Emergency physicians are chiming in about the comments by self-described McCain adviser John Goodman. As you probably heard, Goodman, president of the National Center for Policy Analysis in Dallas, told the Dallas Morning News last week that we don't have uninsured people because they can all get care in ERs. "The next president of the United States should sign an executive order requiring the Census Bureau to cease and desist from describing any American—even illegal aliens—as uninsured," Goodman said.

Now the American College of Emergency Physicians has shot back, the LA Times' health blog tells us. The group's president Dr. Linda Lawrence said:

Emergency physicians can and do perform miracles every day, but taking on the full-time medical care for 46 million uninsured Americans is one miracle even we cannot perform. Access to care in the emergency department is no substitute for the comprehensive healthcare reform policy that should be at the heart of the platform of any presidential campaign.

Goodman's comments had lit up the blogosphere for several days (there is some question about how much of an adviser he really is for the campaign, although his conservative market-oriented health care philosophy and advocacy of health savings accounts have had an impact on Republican thinking on health care in recent years.). But as the AP reminds us today in a report from economically hard-hit Michigan, the flap over Goodman's rhetoric shouldn't distract us from ER realities. Detroit has about 200,000 uninsured people. Uncompensated care adds up to about $50 million a year, according to Dr. Herbert Smitherman, assistant dean of community and urban health at Wayne State University Medical School. The article continues:

The uncompensated care means less money coming into the medical school to support programs and make infrastructure improvements necessary to attract top-notch physicians and highly qualified students. The school's doctors also could be using time they are not getting paid for to educate new generations of physicians, conduct grant-sponsored research, and staff other programs geared toward the city's poor.

Overcrowded and underfinanced ERs aren't good for any of us, no matter how great an insurance policy we have. Our colleagues at New America have been working on an ER project, and we'll be sharing it with you in a few days.