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Jens 'n' Frens |
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Megan McArdle asks how many people die from lack of health insurance, and finds that it's hard to say, but is probably a lower number than many of those that get thrown around as potential figures:To give you an example of what I mean, one of the two studies that went into the most commonly cited number--the roughly 20,000 a year figure from the Institute of Medicine and the Urban Institute--found that the highest mortality was not associated with being uninsured, but being on a government health care program. (the other excluded those patients). This was true even after they'd run all their controls. Given that the bulk of the coverage expansion in both the Senate and the House plans comes from Medicaid expansion, this is a little disturbing.You could raise this with friends who support the Democrats' bills, but if you want to be intellectually honest, you should continue.But how likely is it that Medicaid is killing people? Possible, I suppose, but not really all that likely. Medicaid and Medicare patients, too, are not like the broader population. The authors in fact recognized this fact in their paper, pointing out that these patients have higher rates of disability--but then failed to address the obvious question this raised about their data on the uninsured.Her main point, in fact, is that almost all* the confounding factors, including those that no researcher thinks to correct for, will bias the number upward because uninsured people are disproportionately higher risk in a lot of other ways.To my mind probably the single most solid piece of evidence is this: turning 65--i.e., going on Medicare--doesn't reduce your risk of dying. If lack of insurance leads to death, then that should show up as a discontinuity in the mortality rate around the age of 65. It doesn't. There are some caveats--if the effects are sufficiently long term, then it's hard to measure, because of course as elderly people age, their mortality rate starts rising dramatically. But still, there should be some kink in the curve, and in the best data we have, it just isn't there.Life expectancy in the US, incidentally, does improve in comparison to other countries as age increases, though it does so smoothly; life expectancy for octogenarians is higher in the U.S. than in any other country on the planet. I don't know whether I've presented the following thought experiment here before, but it probably won't hurt too badly if I'm repeating myself. |
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