Health Reform is About Saving Lives
Between 2000-06, about 137,000 people died because they did not have adequate health insurance. For a country as rich as the United States, this is a grave scandal – and one made all the worse by the massive amounts of money devoted to the military. Ezra Klein does a quick and dirty calculation, estimating that at least 150,000 lives would be saved by this health insurance bill. At the very least.
He concludes:
“All this is intuitive. The uninsured are less likely to seek early care. They are less likely to get good care. They are less likely to return for follow-up care. They are less likely to be able to afford the maintenance of chronic conditions. At its most basic level, that’s what this is all about. That’s why people have been fighting for universal health care for almost a century now. That’s why this matters, and why the basics of the bill — subsidized access to health-care insurance — are so terribly important. This is life and, well, death. Lots of it, in fact.”
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Thing is, MM, the Dems need to kick Lieberman to the curb: what then? Reconciliation? End the filibuster?
The 150,000 figure is somewhat dubious, but let’s say for the moment that it’s accurate. By my math, that works out to about $6 million per life (or $600k per year of life for the ten years of the bill). Is it really the case that saving the life of someone without insurance costs $6 million? I’m skeptical.
One other thought: so far as I can tell, Klein’s 150,00 figure is not dependent on there being a public option in the bill. If Klein wants to say that Lieberman’s opposition to the public option means he’s potentially causing 150,000 deaths, then wouldn’t the refusal of other Democrats to drop the public option equally be causing 150,000 deaths?
The present use of the filibuster is ludicrous. As for Lieberman, I find him quite despicable. He’s willing to gamble with people’s lives to settle old scores. He’s also one of the most pro-war members of Congress.
Personally, I would like them to do a deal with Snowe on triggers and Nelson on abortion, and strip Lieberman of all his committee privileges.
Personally, I would like them to do a deal with Snowe on triggers and Nelson on abortion, and strip Lieberman of all his committee privileges.
Good call – on all three, MM. I mean, the guy’s whole shtick is sabotaging the Democrats. He needs to be thrown out of the caucus once and for all.
Blackadder,
I’m sure you are aware that you are using a cold utiliarian calculus to value life, and utilitarianism is merely a special case of consequentialism. Do you want to start down the road that can easily lead to a determination that the number of lives saved is not enough to warrant an increase in taxes (say the top marginal tax rate for millionaires or the estate tax)?
The logic is plain – hundreds of thousands die in this very rich country because they do not get healthcare, because those in power think spending money on war is more virtuous. And this is only the tip of the iceberg – countless others suffer in silence from being rationed by cost from seeking healthcare, or because doing so would bankrupt them.
And besides, the plan being considered would actually reduce the deficit. But it is indeed redistributive. And that’s what the free market zealots don’t like about it.
I’m sure you are aware that you are using a cold utiliarian calculus to value life
No, I’m not. What I said was ‘I find it hard to believe it takes $6 million to save a life’ not ‘saving a life ain’t worth $6 million.’
I would note, though, that the medical systems in other countries (the ones you prefer to the U.S. system) *do* engage in precisely the sort of cold utilitarian calculus you accuse me of espousing, and they apparently value a life at a lot less than $6 million.
Cosmic Markdown: EPA Says Life Is Worth Less
Blackadder;
I noticed that the Time article you linked stated that private insurance companies use the same $50,000 limit for one year of quality life as single-payer systems. It would appear that, since Medicare doesn’t use financial concerns to determine care, the public option might be the only way to get around the cold utilitarian calculus of private insurance companies denying care based on the valuation of human life.
“Saving 150,000 lives” sounds like Palin’s death panels in reverse. It won’t work as well though. Fear is a better motivator.
The $6 million is not only to safe one life a year over ten years, but to make important improvements in the health and quality of life of many, many more.
Universal coverage will save lives. It will also make many lives healthier.
Also note the Time article referes not to public systems but private insurnace and public systems. They fail to make a case private insurance is any better than social insurance.
The figures do nothing to show a cause and effect relationship. The figures show that people died and did not have health insurance. The figures do not show that they died because they did not have health insurance. How many people would have died from the same causes had they been insured? What about statistics for people with health insurance?
You want government-run health insurance and you will use any argument to support your cause.
Get all the Catholic Democratic Senators to vote for the Nelson amemdnment, then you have Senator Nelson on board, and you’ve saved the hundreds of thousands of lives.
Buying 150,000 cars for people doesn’t let you move 150,000 people. You need to widen the highways. As more people gain access to health care, there will be bottlenecks. The number of doctors and facilities is fixed. Each of these 150,000 people showing up for care is going to bump someone else to the back of the line. So we’ll be paying $6 million and one random death for each person we save.
Ryan,
Medicare and the public option aren’t the same thing (in fact, other than being run by the government, they don’t have much in common). If there was a public option, it would invariably end up using some sort of dollar figure per life in deciding whether to approve medical treatment or it would go bankrupt.
It’s kind of a moot point, though, as the only way a health care bill is going to pass at this point is if the Dems drop the public option.
It’s not that 150,000 uninsured people died. The article states that 150,000 people died because of a lack of insurance over the last 10 years. That is to say, statistically speaking, if every American had health insurance, there would have been 150,000 fewer deaths. In essence, the study looked at 30 million uninsured Americans and compared them to 30 million insured Americans from similar demographic categories and found that 150,000 more people died in the uninsured group than the insured group over 10 years.
To quote from the study:
“The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.”
Pinky – Are you really worried about receiving less effective health care because someone who previously had no access to health care now does?
The more those on the left ratchet up this “lives are at stake!” rhetoric, the less defensible the defeat of the Nelson amendment becomes.
“Pinky Says:
December 15, 2009 at 10:56 am
Buying 150,000 cars for people doesn’t let you move 150,000 people. You need to widen the highways. As more people gain access to health care, there will be bottlenecks. The number of doctors and facilities is fixed. Each of these 150,000 people showing up for care is going to bump someone else to the back of the line. So we’ll be paying $6 million and one random death for each person we save.”
Interesting thought, now that the government will mandate compensation for medical professionals, will the government also mandate the cost of medical training so those entering the field are not in financial disarray for an even longer period? Or will the service side dry up because the practitioners cannot make ends meet?
Blackadder;
I know the public option is not Medicare writ large, but many critics seem to claim it is. But it’s important to see that insurance companies ration care according to financial considerations while the government plan (i.e. Medicare) does not ration care. Again, this is the exact opposite state of affairs that most health care reform critics claim.
John,
No one here is defending the defeat of Nelson. For mem I know I am supporting him in his on-going discussions with Senators Reid and Durbin.
Lieberman does not plan to run again in 2012. That frees him up to spend this final term indulging his spitefulness and thumbing his nose at the people of Connecticut. Immediately upon leavng the Senate he will be appointed to lucrative seats on the boards at several insurance companies in gratitude for his help to the industry. He kept his chairmanships only because they needed his vote on healthcare. Now that we’ve seen how well that worked out, it’s time to get real and throw the schmuck under the bus without further delay.
Perhaps Lieberman does not plan to run in 2012 (as a CT resident, I hope he doesn’t,) but considering that over 60% of Americans are against the form of health care reform currently being pushed through, I wouldn’t consider that “thumbing his nose.”
Kurt,
I’m not sure if you and MM completely understand what a huge moment this is for you, considering the votes you have asked those concerned about the unborn to make.
Last year, the appeal was that we should set aside our concerns about abortions because Democrats were so much better on other issues, and that abortion didn’t matter anyway. Given that eight years of the Bush administration had yielded two wars, a ruined economy, and no progress on abortion policy, this argument had a certain appeal.
But now, it appears that the Senate is willing to let legislation that they claim would save hundreds of thousands of lives die in order that the pro-life cause not gain one inch of progress.
If that is the case, then the entire rationale for pro-life people to vote for pro-choice Democrats disappears. We are expected to set aside our concerns about abortion for the greater good, but the politicians elected on that basis aren’t expected to do the same.
And I feel the same way when people refuse to hold Republican politicians elected on “Aborion! babies!” platforms accountable for making the unborn their first priority.
John,
First of all, I never had any such expectation of you. My repeated request to you and many others was not that you change your intended vote, but that simply you respect those of us who made a different choice and particularly refrain from calls for spiritual sanctions against us such as withholding the sacraments.
At the present moment we have a very good bill passed by the House designed to both give us national health care AND the most profound advance in the pro-life movement in decades. The Senate has a less robust health care plan and a very weak pro-life provisions. The Democratic leadership will be making that provision stronger. I hope it can be moved as close to teh Stupak language as possible.
Ryan and SC – I’m not panicked about the idea of increasing numbers of insured people, but it’s worth pointing out how weak “all other things being equal” statistics are.
So let’s assume that 30 million more people will be insured (a lousy statistic). Let’s assume that 45,000 people die every year due to medical mistakes (a terrible statistic). How much do you think that 30 million will drive up the number of medical errors? If there are no bottlenecks in the system, there will be about 5,000 more deaths due to error (a statistic that’s so bad it’s pointless). If there are bottlenecks, they could entirely offset the gain of 15,000 lives.
BTW,
My phrasing “abortion didn’t matter anyway” was poorly done, and comes off as less charitable to those supporting pro-choice candidates than I meant it to.
What I wanted to say was that the position of a politician on abortion does not seem to have much of an impact on policy.
I apologize for the original phrasing.
Let’s assume that 45,000 people die every year due to medical mistakes (a terrible statistic).
Pinky,
Somewhere between 90,000 and 100,000 die because doctors, nurses, and other hospital personnel don’t wash their hands. So I would put the number of deaths due to medical “malpractice” much higher. However, I have heard arguments that health care reform will give us a better opportunity to control medical slovenliness and mistakes.
My brother-in-law was hospitalized with a “superbug” infection, and when my sister and their kids went to visit him in the hospital, they had to wear gowns, masks, and coverings on their shoes. However, my brother-in-law said he had to constantly remind the doctors and nurses to wash their hands. (He had managed a nursing home and was familiar with medical settings.)
It is perfectly scandalous that so many thousands of people unnecessarily get infections in hospitals and so many die.
Dave, I actually went with the lowest number I could find. It’s a nightmare to support a statistic like that, because you need to account for each particular medical mistake and identify the one primarily responsible, then exclude the people who would have died anyway.
I’d be interested to hear how the current health care legislation is going to address the problem of infections. We have officials who make sure that gas pumps give accurate readings, you’d think we could monitor doctors’ cleanliness. (You’d think we could do it for less than $1 trillion.)
Well, from what I can gather from today’s news, it appears that reform is no longer about saving lives – or even reform. It’s now more about passing any type of legislation whatsoever, even if the democrats succeed at enraging both the left and right, so that Obama can have a bragging point at his first state of the union.
I have been assured by a very knowing American of my acquaintance in London, that a young healthy child well nursed is at a year old a most delicious, nourishing, and wholesome food, whether stewed, roasted, baked, or boiled; and I make no doubt that it will equally serve in a fricassee or a ragout.
I do therefore humbly offer it to public consideration that of the hundred and twenty thousand children already computed, twenty thousand may be reserved for breed, whereof only one-fourth part to be males; which is more than we allow to sheep, black cattle or swine; and my reason is, that these children are seldom the fruits of marriage, a circumstance not much regarded by our savages, therefore one male will be sufficient to serve four females. That the remaining hundred thousand may, at a year old, be offered in the sale to the persons of quality and fortune through the kingdom; always advising the mother to let them suck plentifully in the last month, so as to render them plump and fat for a good table. A child will make two dishes at an entertainment for friends; and when the family dines alone, the fore or hind quarter will make a reasonable dish, and seasoned with a little pepper or salt will be very good boiled on the fourth day, especially in winter.
I grant this food will be somewhat dear, and therefore very proper for landlords, who, as they have already devoured most of the parents, seem to have the best title to the children.
Infant’s flesh will be in season throughout the year, but more plentiful in March, and a little before and after; for we are told by a grave author, an eminent French physician, that fish being a prolific diet, there are more children born in Roman Catholic countries about nine months after Lent than at any other season; therefore, reckoning a year after Lent, the markets will be more glutted than usual, because the number of popish infants is at least three to one in this kingdom: and therefore it will have one other collateral advantage, by lessening the number of papists among us.
Yep, I had to reach back to Jonathan Swift to do justice to the absurdity of this discussion. Some Americans really should have their heads examined. Then again, it might be a pre-existing condition.
The entire piece can be found here http://art-bin.com/art/omodest.html
Yes, Gerald, this conversation has been silly at times. I don’t know if we agree on which parts were silly though.
None of the health insurance “reform” plans will be of benefit to me, that is for certain. As far as I can tell, despite being unemployed just at the moment, I would not qualify for any of the various assistance supposedly being made available.
The type of policy I would like to have, and have been looking into, is something of the low premium, high deductible sort. (Much like how I do not have comprehensive coverage on my car. If I drive it into a tree or something I will have to buy myself a new car out of my own pocket. However, I have saved the far more than the cost of a new car already this way, so essentially I self insure against that risk.) Unfortunately, those sort of policies that best suite my needs, and are really the last vestiges of actual insurance in the sense of insuring a person against a risk they otherwise can not afford to cover, are soon to be made illegal because the new plan requires all insurance to essentially be the high cost full coverage sort.
To make matters worse, as a reasonably healthy young person who takes pretty good care of himself, even one with some medical conditions in my health history, my insurance rates will be several times higher under the new plan than now. Why? Because the new law will require that the difference between the lowest premium and the highest on the same coverage will be a much smaller gap. The insurance companies will probably not lower the high end premiums, but they will certainly raise the low end ones. So that makes it even harder for those of us just starting out on careers and such, since this will now shift costs to those who are at the lowest end of the earnings spectrum (young, inexperienced workers in entry level jobs).
Further, by increasing the demand for health care, which is what will happen if everyone is insured, then the price will go up and the supply will become harder to acquire. You should expect longer waiting times, more run around on things like referrals, and higher costs both of your insurance premiums and your out of pocket portions.
None of the plans currently offered are reforms of the health care system, nor do they improve that system in any way. They do however change somewhat the health insurance system. However, these plans do not offer even the possibility of universal coverage. There will still be millions of uninsured people when this is all done. Many of those millions will still not be able to afford insurance at all. Many others of those millions will decide it is cheaper to continue opting out.
Another thing people should know, must of these plans are set up with ten year budgets and have been scored on the ten year time frame. However, while these plans begin to phase in extra taxes and fees earlier on, the high cost portions don’t kick in for three years. This means all the budgets are based on ten years of revenue covering only seven years of expense. Not good.
Finally, the huge size of the various proposals means this will be a boondoggle from day one. There will literally be not a single person who will actually have a full understanding of the plans being proposed. Not one government official and certainly not one citizen. 2000 pages of legislation will almost certainly be expanded upon by various rules made by the executive, and various opinions by the courts, until the full volume will reach easily ten times those 2000 pages. It will be able to mean everything, anything, and nothing all at once. Napoleon once had the idea that the French legal code should be simplified down to something of similar size and complexity to the Bible so ordinary mortals would be capable of reading and understanding it. I guess the crazy despot had at least one good idea.
I want a better system than the current one. I want everyone to have access to basic health care, regardless of their financial condition or health history. However, none of the current plans will do this. These plans will make the system worse, and will continue to leave millions out. Truth be told, while I am very much a less government is good government type, I would much rather have a real universal health system than the Frankensteins’ monster we are about to get.
p.s. The link between insurance and health outcomes is not nearly as strong as one would think or hope. This can be shown both with copious anecdotal evidence, and at least some of the statistical data. Turns out many of the insured still die of treatable or preventable diseases that their policies would have covered. My grandfather is one such case, dying of a cancer that could have been treated if it was found early, but he just assumed when you got old you were supposed to have the sorts of problems that were actually the symptoms of the cancer, so he never complained about it to either his doctor or the family until it was at stage four. Even then he fought on at least 18 months longer than the doctors even thought was remotely possible. My mother has some digestive problems that developed over a decade ago and were never able to be diagnosed despite repeated attempts. One day she read about something similar on the internet, and so she tried some rather radical diet modifications, and now she is fine. I have another relative with diabetes, diagnosed long ago, but she didn’t like the side affects of the various meds, so she didn’t really take them properly. Now she is spending more time in the hospital than at home, and in fact she worked in a hospital and had a very full featured insurance plan before she became too sick to work. My point isn’t that insurance is useless, far from, but it is not a panacea.
SMF, you raise a lot of good points. Ezra Klein’s numbers were based on an Urban Institute estimate that assumes that health care will save lives at the same rate in all age brackets. 30,000 of the 150,000 to be saved will be under 40. That’s nonsense. People under 40 don’t go to doctors even if they have insurance, they don’t die from disease at the same rate as 60-year-olds, and the conditions they do die from tend to be congenital and/or genetic, the kind of thing that increased preventative care and general-maintenance office visits won’t detect.
None of the health insurance “reform” plans will be of benefit to me, that is for certain. As far as I can tell, despite being unemployed just at the moment, I would not qualify for any of the various assistance supposedly being made available.
Individuals with income up to 400% of the poverty line will be eligibe for assistance, however, the unemployed or others without wage income may not qualify if their unearned income (dividents, trust fund disbursements, etc.) put them above the 400% mark.
Further, by increasing the demand for health care, which is what will happen if everyone is insured, then the price will go up and the supply will become harder to acquire.
Yes, million who currently go without needed health care will have health care under the President’s plan. But providers are the first to admit that there is excess capacity in the system. Further there is no reason to assume supply is static when demand goes up.
There will still be millions of uninsured people when this is all done.
Mostly undocumented residents. That is a difficulty. I would be open to advice, particularly from our Republican friends, on how to address that.
There will literally be not a single person who will actually have a full understanding of the plans being proposed. Not one government official and certainly not one citizen.
What don’t you understand? I would be happy to try to explain it to you.
Napoleon once had the idea that the French legal code should be simplified down to something of similar size and complexity to the Bible so ordinary mortals would be capable of reading and understanding it. I guess the crazy despot had at least one good idea.
60,000 Christian denominations and more every day all saying their interpretation of the Bible is correct.
I would challenge any private sector insurance company to show me their insurance policy with a lower page per beneficiary ratio than the Democratic bill.