BCRA will probably kill thousands of Americans every year

…And it’s not alarmist or uncivil to say so.

The effects of insurance on mortality are inherently difficult to precisely forecast.
But we have many strong reasons to believe that uninsuring millions of Americans would cause thousands of them to needlessly die every year.

We can debate the magnitude of this effect and how we might measure it. But the burden of proof does not rest with liberals to defend this sensible proposition, nor to prove that the likely harms associated with BCRA will definitely come to pass. Rather, the burden resides with BCRA supporters to show why we can be confident that snatching coverage from low-income people will not bring serious harm. Bill supporters have not come close to meeting this standard.

At least that’s what I argue in my second piece for Slate.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect, tnr.com, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

14 thoughts on “BCRA will probably kill thousands of Americans every year”

  1. Is it not patently obvious that lots of people will needlessly die when lots of people needlessly do not have access to proper healthcare? Such is the value of health care, for heaven's sake.

    The argument against this dreadful bill should not be statistical, it should be because the bill is immoral, and is the overt afterbirth of naked political corruption.

    1. Really? Well, then, let's all give up our health care policies. Obviously, access to health care makes no difference. You…ahem… first.

      This study you link to, btw, does not measure mortality or most morbidity, it measures:

      "glycated hemoglobin, a measure of blood sugar levels; blood pressure; and cholesterol levels-there was no significant improvement."

      And it is only in Medicaid patients. A chronically underfunded program in every state which is not even accepted by most docs. So, I can not see how this study addresses any of the issues concerning the ACA destruction.

    2. Yeah, that, uh, Oregon study "no effect" result has been debunked all over, including here, IIRC. There's also the evidence from Mass when Romneycare was instituted, which is decidedly positive. And then there's that she's a moral imbecile — gotta weigh that in. Oh, and "moral imbecile" is a real term — look it up — I didn't just make it up. And it -does- fit.

      1. "No significant effect" does not of course mean the same as "a significant finding of no effect".

        In the parallel and long-running McArdle study (n = 1), considerable intellectual resources have been deployed in efforts to educate the subject in statistical reasoning and other impartial forms of weighing evidence. No significant impacts have been observed. Time to pull the plug on McArdleaid? Nobody thinks it's worthwhile to engage with Bret Stephens, as opposed to denouncing his hackery.

        1. There is something else here that bothers me.

          Instead of looking at individual measures one at a time, shouldn't we be looking at measures jointly?

          Suppose half the group experienced no improvement in BP, but a reasonable improvement in cholesterol levels, say, while the other half experienced the opposite. On average, neither of these improvements is significant at the magical 5% level. But if we reframe the test as improvement in an important measure of health, that might well change. In other words, shouldn't we be asking, "Does Medicaid help with the actual health issues participants have, rather than "Does it improve things that don't need improvement?"

          On a related point, as has been pointed out elsewhere, some measures were normal to begin with. There is no reason to expect or want them to change, but they drag down the average change. Take two thousand uninsured people, of whom 1800 have normal BP, and put half on Medicaid. Now compare the average BP difference. If you calculate the average based based on he entire group, you are seriously diluting the effect, because you are including untreated individuals in your measurement of treatment effects.

          Am I missing something here, or making some sort of gross error?

          1. Yes, we should not be asking, "Does Medicaid help with the actual health issues participants have?" We should be asking, "Does Medicaid help with the actual health problems participants have?"

          2. Sorry; I was objecting to the use of "issues" to mean "problems," which has become common in recent years. An issue used to mean a question that could be debated. I don't know why it has come to be used to mean "problem"; perhaps "problem" seems harsh and "issue" is intended as a euphemism. I realize that this was not the appropriate forum to make this objection.

          3. Jarndyce,

            Thanks for the explanation. I'm not unsympathetic to your point about usage.

    3. Saying health insurance doesn't work is really just saying that medicine doesn't work. Because frequently, it doesn't. A lot of expensive drugs are, at best, slightly more effective than placebos. A lot of the care one receives in a hospital, or in a doctor's office, is effective for the same reason just waiting is effective - the ailment was going to go away on its own. Many times, medicine is not effective at all. And sometimes, people get infections in a hospital, and come out — if they come out at all — worse than when they went in. Or suffer other medical errors.

      Knowing all that, and knowing that medicine failed to cure some people very close to me, does not dissuade me from buying - and valuing - health insurance. The loved ones I know who weren't cured at least had the most hope anyone can have in that situation. They knew that they could afford their treatments. If they didn't make it, it was because medicine failed or wasn't up to the challenge, not because they didn't have enough money to have a fighting chance.

      I too want a fighting chance, if it comes to that, so I drop the big bucks for insurance. There a lot of places that aren't as rich as the US — "a lot" in this case meaning every other industrialized country on earth — where you can get sick without having to worry that paying for medical care will ruin your life, even if ultimately it doesn't save your life. Ten or twenty years after the US achieves universal healthcare, the thought of people suffering or going broke because they couldn't afford treatment will be as foreign as the world where segregation was legal.

    4. There is a study based on the Oregon Medicaid data that concluded that Medicaid is a cost-effective way to improve health. The study is behind a paywall, but is discussed here:

      Also, Megan McArdle wrote, “There's been a bit of revisionist history going on recently about what, exactly, its supporters were expecting from Obamacare-apparently we always knew it wasn't going to "bend the cost curve", or lower health insurance premiums, or necessarily even reduce the deficit…”

      I won't track down the links, but people have in fact argued (convincingly, in my view) that Obamacare has bent the cost curve, lowered insurance premiums in the individual market, and reduced the deficit.

  2. The corollary of the proposition that taking health insurance away from 22 million Americans will kill many thousands of them is that the baseline, in which another 20 million Americans plus 10 million illegal immigrants are still uninsured, is unacceptable.

    The estimate published in Vox for the former is 208,000 over a decade. This is if course imperfect but it must be in the right boneyard. For comparison, US fatal military casualties in the Pacific theatre of WWII, following "the day that will live in infamy", were 161,000. So leaving 30 million uninsured could easily cause another 280,000 premature deaths. These will happen: even on the most optimistic scenario of a Democratic clean sweep in 2020 on a platform of universal health care, it won't be fully in place before 2025. But there is still, I suggest, an obligation on American progressives to fight not just to save ACA but to go beyond it in non-geological time.

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