Introduction

I understand where Mitt Romney was coming from when he said last week that Americans without health insurance don’t have to worry about dying at home.

“We don’t have people that become ill, who die in their apartment because they don’t have insurance,” the GOP presidential nominee told members of the Columbus Dispatch editorial board. “We don’t have a setting across this country where if you don’t have insurance, we just say to you, ‘Tough luck, you’re going to die when you have your heart attack.’ No, you go to the hospital, you get treated, and it’s paid for, either by charity, the government or by the hospital.”

I have no reason to believe that Romney saw anything wrong with what he said. In fact, I probably would have said the same thing back when I was still a health insurance PR guy and trying to convince folks that the problem of the uninsured wasn’t really such a big deal.

And Romney is absolutely right, people who are uninsured don’t have to die in their apartments. They can indeed be rushed to a hospital, and the hospital is obligated to treat them. It’s what he didn’t say, and likely doesn’t understand because he simply can’t relate to 47 percent of us, that is actually more important: many of the uninsured die in the hospital, in the emergency room, because they could not afford to get care earlier when it might have saved their lives. Instead of going back home to their apartments, many of them, unfortunately, go to the morgue.

In 2007, when the Democratic candidates for president were beginning to talk about health care reform, I was asked to write a policy paper that the insurance industry would use to “educate” people about the uninsured. I found that if you sliced and diced the data in just such a way, you could make people believe that many of the uninsured were simply shirking their responsibility by not buying coverage.

It is true, for example, that young adults comprise almost a third of the uninsured. We in the insurance industry perpetuated the belief that those young people consider themselves so bullet-proof that they didn’t see the need for insurance. Hence the term “young invincibles” that insurers use to describe them.

It is also true that some relatively high-income people are uninsured. A lot of politicians have pointed this out over the years, including former House Speaker Newt Gingrich, who said this last year on Meet the Press:

“A large number of the uninsured earn $75,000 or more a year (and) don’t buy any health insurance because they want to buy a second house or a better car or go on vacation.”

It is true, as I pointed out in that paper, that about 20 percent of the uninsured live in households with median household incomes of $75,000 or more.

But there are some crucial facts I left out of that policy paper — and of course, I left them out on purpose.

Many of those “young invincibles” were (and still are) unemployed. Consequently, they are not eligible for employer-subsidized coverage and don’t have the extra cash lying around to buy health insurance. And many who are employed work for small employers that don’t offer coverage, and they make so little that they must live paycheck-to-paycheck.

And many of those folks in households that bring in $75,000 or more a year would love to have health insurance but simply can’t buy it — at any price — because of pre-existing conditions. A Silicon Valley millionaire told me his wife went back to work for no reason other than for him to qualify for coverage as her spouse. He had been deemed uninsurable because he had been treated in the past for — get this — gout.

The reality is that most people who are uninsured are not that way by choice; they have no insurance because they can’t afford coverage or can’t even find a company willing to sell it to them. That will change in 2014 under Obamacare. Insurers will no longer be able to deny coverage to anyone because of a pre-existing condition — unless Romney is elected and persuades Congress to repeal the law.

A 2009 study published in the American Journal of Public Health estimated that almost 45,000 annual deaths in this country are associated with a lack of health insurance.

The researchers found that uninsured Americans have a 40 percent higher risk of death than their privately insured counterparts. One main reason: the quality of care for those with insurance is considerably higher than for those without it.

Those unfortunate folks might not have to die in their apartments. But many of them are dying prematurely, nonetheless, because they are not fortunate enough to have insurance.