Debate exchange offers window into larger question about role of health care

Republican presidential candidate Rep. Ron Paul, R-Texas, gestures during a Republican presidential debate Monday, Sept. 12, 2011, in Tampa, Fla. AP Photo/Mike Carlson

Republican presidential candidate Rep. Ron Paul, R-Texas, gestures during a Republican presidential debate Monday, Sept. 12, 2011, in Tampa, Fla.
AP Photo/Mike Carlson
An interesting exchange in tonight's CNN Republican debate was prompted by the question to Rep. Ron Paul, R-Tex., about who should pay for medical care of the uninsured.

"A healthy 30-year-old young man has a good job, makes a good living, but decides, you know what? I'm not going to spend $200 or $300 a month for health insurance because I'm healthy, I don't need it. But something terrible happens, all of a sudden he needs it. Who's going to pay if he goes into a coma, for example? Who pays for that?" asked host Wolf Blitzer.

Paul, a medical doctor, first responded by saying American society is primed to believe government would pay for it.

"Well, in a society that you accept welfarism and socialism, he expects the government to take care of him,' he said.

When pressed on the question, Paul responded: "That's what freedom is all about, taking your own risks," to applause from many tea party backers in the audience.

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"But Congressman, are you saying that society should just let him die?" asked Blitzer, to which several voices in the audience cried out, "Yes!"

"No. I practiced medicine before we had Medicaid, in the early 1960s, when I got out of medical school. I practiced at Santa Rosa Hospital in San Antonio, and the churches took care of them. We never turned anybody away from the hospitals," said Paul to additional applause. "And we've given up on this whole concept that we might take care of ourselves and assume responsibility for ourselves. Our neighbors, our friends, our churches would do it. This whole idea, that's the reason the cost is so high. The cost is so high because they dump it on the government, it becomes a bureaucracy," he added.

This small exchange is the key to a major debate going on with regards to health care, both President Obama's health reform law and former Massachusetts Governor Mitt Romney's own health reform law that is under attack by his Republican opponents.

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Romney's version of the mandate to buy health insurance was based on the conservative notion of individual responsibility. President Obama used the idea to expand coverage to the uninsured by requiring the purchase of insurance. That way the uninsured don't live free off the backs of those pay for health care - and by having more healthy people in the insurance pool, ideally, costs for everyone will decrease. Both concepts of the mandate requiring health insurance are under attack from conservatives.

"Paying for the uninsured, especially with costly emergency room visits, raises everyone's costs and gets paid for in increased premiums. The way to get around that using basic economics is the individual responsibility provision like Romney did in Massachusetts," said Eddie Vale, the Communications Director for Protect Your Care, a pro-health reform group.

The exchange in the debate "was a disturbing window into the Tea Party's extreme views on health care," he added.

The reason why people who don't have health insurance can go to the hospital for emergency care and not be turned away, and therefore, have the cost of their care covered by the system, is simply because the federal government requires it.

But this is not a new thing arising from Mr. Obama's health care law - or even Romney's. The Emergency Medical Treatment and Active Labor Act requires nearly every hospital to cover emergency care for those Americans who can't afford it and says not to turn away the sick simply because they can't pay for the care.

That is the premise of the question tonight: A healthy young American who doesn't have health insurance suddenly needs emergency care. Federal law requires that that care is paid for. That law was passed in 1986, which means it was signed into law by not by Mr. Obama or even Bill Clinton, but by Ronald Reagan.

While many in the Tea Party favor more limited government and more personal responsibility, as was evidenced from the crowd's reaction to Paul's answer, it was in fact the president most beloved by the movement who signed the law that firmly put government behind this part of the health care cost equation.

  • Robert Hendin On Twitter»

    Robert Hendin is senior producer for "Face the Nation" and a CBS News senior political producer.

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