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When opinions on health-care insurance stop being polite and start getting complicated

One further comment on the skepticism that some have adopted on whether health insurance coverage saves lives: This is not a skepticism consistent with either their actions or their professed beliefs.

For one thing, all involved have good health-care insurance that is costing them a lot of money. If the benefits of health-care coverage were as unclear as they're suggesting, or if medical care was as dangerous as they're implying, you'd expect to see different behavior. But the skepticism is not even in service of the argument that the affluent and insured should give up their insurance and spend their money on more measurably beneficial goods. It's being applied to health-care reform, which is to say, whether insurance should be extended to people who don't currently have it because they can't afford it.

That's particularly peculiar given that the Rand health-care insurance experiment, which skeptics frequently cite, found that low-income folks benefit the most from health-care insurance. That is to say, the evidence actually suggests that health-care reform makes a lot more sense than, well, the health-care coverage of its skeptics.

Second, the argument that Megan McArdle has previously made against health-care coverage is that cost controls should be avoided because medical innovation is of incredible value. I don't think much of the rigor with which that argument had been made, but put that aside.

What health-care coverage does, in its simplest form, is secure access to medical innovations. To express skepticism about the value of health-care coverage while opposing anything that might reduce the treatments health-care coverage can buy is strange indeed. If the product's value is so unclear even given how much we spend on it, that would strengthen the case for harsh cost controls considerably. Instead, the argument is both that health-care insurance isn't obviously worth it, but that we should also aggressively resist any efforts to cut back on it. There's a lot more respect for the speculative further benefits that insurance can offer the insured than the more measurable benefits insurance can offer the uninsured.

There's also real confusion between whether something is "too small to measure" and whether it's not being measured because we're not cruel enough to run the kind of experiment that would measure it.

The observational studies attempting to control for relevant variables find insurance saves you from death. But if observational studies aren't good enough -- and that's the actual argument of McArdle's piece -- then you've got the studies, some of them natural experiments, that find insurance is very effective at saving you from things that will kill you. In the middle are some studies that are not designed to measure the mortality benefit of insurance, but now they're the studies worth consulting, which is not the position of the people who conduct those studies. (For a more thorough, rigorous look at the research, see this literature review from one of the leading researchers on this topic.)

What we're really left with is a sudden skepticism of health-care coverage being made by people with health-care insurance who believe in medical technology and who are using methodological difficulties to argue against the value of an expansion of health-care insurance to the poor -- who, for that matter, appear to be helped more by health-care insurance than the rich.

I think McArdle, for one, would object to that characterization, and say something along the lines of her point is simply that these are tough questions to answer. I guess they are, but they become very easy to answer when the question is "should I have health-care insurance" or "should I advocate policies ensuring society devote a heavy share of its resources to making sure my health-care insurance can buy me more services in the future." In those cases, the overwhelming bias is towards insurance and its benefits. Things just get weird when we're talking specifically about an expansion of health-care insurance to the poor.

I don't want to be too harsh, and I don't want to imply that anyone is sitting around twirling their mustache thinking up ways to hurt poor people. But opposition to health-care reform (which is different than opposition to the people who would be helped by health-care reform) is leading to some very strange arguments about the worth of health-care insurance -- arguments that don't fit with previous opinions, revealed preferences, or even the evidence the skeptics are citing.

There are methodological questions worth exploring when you're trying to assess the worth of coverage, and though I'll defend my use of the studies that have labored to come to a usable answer on the subject, I think that a fair case can be mounted against the observational studies that best lend themselves to estimating specific death tolls. But the arguments on the table go considerably further than that. Saying that the protective effect of health-care insurance is hard to measure is very different than saying it is "too small to measure," particularly when the comment is coming from someone who pays for health-care insurance, and is being made in context of whether the uninsured should get insurance rather than whether the insured should let go of theirs. There's a methodological question here, and then there are political agendas here, and the two are getting mixed up.

By Ezra Klein  |  February 15, 2010; 12:00 PM ET
Categories:  Health Coverage  
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Comments

Couldn't have said or written it better. Let all those who think health insurance has no effect on one's mortality "show me the money!" Cancel your health insurance. It doesn't make any economical sense to keep it. But I can say confidently that they are all going to keep their health insurance because of some probability (no matter how small), that some day they might fall into that group...those with chronic and/or critical health needs...that clearly benefit from having health insurance.

Posted by: ZnanaB | February 15, 2010 12:07 PM | Report abuse

> Second, the argument that Megan McArdle
> has previously made against health-care
> coverage is that cost controls should be
> avoided because medical innovation is of
> incredible value.

There has been a lot of progress in medical science over the last 50 years, but perhaps not as much as people think. Efficient sewers, clean water, vaccination, basic antibiotics, and emergency surgery (from MASH-type war experience) account for most of the improvements. Yes, we have developed a lot of fancy new drugs since 1970. Some have been true miracles (inhaled steroids for seasonal allergies) but on many many others the jury is still out (statins). And for every miracle drug there has been at least one with substantial unintended side-effects (Vioxx) - which never seem to get counted by the McArdles of the world.

sPh

Posted by: sphealey | February 15, 2010 12:22 PM | Report abuse

"What health-care coverage does, in its simplest form, is secure access to medical innovations"

Is this generally true? Wouldn't you describe it as securing access to costly, but tried-and-tested procedures? Specifically, most insurance does not and has not covered experimental or new treatments (even when these "new" treatments, though still expensive, have show demonstrable results). Historically, healthcare coverage does not secure access to medical innovations until such time as those innovations are considered established medical standards.

"The observational studies attempting to control for relevant variables find insurance saves you from death."

For how long? Obviously, good health insurance does not make us immortal. But, if it's an obvious good, there should be a clear difference in life expectancy between the insured and uninsured, particularly between the perpetually uninsured and the perpetually insured. What is it? And why doesn't the conversation focus on that number, which would seem to be the most relevant? If having health insurance save millions of lives, but those millions of lives saved ends up equating to approximately 3 extra weeks of life, on average, per persons, that very different than saying that good healthcare leads to, on average, 10 extra years of life per person.

Been searching for the numbers, and I can't find anything.

"Saying that the protective effect of health-care insurance is hard to measure"

It's not hard to measure when it comes to the impact extended or catastrophic illness has on individual wealth. A serious illness can bankrupt folks without good health coverage.

Posted by: Kevin_Willis | February 15, 2010 12:23 PM | Report abuse

I think it important to point out that Ms. McArdle does have a chronic condition (asthma). I have followed her columns on and off for a year. She often writes of having food poisoning, has mentioned difficulties with generic drugs for treating her asthma, and many other personal health related issues. She also frequently describes being poor or underemployed and without access to good medical treatment. I believe she is quite vested in ensuring that her health benefits continue as they are for her personally. Her writings and rationales must be assessed through this lens. I do not believe she can be objective here.

Posted by: Kew100 | February 15, 2010 12:25 PM | Report abuse

I long wondered why anyone takes the time to respond to Jane Galt's columns, only to eventually come to the realization that there are far too many people who are grasping for anything resembling a logical argument that will justify those conclusions. She provides a valuable service for those too polite to say what they're shopping for.

Posted by: cog145 | February 15, 2010 12:26 PM | Report abuse

I think that Ezra is conflating "killing you" with "bankrupting you." If you don't have health insurance, most times and in most ways, it is going to be really expensive to secure treatment for chronic expenses and could lead to a severe hit to your net wealth and likely bankruptcy. However, a similar result is true for homeowner's insurance: if you don't insure it and you suffer an expensive loss, it can and likely will wipe out a significant portion of your net wealth and likely bankrupt you. That's why people carry insurance.

Most if not all people have health insurance because they don't want a single catastrophic event to wipe them out. They don't think that they'll necessarily die from a lack of insurance, they just don't want to be wiped out because of it.

This cul-de-sac of a discussion arose simply because proponents of health care have at times fallen back on saying "so and so would rather kill x thousands of people every year than support HCR." That has led to the question, "really, how did you come up with that number?" It's crazy and frankly an obvious distraction, but well, here we are. Again.

Posted by: Philly213 | February 15, 2010 12:32 PM | Report abuse

No, I'm really not. There's a different body of research on the financial protections offered on health-care insurance. This is entirely about the effects on mortality and morbidity.

Posted by: Ezra Klein | February 15, 2010 12:39 PM | Report abuse

The methodology behind measuring the causality of treatment effects when the counterfactual is absent is incredibly complex and the statistical literature on the subject isn't very old at all. Many methodologies are only a couple years old and still being actively expanded and explored.

Absent of really cruel experiments where we force people to live their lives in a specific way to see whether or not they die quicker, the effects are going to be very difficult to calculate. This does not mean they don't exist. I have very little faith that McArdle understands even the teeniest bit about these methodologies. They are definitely way past anything she learned 10 years ago in an MBA program and not the kind of thing ou can teach yourself unless you have a great graduate level grasp of statistical theory.

The humorous part is that anyone is treating her opinions as anything other than they are - purely ideological stances masked by citations she doesn't even comprehend, and filled with enough dependent clauses and qualifiers to give her plausible deniability when confronted about a stance on any particular detail. (This tends to hold true for nearly everything McArdle writes that does not involve kitchen gadgets.)

The particular irony, as Ezra points out, is that her own revealed preferences entirely contradict the stated viewpoint. All these people arguing that insurance does nothing spend significant amounts of their own personal income to purchase insurance for themselves. I think that says all that is needed to be said about what they actually believe. They know it does good. They just don't want their money doing good for someone besides themselves.

If that is their belief, then argue the merits of self-sufficiency, but this whole, "well, when I buy it for me, it helps me, but if I bought it for you, it probably wouldn't do much, so I won't buy it for you," argument is hogwash.

Posted by: nylund | February 15, 2010 12:50 PM | Report abuse

"This is entirely about the effects on mortality and morbidity."

Do you know what the equates to in terms of average extended lifetime of those who have coverage vs. those who don't? You can say millions of lives will be saved, but if they are save so they can die tomorrow vs. ten years from now, it's a significant and important difference.

And one, I'm a quick to note, I'm sure has been brought up, I just missed it somehow and apparently can't use the Google all smart-like this morning and find it.

Posted by: Kevin_Willis | February 15, 2010 12:52 PM | Report abuse

I have essentially opted out of traditional health care insurance, because the benifits did not match the cost. Instead I purchased a very high deductible policy ($6,700 deductible per year) and use a health savings account to pay for medical care. This has motivated me to shop around for low cost routine care and to live a healthier life style. It has substantionaly reduced my yearly healthcare costs.I highly recomend it to everyone, even those with an existing illness.

Posted by: cummije5 | February 15, 2010 1:19 PM | Report abuse

Philly213 says..."This cul-de-sac of a discussion arose simply because proponents of health care have at times fallen back on saying "so and so would rather kill x thousands of people every year than support HCR." That has led to the question, "really, how did you come up with that number?"

Are you saying that if you put "bankrupt x" in place of "kill x" that resolves the issue? Yes, the choice of words may be a little over the top, but people going bankrupt or losing a significant portion of their networth isn't a minor thing, especially if you are poor. And in fact, in the series of posts that started this discussion, McArdle says similar things about medical bankruptcies...namely that the numbers may be inaccurate.

Also, you forget one critical difference between having insurance on your home and medical insurance. Yes, home insurance is truly for that catastrophic event that rarely happens to most of us. Health insurance on the other hand, in its present form, conflates catastrophic and routine events and forces me (or my employer and me) to pay a premium that is many times what I pay for my home insurance. How much to you pay for home insurance versus health insurance?

Posted by: ZnanaB | February 15, 2010 1:27 PM | Report abuse

"No, I'm really not. There's a different body of research on the financial protections offered on health-care insurance. This is entirely about the effects on mortality and morbidity."

Ezra, you are conflating them when you suggest that McCardle or Cowen shouldn't buy health insurance if they don't think it will save their lives. Protecting your assets is a very good reason to buy health insurance, and there is nothing at all inconsistent about purchasing health insurance even when you don't believe it will save your life.

And let's remember, this whole discussion is only taking place because you and others have decided to take the sensationalist and dishonest "Joe Lieberman wants to kill hundreds of thousands of people" approach to the health care reform debate. Throughout all of this, the question that McCardle, Cowen and everyone else are failing to ask is, what is the expected net effect on mortality from this particular version of HCR? Do you think that we can extend insurance coverage to all of the uninsured with no change in outcomes (not just in the short term, but 10-20 years down the road) for all of the currently insured?

I also find it interesting that you've focused on McCardle's arguments and ignored those of Tyler Cowen. It seems like you've chosen the easier path. Cowen has asked a very simple question, if you believe that HCR will save X number of lives at a given cost, what other policy choices are there that would save just as many at a lower cost? You're getting bogged down in this silly "how many deaths does lack of health insurance cause, to the 4th decimal place" argument when we ought to be asking what are the most cost-effective ways to improve the health and financial well-being of the most needy.

Posted by: ab13 | February 15, 2010 1:28 PM | Report abuse

"This cul-de-sac of a discussion arose simply because proponents of health care have at times fallen back on saying "so and so would rather kill x thousands of people every year than support HCR." That has led to the question, "really, how did you come up with that number?" It's crazy and frankly an obvious distraction..."

Uh, no.

Health insurance is a life and death matter and if you don't want the heat don't jump in and start claiming folks don't need coverage.

Just from my personal experience, the following. NOTE: 3 deaths.

1. My boss, an entrepreneur, during start up phase (in his 30's) did not carry health insurance. Everything went into the business. He got cancer. Went bankrupt from treatment expenses (a million in the hole). Tried to come back with a new business. Failed. Killed himself.
2. A brother in law, trying to start a business, began feeling very sick. No health insurance. He put all his money into the business. He got sicker and sicker, ended up in critical, now has a health condition much worse than if he had caught it early. Tens of thousands in debt, natch.
3. A friend's son, turned away from one ER and sent to another when he needed emergency surgery, died en route. No health insurance. Very treatable condition. In his twenties.
4. Another friend, congestive heart failure that went untreated for several years until he qualified for Medicare. Will he die earlier as a result? Probably.
5. Another friend of a friend got pneumonia and didn't go to the doctor because he didn't have insurance. Finally, he went. Then, he died. It was too late.

This is why I have found Jane Galt and her minions taking the position that extending health care insurance is of very dubious value in saving lives to be extremely offensive.

Yes, they are arguing for killing tens of thousands of Americans every year.

Ezra is being polite.

Those are exactly the stakes.

What Jane Galt and minions are doing is disgraceful!

Posted by: mminka | February 15, 2010 1:47 PM | Report abuse


Note that no one is taking on you, IOM, et al. in a real counter argument. No one is trying to say, "No, you're wrong, the data/methodology does not support the assertion that insurance saves lives." Sure, there's some quibbling about study design and I'd somewhat dismiss McCardle's quasi-objection out of hand, but, ultimately, it is a very sound conclusion and I haven't found anyone writing a firm objection. Given that, I'm with you, why isn't this being shouted from the rooftops?


Posted by: ThomasEN | February 15, 2010 1:52 PM | Report abuse

This is great commentary but other commentators are right. I think the primary reason Cowen (or at least I) would be health insurance is insurance of my assets. McCardle does contradict herself when she argues that medical innovation is so valuable yet there has ben so little it saves an insignificant number of lives. She also doesn't understand enough about power calculations to see the problem with her "too small to measure" argument.

You also need to admit that the "you want to kill 10,000 people" arguments do have complications. First, they ignore the costs. I can't jump onto the health reform bandwagon that fast because $9 million per life is a lot. There are tons of ways to save multiple lives for $9 million so why is health care that important? Second, you implicitly value American lives a lot more than foreign lives. Can you explain why?

Posted by: steve10c | February 15, 2010 1:54 PM | Report abuse

There are three key points I want to make:

1) A danger doesn't have to be 100% certain for it to be worth doing something about it, insuring against it. Republicans have become the party of risk. We don't know 100% for sure that global warming could devastate the planet, so let's not spend any money to insure against that. We don't know 100% for sure that health insurance could save your life; there's merely a very strong chance it could, and that it could save you from terrible disability and suffering, so let's not make it something you can really be sure you and your family will have. We don't know for sure that our house could burn down, so let's not spend money on home owners insurance.

2) Republicans and libertarians argue about how rational and informed people are, but then they argue against health insurance being worth much, even though most people spend a tremendous amount of money for it. How can people be so rational and informed and still spend so much money on something you argue is worth so little?

3) Obviously the Republican party will without hesitation make dishonest arguments to get what they want, which is as little spending and protections for the middle class as possible, and as much tax cuts and deregulation for the rich and business as possible.

Posted by: RichardHSerlin | February 15, 2010 2:00 PM | Report abuse

Ezra,

"What we're really left with is a sudden skepticism of health-care coverage being made by people with health-care insurance who believe in medical technology and who are using methodological difficulties to argue against the value of an expansion of health-care insurance to the poor -- who, for that matter, appear to be helped more by health-care insurance than the rich. "

I understand your overall point here and it is good.

But you are making a serious mistake in saying the health care reform is really an expansion of health care insurance to the poor.

In terms of our economy, our innovation and our small business sector, it is much more signif that this is an expansion of health care reform to entrepreneurs.

Right now, if you go out on your own to start a business, it is quite likely you will go without insurance for awhile.

My list shows two cases, one including death, two cases just from my experience, of this problem.

We are slaves to the corporate sector, even as they outsource, slash jobs and benefits, etc. Because they provide health insurance. This simply must stop.

Posted by: mminka | February 15, 2010 2:06 PM | Report abuse

M Minka is right. The truly poor have access to Medicaid. It is the people who are lower-middle or borderline poor who need health insurance, plus the entrepreneurs and their employees. This latter should be stressed more to box in GOPers. I remember seeing an entrepreneur/small business person confound the talking heads at CNBC by being in favor of the public option and reform in general. Why does the GOP hate small business and entrepreneurship?

Posted by: Mimikatz | February 15, 2010 2:29 PM | Report abuse

Ezra, thanks for responding to my post.

My response was to your primary point that: "For one thing, all involved have good health-care insurance that is costing them a lot of money. If the benefits of health-care coverage were as unclear as they're suggesting, or if medical care was as dangerous as they're implying, you'd expect to see different behavior."

My position (and I imagine some of the critics) is that the "benefits" of having health care can be unrelated to, or even insignificant to, your overall physical health and the quality or danger of medical care. Rather, the primary benefit to me is that if I get sick, my family won't be bankrupted. I realize that I'm fortunate, but my weight, family history, diet, physical fitness, and other conditions and habits relate much more closely to the state of my physical health than my insurance status. Again, I have insurance for the catastrophic event. Maybe I'm the rare case, but I doubt it.

Frankly, I think that the financial security of expanding health care coverage is more important to most folks than the numbers of lives saved, improved, etc., because people can't really wrap their arms around that concept and probably are dubious of the more vociferous critics' numbers. If there were a model that moved more to out-of-pocket expenses being paid outside of the insurance system as the means of signalling costs (rather than the byzantine cadillac tax approach), along with a moderate increase in Medicaid coverage to prevent the working poor from being financially wiped out by a significant medical event, I think that approach would have broader support.

I really enjoy your coverage of this topic and I appreciate the forum that you provide for your commenters' wide range of opinions.

Posted by: Philly213 | February 15, 2010 2:30 PM | Report abuse

Two men get invited to a ski weekend. One has insurance, the other doesn't. The one that does not decides its too risky to go skiing. Even a mild injury would cost too much financially. The other goes, and dies. You do the econometrics and sure enough, having health insurance seems to INCREASE the chance you'll die. This is a hyperbolic example with only two data points, but the idea is simple. The act of having insurance can change behavioral choices. As one commenter above noted, after forgoing health insurance, he actively sought to live a healthier lifestyle in an attempt to lower the risk that he may need medical care that he may not be able to afford.

In a sense, its a moral hazard issue. If you pass on the financial risk of your behavior from your own pocket to the pocket of the insurance company, you may find yourself taking on more health risk. And conversely, if that risk is transferred back to you, you may choose to engage in less risky behavior. These individual specific random effects are just one aspect of the difficulty in modeling such things.

Posted by: nylund | February 15, 2010 2:33 PM | Report abuse

When McArdle says the value of insuring the poor is too small to measure, she means the value TO MCARDLE.

Posted by: mattmdavis1 | February 15, 2010 2:42 PM | Report abuse


nylund,

yeah, but several studies have shown that plans with more cost-sharing (Health Affairs had one a few years back, and NEJM just a few weeks ago) result in patients missing preventive care and, presumably as a result, higher rates of hospitalization. There might very well be some element of being more careful, but when you also have poorer health outcomes, careful doesn't do much good.

Posted by: ThomasEN | February 15, 2010 2:54 PM | Report abuse

I've sometimes wondered why writers like Ezra bother responding to bad faith arguments by people like McArdle. Posts like this are the answer. Well done, Ezra!

Posted by: redwards95 | February 15, 2010 3:25 PM | Report abuse

Ezra makes some good points, not with the ad hominem type agruments, but with the general point that some health care is good.

I think the point that the mortality studies, and the more general fact that increased health care spending does not seem to lead to better outcomes points to a different solution to the problem than Ezra has traditionally supported.

What it points out to me is that most health care innovation is overpriced. Since we seem to locked into a process where all new treatments get added into health plans, encouraging value-based, disruptive innovation in health care would be a positive change.

While we certainly want basic health care for everyone, we can't necessarily afford robotic surgery or the latest drugs for everyone. If slowed the pace of what was approved for Medicare and Medicaid, we could afford to pay for what have today tomorrow. If we changed to a more direct payment structure, patients would have an incentive to save money on their own care, as opposed to not even being aware of the cost of their treatments to society.

Posted by: staticvars | February 15, 2010 4:21 PM | Report abuse

"If you pass on the financial risk of your behavior from your own pocket to the pocket of the insurance company, you may find yourself taking on more health risk."

Really? This is an interesting supposition, but I think it overlooks what actually takes place in the real world.

The person that has health insurance is more likely to have annual routine check-ups, preventative care, and to receive early diagnosis and treatment. The doctor will advise (and nag) the patients about risky behaviors and identify "silent" conditions about which the uninsured patient who does not receive routine examinations might otherwise be completely unaware.

To put it another way, is a person who has been diagnosed with high cholestorol more or less likely to consume "heart healthy" foods than a person who does not even know their cholesterol numbers?

In my experience people who are keeping up with routine medical care and tests take better care of themselves than people who avoid seeing the doctor because of the financial burden (or for any other reasons). My own limited experience is purely anecdotal, I'll freely admit. But it seems more intutive to me that this is generally true when compared against the idea that people who are insured against much of the expense of illness are more likely to engage in behaviors that will make them sick.

Posted by: Patrick_M | February 15, 2010 4:33 PM | Report abuse

"I think McArdle, for one, would object to that characterization, and say something along the lines of her point is simply that these are tough questions to answer." Fortunately, McArdle has already posted her actual answer.
http://meganmcardle.theatlantic.com/archives/2010/02/the_benefits_of_health_benefit.php

Posted by: MikeR4 | February 15, 2010 4:45 PM | Report abuse

Overall lesson: 30-something libertarians vastly underestimate the chances that they will need significant amounts of health care from age 45 on, and vastly overestimate the amount of control they have over their own long-term health.

sPh

Vegetables are great, I eat a lot of them, and I am sure they make me healthier in some sense - but no amount of carrots will overcome the last 10 generations of genetics and environmental influences that started before I was even sentient.

Posted by: sphealey | February 15, 2010 4:50 PM | Report abuse

"The truly poor have access to Medicaid. It is the people who are lower-middle or borderline poor who need health insurance, plus the entrepreneurs and their employees. "

Which basically supports those who are saying that health insurance is chosen at least as much for protecting assets as for saving life. If you become ill and spend everything you've got, you then qualify for Medicaid. But most people would rather have insurance.

Posted by: bgmma50 | February 15, 2010 6:20 PM | Report abuse

I have a question to ask of those who think that health care reform should include preventative care, low copays, low deductibles, etc.. Would you be willing to incur annual and lifetime caps on expenditures, or do insist on having the whole nine yards?

Posted by: bgmma50 | February 15, 2010 6:27 PM | Report abuse

One thing is certain though, and I thank ezra for pointing this out. The voters of Mass are responsible for killing hundreds of thousands of folks since they effectively killed Obamacare. Where are the cops? Where are the AGs? Where's the outrage?

Posted by: permagrin | February 16, 2010 10:21 AM | Report abuse

Mr. Klein writes "then you've got the studies, some of them natural experiments, that find insurance is very effective at saving you from things that will kill you."

Insurance has never saved anyone. Medical care does, however, and insurance helps pay for that provided the entity offering the insurance actually pays enough for the medical care you need so that the people who can provide that medical care are willing to treat you.

With respect to the question of whether providing government defined health insurance for all saves lives relative to the current system in the U.S., the answer is not obvious.

What is clear is that disaggregated population health measures in countries with government provided health insurance, the UK being a leading example, show that promises of coverage do not necessarily translate into decent medical care.

For a summary of the methodological problems with the work on which the claim that 45,000 die each year in the U.S. is based, see http://www.john-goodman-blog.com/does-lack-of-insurance-cause-premature-death-probably-not/.

Posted by: fourier | February 18, 2010 11:46 AM | Report abuse

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