Lack of Insurance Means We’re Dying for (Media) Coverage

So while still trying to find something about the uninsured vs. insured dying becuase they simply didn’t go to the doctor, rather than blame it on coverage, I found a CBS article and noted that they said John Goodman was in disagreement with their statistics of people dying simply because they lacked insurance.  So I went over to Dr. Goodman’s blog and found several articles.  The following exerpts are from the two I thought were the best.

Does Lack of Insurance Cause Premature Death?  Probably Not

As for the public policy implications of all this, the PNHP authors are on record as favoring Canada’s system of single-payer national health insurance. Yet insured patients in Canada fare worse than the uninsured in the United States. The O’Neills find that:

  • Among US women age 40 to 64, 87% of those with insurance had a mammogram within 5 years.
  • The rate for Canadian women is 65% — the same as for uninsured women in the US.
  • Canadian women also have the same rate of screening for cervical cancer as uninsured US women (80%), over five years. Among insured US women, the rate is 92%.
  • Among uninsured US men, 31% were screened for prostate cancer, compared with 16% of Canadian men. For insured US men, the rate is 52%.

People are Dying for (Media) Coverage

Families USA applied the Urban Institute updates and the IOM method to even more imprecisely estimated state data to produce its Dying for Coverage series.  Page 2 of the Urban Institute report explains the methodology used to create the IOM estimates, the Urban Institute estimates, and the Families USA estimates.  Consider 25 to 34 year olds.  Deaths are allocated among the insured and uninsured for this group in the following way:

  1.  Take the percent of insured (79%) and the percent uninsured (21%) in this age group from the Current Population Survey.  
  2. Let X be the rate at which the insured in this age group die.
  3. Assume that the rate of uninsured death is 1.25 times X (from Franks). 
  4. Add the death rate of the insured and the death rate of the uninsured together to get total deaths. Using U.S. vital statistics data this yields 40,548 = (0.79*X) + (0.21*(1.25*X)).
  5. Do simple algebra to get 40,548 = 1.05*X.
  6. Divide by 1.05 to get the number of deaths assumed to be attributable to the insured population, 38,617.
  7. Claim that the 1,931 difference between total deaths and the deaths attributable to the insured population are “excess deaths” due to a lack of health insurance.

Note that in the seven steps listed above, there is no point at which anyone from Families USA actually examines a medical record.  There is no interview with any doctor, any patient or any family of a deceased patient.  There is only algebraic mumbo jumbo in support of an unsupportable claim. 

3 responses

I looked at the original estimate of 18,000 dead from a lack of insurance developed by the Institute of Medicine called “Care Without Coverage: Too Little, Too Late.”

I found that the number shows up only once in the entire report, buried way back in Appendix D that explains the tortured methodology used to come up with that number. First, they rely entirely on a single study that estimated “a higher overall mortality risk for uninsured adults of 25 percent.” Linda Gorman deconstructs this original study persuasively. She notes the study by Peter Franks begins by looking at people who were uninsured or privately insured in 1971 and then looks at their mortality in 1987. Never mind that this entire population likely went through many spells of being covered or not being covered in the intervening years.

IOM then assumes that the incidence of diseases like diabetes, hypertension, breast cancer, and HIV are the same in the uninsured population as they are in the privately insured population. So they multiply the death rate for the insured by 125% and get the “excess mortality” of the uninsured. Voila! 18,000 dead.

There are at least two problems with this approach. First, the uninsured are not a monolithic population. They include people who are between jobs, people who are eligible for Medicaid but not yet enrolled, the young-invincibles who don’t think health insurance is valuable to them, some pretty wealthy people, some pretty poor people, and a lot in between. It also includes a large number of Latino immigrants who are newly arrived in the United States and who are pretty healthy. There is very little that unifies the uninsured, and certainly not their rate of mortality.

Second, the assumption that the uninsured have the same incidence of disease is almost certainly not true for two reasons: 1. The uninsured are considerably younger than the general population, and 2. People with high risk factors are far more likely to stay insured once they have coverage. They will stay with their employer, exercise COBRA options, pay more to get and retain coverage, enter high-risk pools, and pretty much make having coverage a major priority in their lives, because they know they need it.

So, once again, of all the things that might be said about the uninsured, the one thing that is almost certainly not true is that 18,000 of them die each year simply because they do not have coverage.

I have been looking everywhere for better studies and better statistics becuase I agree with you that saying people die simply because they don’t have health insurance is silly (yesterday’s blog article). Someone pointed me in the direction of the IOM yesterday for an article called “To Err is Human,” saying it talked about preventable deaths that were insured and uninsured. It has numbers, but it is dealing with preventable deaths by medical error, which isn’t what I’m looking for. (Here is the article if anyone wants to take a look: http://iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf)

No study should “assume” statistics, especially assuming they are the same between the insured and uninsured becuase you are right, the demographic is very different. 15.3% of the population is currently uninsured by some statistics. Almost 1/2 of the uninsured population are under 34, and typically don’t want to spend anything on health insurance because they are young and healthy/invincible, and about 1/4 of the uninsured American population are not even citizens, so the reform mandates won’t apply to them. That leaves about 1/4 of the 15% of the US Population that was uninsured and possibly wanted to have insurance. (more info on these numbers: http://medibid.com/blog/?p=2288)

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