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Feb. 13 2010 - 9:49 pm | 150 views | 1 recommendation | 4 comments

A brief post on the ‘lack of insurance kills people’ theme

A few days ago apparently Megan McArdle posted (which seems to be supplanting the verb “wrote” in modern usage) an argument along the lines of “we don’t really know how big an effect universal health insurance has on saving people’s lives.” This occasioned furious blogospheric responses from Matthew Yglesias, Austin Frakt and others. That in turn prompted Megan to explain that she wasn’t saying that lack of insurance doesn’t kill people, but that she doesn’t think we really know how big the effect is, and that the size of the effect makes a difference to arguments that ground the need for universal insurance in that effect. She sums up:

The mortality question is really important, but it doesn’t touch non-mortality outcomes, which are even harder to measure comprehensively.  It doesn’t touch on the financial questions raised by medical bankruptcies–I think they’re overstated by the Himmelstein/Woolhandler crowd, but that doesn’t mean I think they don’t exist.  It doesn’t address the social justice questions.  It just says, this is probably not the best grounds upon which to make the case for national health care, because we don’t have a good handle on the number.

As I understand it, the estimate is that lack of health insurance leads to up to 45,000 premature deaths per year.* [Addendum: Megan points out that the studies she cites find no increase in mortality at all. True; see below for more.] I have no reason to believe this figure is wrong and no time to investigate it, but putting that aside for the moment, the reason why people who argue for universal health insurance have often come to use the increased-deaths argument is that opponents of universal health insurance so often refuse to accept any other arguments. All of the things Megan notes above — the medical bankruptcies issue, the social justice issues, as well as others like the economic inefficiencies issues due to reduced labor mobility, the quality-of-life issues, the population health issues, the question of whether cost reduction is possible without universal coverage, etc. — these are all routinely dismissed by many conservative commentators. When I post on the impossibility of continuing as we are with our ridiculously broken health insurance system, I routinely get responses like: “Will people be dying in the streets? I think not.” For such people, one must demonstrate that people will in fact be dying in the streets, and are in fact dying in the streets, before any reforms will be countenanced.

It is, to me, obvious that the US’s health insurance system is a travesty. Health care in the US costs 150% or more what it costs abroad, and is no better; insurance costs three times as much in premiums (abroad, the rest of the cost is covered by taxes, which spreads the burden equably so that the poor get care when they need it); there is a serious risk in the US that you will lose your insurance because you get sick, which ought to be demonstration enough that the object you are buying does not work to do that thing it is supposed to do. But conservatives have spent the past 18 months working out ever-more-sophisticated arguments to convince themselves that the sun don’t rise in the morning, and by now they’ve just about got the job done. In the face of this, people who support universal health insurance have found themselves resorting to the quickest shorthand justification of its necessity: lack of universal health insurance kills poor people. It’s a solid argument because 1. you would expect it to be true, all else being equal, and 2. studies find that it is in fact true. But if conservatives want liberals to stop talking about it for whatever reason, they should do what Megan begins to do in that paragraph: they should start taking a serious look at all the other reasons to have universal health care (medical bankruptcy, social justice, labor mobility, increased ability to cut medical spending when benefits are distributed more equally, etc.) and evincing some willingness to achieve those goals and some serious approach for doing so. As I recall, Megan’s plan for doing this was universal government-paid catastrophic health insurance, which seems like an OK idea to me; I’d like to hear more about it.

I was wrong to write that I have “no reason to believe” the 45,000 figure is wrong: I have the reason that Megan cited studies saying it’s wrong. But the next part, about not having time to investigate it, is true. I have just enough time to point you to the posts by Ezra Klein and Austin Frakt supporting findings that lack of insurance leads to many premature deaths every year and has powerful negative effects on the health of the uninsured.

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  1. collapse expand

    I agree with what you wrote Matt. I also think we have another issue coming up in the next year or two many people have overlooked, state and local budget deficits. The local ER’s are going to be overrun by people without health insurance and the local, state and federal budgets will swell to cover the cost of their care, pushing it off to the remaining taxpayers. We did not address cost cutting in the latest round of healthcare “discussions” and until all the reasons why we have the most expensive care in the world are addressed nothing will derail the train wreck coming. Is that light at the end of the tunnel just another train heading our way?

  2. collapse expand

    I think it would be better if the proponents of health reform did not consider what the opponents respond to. First, because, as you say and have said, it is not a sincere debate and while the opponents might be the disingenuous ones, the sense of kabuki theater might be responsible for turning off more uninfernal voters than the actual arguments against. Second, because some of the arguments the opposition doesn’t engage are the good arguments, for obvious reasons.

    Third, because I have learned not to compromise with people who want you to fail. (Long self-aggrandizing anecdote warning) In 2003 SEIU proposed a law in California meant to make the system I work in more efficient and easier to organize, The bill was (and deserved to be) very controversial and the Assembly committee working on it set up an advisory panel to help craft an acceptable version.

    There are two major trade associations representing executives at affected companies, both of which were invited and I was asked to represent unaffiliated agencies. At each of the meetings, some of the “stakeholders” would offer recommendations for ways to improve the bill, increase efficiencies, avoid pitfalls, etc. for which we were warmly praised by dignitaries for our wisdom, judgement and distinction.

    Then the one trade association, which was using the red (purple) menace to tractor beam new members, would stand up and present objections. And every other week when the committee met, I would travel to Sacramento only to discover a major revision of the bill ignoring everything presented, except the objections of the people who were selling themselves as a roadblock.

    Our special election and Schwarzenegger’s arrival stopped the calamity from continuing, but that bill had gone from a plausible plan I almost supported to a complete catastrophe nobody sensible could have endorsed, including me. And it remains difficult for me to see The Shipwreck of AB 649 as the opponent’s fault.

    • collapse expand

      Very good point, and not at all self-aggrandizing. But I think it relates more to issues like ignoring single-payer, dropping the public option, ending subsidies for end-of-life consultations (because of “death panel” nonsense), etc. than to the question of whether or not to raise universal insurance’s effect on mortality. And in the cases of single-payer and the public option, it seems more like a question of naked insurance-industry power than one of mistakenly trying to make concessions to one’s opponents’ objections.

      In response to another comment. See in context »
  3. collapse expand

    That’s right, Matt. I should have made clear I was referring to this phrase: “these are all routinely dismissed by many conservative commentators.” The point I was trying to make is that the effective arguments don’t reply to the pundits and pols who just don’t want a reform bill to pass or who earn their living inventing reasons to worry about it.

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    About Me

    I've reported from Vietnam since 2003. I'm now the Hanoi correspondent for the German-based, English-language wire service Deutsche Presse-Agentur, and was previously a Hanoi-based stringer for the Boston Globe and for Voice of America. Before that I reported from West Africa, and before that from the Netherlands; my articles have appeared in the Washington Post, the Nation, the New York Times Magazine and the New York Times. I've got a thing for languages, and have picked up Russian, French, Dutch and Vietnamese. I used to write scripts for the children's cartoon shows "Arthur", "Doug", and a few others. I got a degree in interactive telecommunications back when most people had never sent an email. In April 1991 I predicted the USSR would collapse into its constituent republics and that Boris Yeltsin would become president of Russia. Since then most of my predictions have been rather less accurate, so it was probably a fluke.

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