Mitt Romney doesn’t see dead people. But that’s only because he doesn’t want to see them; if he did, he’d have to acknowledge the reality of what will happen if he and Paul Ryan get their way on health care.

Last week Romney declared that nobody in America dies because he or she is uninsured: “We don’t have people that become ill, who die in their apartment because they don’t have insurance.” This followed on his earlier remark by Romney in which he insisted that emergency rooms provide essential health care to the uninsured.

These are remarkable statements. They clearly demonstrate that Romney has no idea what life (and death) are like for those less fortunate than himself.

Even the idea that everyone gets urgent care when needed from emergency rooms is false. Yes, hospitals are required to treat people in dire need, whether or not they can pay. But that care isn’t free — if you go to an emergency room you will be billed, and the size of that bill can shocking. Some people can’t or won’t pay, but fear of huge bills can deter the uninsured from visiting the emergency room — and sometimes they die as a result.

More important, going to the emergency room when you’re very sick is no substitute for regular care, especially if you have chronic health problems. When such problems are left untreated — as they often are among the uninsured — a trip to the emergency room can all too easily come too late to save a life.

So the reality, to which Romney is blind, is that many people in America really do die because they don’t have health insurance. How many deaths are we talking about? That’s not an easy question to answer, and conservatives love to cite the handful of studies that fail to find clear evidence that insurance saves lives. The overwhelming evidence, however, is that insurance is indeed a lifesaver, and lack of insurance a killer. Surely the fact that the United States is the only major advanced nation without some form of universal health care is at least part of the reason life expectancy is much lower in America than in Canada or Western Europe.

So there’s no real question that lack of insurance is responsible for thousands of excess deaths of Americans each year. But that’s not a fact Romney wants to admit, because he and his running mate want to repeal Obamacare and slash funding for Medicaid — actions that would take insurance away from some 45 million nonelderly Americans. And their longer-term plans to convert Medicare into Vouchercare would deprive many seniors of adequate coverage, too, leading to more unnecessary mortality.

Oh, about the voucher thing: In his debate with Vice President Joe Biden, Ryan was actually the first to mention vouchers, attempting to rule the term out of bounds. It’s apparently the party line on the right that anyone using the word “voucher” to describe a health policy in which you’re given a fixed sum to apply to health insurance is a liar.

Among the liars, then, is the guy who, in 2009, described the Ryan plan as a matter of “converting Medicare into a defined contribution sort of voucher system” — Ryan himself.

And what if the vouchers turned out not to be large enough to pay for adequate insurance? Then those who couldn’t afford to top up the vouchers sufficiently — a group that would include many older Americans — would be left with inadequate insurance.

So let’s be honest here. The Romney-Ryan position is that millions of Americans must be denied health insurance, and millions more deprived of the security Medicare now provides, in order to save money. At the same time, Romney and Ryan are proposing trillions of dollars in tax cuts for the wealthy. So a literal description of their plan is that they want to expose many Americans to financial insecurity, and let some of them die, so that a handful of already wealthy people can have a higher after-tax income.

It’s not a pretty picture. You can see why Romney chooses not to see it.

Paul Krugman is a New York Times columnist.