There They Go Again…
Einstein once defined insanity as doing the same thing over and over again and expecting different results. Hopefully Families USA will get the hint. The advocacy group is out with yet another study in its “Dying for Coverage” series claiming the link between uninsurance and mortality. The report asserts that over 26,000 working-age Americans die prematurely each year because they lack health insurance. Families USA derives its flimsy results, based on the years 2005 to 2010, from extrapolations of the inaccurate numbers presented in a 2002 Institute of Medicine study. The NCPA has previously addressed the flaws of the IOM study, a 2008 Families USA report, and the assertion that uninsurance causes death here, here, here, and here.
Shame on Reuters, The Hill’s “Healthwatch” and CNN for perpetuating this fallacy. See Chris Jacobs’ post on the issue.
Sad to say, but you can disprove it a thousand times, but if people want to believe it then they will.
Alex is correct. This ill-conceived argument is hard to kill despite its faulty logic.
Public health advocates like to preach how they can affect a change in other peoples’ lives by controlling how people live. They argue taxing soda, cigarettes and alcohol might prompt people to consume less of these vices. Advocates believe providing free health coverage to those who make poor lifestyle choices (and engage in unhealthy behavior) somehow might prolong lives by reducing the likelihood of dying prematurely from preventable causes.
Research has shown nearly two-thirds of disease and medical treatment is to mitigate the effects of lifestyle choices. The rest is natural aging and genetic factors. Whether or not someone has health insurance doesn’t effect when they die: what influences your mortality is your genetic legacy, and the way you treat your body.
So let me get this straight, @Devon. If I am diagnosed with cancer, but have no insurance to pay for treatment, I’m still going to live as long as someone who does have insurance to pay for treatment?
Does that mean everyone gets treatment, whether they can or cannot afford it? Or does that mean cancer treatment doesn’t work?
Unfastened seatbelts don’t cause car crashes, but the fastened variety does quite a bit to save lives. The same is true of insurance.
A lack of health insurance might lead to lower health quality eventually for a lot of people who lack it, but premature death? – that’s seems like a stretch.
David,
The fact that one does not have insurance to pay for treatment does not necessarily mean that one will not be treated. Medicaid enrollment, for example, can be retroactive. We also know that people who believe that they will need medical care are less likely to be uninsured.
It is also clear that having insurance is not the same as getting medical care. Everyone in Britain has medical insurance yet the death rate from cancer there is higher than in the US with its much higher rate of uninsurance.
If the goal is to get to the truth of the matter, one cannot pretend that usuable estimates are produced from insignificant statistical results using a sample that assumes that people had the same insurance status for almost two decades.
The Chris Jacobs post you reference above includes the following passage:
“Adjusted for demographic, health status, and health behavior characteristics, the risk of subsequent mortality is no different for uninsured respondents than for those covered by employer-sponsored group insurance at baseline.”
I find this incredibly unlikely. From where I’m sitting, fine, dispute the 26,000 figure. But telling me that there is not premature mortality differential between those with and without insurance? That seems fanciful.
@Ambrose, from PolitiFact:
“The most notable difference between the Institute of Medicine’s data — which were drawn from the CDC’s National Health and Nutrition Examination Survey as well as the Census Bureau’s Current Population Survey — is that Kronick adjusted it for a number of demographic and health factors, such as status as a smoker and body mass index. When he did that, “the risk of subsequent mortality is no different for uninsured respondents than for those covered by employer-sponsored group insurance.” In other words, once you compare death rates in an apples-to-apples fashion — comparing insured smokers to uninsured smokers, for instance — the likelihood of dying evens out. This, in turn, would mean that IOM’s estimate of 18,000 deaths would drop essentially to zero.
In his paper, Kronick acknowledges that this is a “counterintuitive” result, possibly resulting from the safety net of public hospitals and community clinics providing “‘good enough’ access to care for the uninsured to keep their mortality rate similar to that of the insured.”’
And PolitiFact continues…
“Kronick even told PolitiFact that his finding was “not the answer I wanted” and, as a result, he agonized over whether to publish it or not. He said he’s “grateful” that it has so far been unnoticed in the increasingly hostile debate over health care. “I don’t have a whole lot of friends, and will probably lose a few over this,” he told us. “And I might make some friends I didn’t want.”’
That said, I agree with you and Professor Kronick. The results truly are counterintuitive. His well-intentioned finding should not be used to fuel the partisan debate over health care reform. Rather, the flaws inherent in the IOM study and Families USA studies should serve as a call to action to better assess the potential link between uninsurance and mortality with updated numbers. The patients, not politics, come first.
@Brian, Death=lowest health quality possible
@Linda, I don’t disagree that one being uninsured does not necessarily mean one will not receive treatment. However, for insurance status to make NO difference whatsoever, then either every single uninsured individual receives treatment anyway or the treatment doesn’t work.
I also don’t really see how GB is relevant. There, they do not have “insurance to pay for treatment,” as I was describing. Having insurance there doesn’t mean it will pay for treatment. If it did, however, are you really going to say the British wouldn’t have a better chance of survival–adjusting for other factors–than would some American who isn’t afforded that luxury?
I, like Ambrose, find it very unlikely that uninsured people have the same chance of survival as the insured.
It may be, as Linda says, that those who expect to need care buy insurance and, assuming their expectations are accurate, they receive care when they do. However, if that is the case, this data only shows that people who buy insurance under a false expectation of need balance out those who need it but can’t afford it.
I’m also a bit suspicious that the Chris Jacobs post is littered with arguments of dissimilar associations, i.e. “himself a former Clinton Administration official” and “himself a member of the Institute of Medicine”.
Using the exact phrasing twice is not only aesthetically unappealing, but it sounds like (and the final paragraph basically expounds that) his argument is “Look! Your pals disagree! You must be wrong!”
I would hate to assign beliefs to those who do not share them, but I gather that David, Nikita, and myself are all in agreement on the following:
1. The 26,000 annual premature deaths figure is probably too high.
2. The 0 annual premature deaths provided by Jacobs is probably too low.
3. Given that it’s not one or the other, this is going to simply become a debate about how many lives lost is too many.
I agree with #1 and #2, but I long ago stopped trying to put a price on priceless things, such as a life.
One life is too many.
One life is too many? Sounds mighty insupportable to me, in terms of creating effective public policy.
True, but have you ever known a life-valuation to be well-received by the public?
The problem with the Ford Pinto was not that they only valued a life at $200K or whatever it was, but that they put a monetary value on a life in the first place. Certainly, decision have to be made, but how many lives is too many is a death-trap for those who try to come up with an answer because there is no good answer, other than the one I provided.
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