Let's give the benefit of the doubt: "Let them die" is probably not going to be the Republicans' official plan for dealing with people who have no health insurance.

Right?

The hesitation in my voice there is because of the GOP presidential debate last week, at which some of the tea-party crowd cheered the notion of letting a 30-year-old freeloading, uninsured guy die rather than have society pick up the costs to treat him.

It was the Roman Coliseum blood lust that got the media buzz. But the question was the best one I've heard in politics in a long time, because it goes to the core of the health-care crisis. Maybe it should be asked of all politicians, because it's revealing of who is serious about the tough choices in the health-insurance mess.

Who should pay when someone with no insurance — who could have afforded it — shows up in the emergency room with a costly, life-threatening health problem?

At the debate, Congressman Ron Paul was the only one to answer. He said freedom is about taking responsibility for your own risks, implying the uninsured guy was out of luck. But then later he suggested the man should be treated regardless, without saying who would pay.

"In a society where you accept welfarism and socialism, he expects the government to take care of it," Paul said, to righteous applause.

"Are you saying the society should just let him die?" asked the moderator, at which point there were some shouts of "yes!" from the audience.

Not mentioned is that a 25-year-old federal law, signed by President Reagan (!), requires hospitals to treat anyone who needs emergency care, regardless of citizenship or ability to pay. This state has a similar law. So it's illegal to let him die.

It's no hypothetical. Last year, Seattle's Harborview Medical Center did $187 million worth of free care for the uninsured — up 21 percent from the year before. Real patients with no insurance and little money racked up more than $500,000 every day in medical costs — at a single hospital.

Much of that tab was passed on to the rest of us, in higher medical costs or taxes. Private hospitals also do charity care, but much less — typically in the $10 million-per-year range.

So who should pay? Right now, we all do.

What was so provocative about the question is that the health-reform plan routinely denounced as socialist — so-called Obamacare — seeks to get the freeloading guy to pay his own way. He'd have to get insurance or be fined. He'd pay for it himself, unless he were very poor. The idea is then there'd be no need for the rest of us to pick up his huge charity-care bills.

It's true that coercing people to buy insurance is not "freedom." But what's so aggravating about the health-care debate is that neither is what we have today. It sure seems socialistic that all of us have to cover the uninsured guy's bills, as we do today. Yet an effort to stop doing that — to try to get him to pay for himself — is what gets derided as un-American.

Forcing people to buy anything does push the envelope. The individual mandate may be judged unconstitutional. But wishing everyone would be responsible isn't going to make a bit of difference up at Harborview. We'd have a better chance of solving this issue if we could just honestly answer: What do we do with the uninsured guy?

We keep paying for him. Try to get him to start paying. Or let him die. For better or worse, Democrats chose door No. 2 when they passed health-care reform. I'd be surer Republicans weren't drifting toward the let-him-die plan if they would actually choose one of the others.

I'll hand it to the tea partyers, though, the ones who whooped for letting him die. At least they answered the question.

Danny Westneat's column appears Wednesday and Sunday. Reach him at 206-464-2086 or dwestneat@seattletimes.com.