools for peo­ple like Bil­ly. And Oba­macare will extend Med­ic­aid to more low-income peo­ple like Billy.

Rom­ney has pledged to repeal Oba­macare on his first day in office. Like a 21st Cen­tu­ry Marie Antoinette, he says: Let ​‘em go to the emer­gency room.

Romney’s pre­scrip­tion doesn’t work. It wouldn’t work for his own wife, Ann, who has mul­ti­ple scle­ro­sis and sur­vived breast can­cer. As quar­ter bil­lion­aires, the Rom­neys have the best insur­ance in the world. But with­out it, a hos­pi­tal emer­gency room would not have pro­vid­ed Ann Rom­ney with the care she need­ed. Emer­gency rooms don’t per­form lumpec­tomies or radi­a­tion ther­a­py. Emer­gency rooms don’t pro­vide ther­a­py for fatigue, dizzi­ness, numb­ness or paral­y­sis caused by MS. Emer­gency rooms don’t dis­pense MS drugs that can cost $3,000 a month. Romney’s clear­ly unaware of the emp­ty chair cam­paign. Not hav­ing health insur­ance or $60,000 for surgery is incon­ceiv­able to him. He bought his wife a $500,000 dres­sage horse for MS ther­a­py, after all.

Amer­i­ca can’t afford to have in the White House an emp­ty Armani who has made no attempt to find out what it’s like to try to sur­vive unin­sured, who remains clue­less about all the chairs in Amer­i­ca emp­tied by lack of insur­ance. The nation can’t afford a pres­i­dent so comatose to the lives of aver­age Americans.

Full dis­clo­sure: The Unit­ed Steel­work­ers union is a spon­sor of In These Times.