Birds on the Brain

How many Americans would be left out in the cold under Mr. Romney’s plan? One answer is 89 million. According to the nonpartisan Commonwealth Foundation, that’s the number of Americans who lack the “continuous coverage” that would make them eligible for health insurance under Mr. Romney’s empty promises. By the way, that’s more than a third of the U.S. population under 65 years old.

Another answer is 45 million, the estimated number of people who would have health insurance if Mr. Obama were re-elected, but would lose it if Mr. Romney were to win.

That estimate reflects two factors. First, Mr. Romney proposes repealing the Affordable Care Act, which means doing away with all the ways in which that law would help tens of millions of Americans who either have pre-existing conditions or can’t afford health insurance for other reasons. Second, Mr. Romney is proposing drastic cuts in Medicaid - basically to save money that he could use to cut taxes on the wealthy - which would deny essential health care to millions more Americans. (And, no, despite what he has said, you can’t get the care you need just by going to the emergency room.)

Wait, it gets worse. The true number of victims from Mr. Romney’s health proposals would be much larger than either of these numbers, for a couple of reasons.

One is that Medicaid doesn’t just provide health care to Americans too young for Medicare; it also pays for nursing care and other necessities for many older Americans.

Also, many Americans have health insurance but live under the continual threat of losing it. Obamacare would eliminate this threat, but Mr. Romney would bring it back and make it worse. Safety nets don’t just help people who actually fall, they make life more secure for everyone who might fall. But Mr. Romney would take that security away, not just on health care but across the board.

What about the claim made by a Romney adviser after the debate that states could step in to guarantee coverage for pre-existing conditions? That’s nonsense on many levels. For one thing, Mr. Romney wants to eliminate restrictions on interstate insurance sales, depriving states of regulatory power. Furthermore, if all you do is require that insurance companies cover everyone, healthy people will wait until they’re sick to sign up, leading to sky-high premiums. So you need to couple regulations on insurers with a requirement that everyone have insurance. And, to make that feasible, you have to offer insurance subsidies to lower-income Americans, which have to be paid for at a federal level.

And what you end up with is - precisely - the health reform President Obama signed into law.