Oren Cass:
If you are going to claim that someone’s policy will cause upward of 200,000 deaths, I feel that you should have relevant supporting evidence. Maybe I’m just old-fashioned that way. Certainly, no such standards seem to hamper the editors at Vox.
Instead, they’ve just published “208,500 additional deaths could occur by 2026 under the Senate health plan,” in which Ann Crawford-Roberts et al. assure readers that they are using “solid estimates firmly rooted in scientific evidence — unlike the dubious claim that the ACA has saved ‘zero’ lives.”
Except here’s the thing: That claim about zero lives saved is supported by multiple independent lines of analysis. (To be precise, the claim is that “the best statistical estimate of the number of lives saved each year by the ACA is zero,” in large part because the ACA’s main effect has been to expand the notoriously ineffective Medicaid program.) There are the numerous studies showing that patients on Medicaid achieve worse health outcomes than those without any insurance. There is the “gold-standard” randomized controlled trial in Oregon that found no significant improvement in physical health from Medicaid coverage. There is work by economist Raj Chetty that found health-care access was not a determinant of life expectancy for low-income households. There is a paper from Yale researchers that found states achieve better health outcomes when they allocate less of their social spending toward health care.
And now we even have data from the ACA itself. As I have shown, the nation’s mortality rate stopped decreasing and actually increased when the ACA was implemented, and matters were worst in the states that accepted the ACA’s Medicaid expansion. A new working paper at the National Bureau of Economic Research likewise finds no significant improvement in self-reported health.
So if all that amounts only to a “dubious claim,” what must the “solid estimates firmly rooted in scientific evidence” look like? Well, it’s three studies. All with the same lead author. Two of them are analyses of the same Medicaid expansion from the same time period in the same three states (Arizona, Maine, and New York). So really it is one study of Arizona, Maine, and New York, and then a separate study of Massachusetts.
The three-state studies found no significant reduction in mortality from expanding Medicaid in either Arizona or Maine, only New York. So one might conclude that in some circumstances Medicaid may have a positive effect; in others, not. But it is in Massachusetts where things get fully derailed, because while the goal here is to show that a Medicaid-heavy reform reduces mortality, the Massachusetts policy did little to expand Medicaid.
For its estimate of 200,000 deaths nationwide, Vox relies on reductions in mortality achieved by Massachusetts when the state pursued health-care reform in mid 2006. The authors consider this a valid proxy for the ACA because “the national patterns [of coverage gains] are not so different from what those were in Massachusetts.” Specifically, they say that 47 percent of the coverage gain in Massachusetts came through Medicaid. This is not correct.
Their supporting evidence is a report that shows 47 percent of the growth in Massachusetts insurance coverage between 2006 and 2010 came from growth in Medicaid. But that’s the wrong time period. The increase in coverage produced by reform was over by the end of 2008 and Medicaid accounted for less than 20 percent of that increase; more than 80 percent was in the private market. The Medicaid growth comes in 2009 and 2010, when coverage shifted away from the private market, likely as a result of the economic downturn.
The most recent CDC data I could find was 2015, five years since the passage of Obamacare…the greatest thing since indoor plumbing according to our liberal friends.
So, I searched 2010, the year we were ‘saved’ by O-care as well as 2005, five years prior, since the most recent data was five years after.
My, my, my… in terms of deaths per 100,000 population
2005 – 798.8
2010 – 747
2015 – 823.7
So, a simplified look at the actual death rates in the US seems to indicate health (as represented by annual deaths, since the liberal hue and cry is about how the Republican plan will kill more people) was actually getting better before the Democrats gifted us with Obamacare, but has declined pretty significantly post-Obamacare.
It appears that removing the ‘improvements’ we were forced into under the Democrat’s solution would reduce the number of deaths, not increase them.
Not that most (any?) liberals have much interest in facts…
@Jay, #1:
The increase in the death rate isn’t directly related to access to health insurance. It has to do with demographics. The number of annual deaths per 100,000 is rising because the percentage of the U.S. population that is elderly is rising. The Baby Boomer generation is beginning to die off. There will be an increase in deaths that matches the previous post-WW2 surge in births. This is because human beings are mortal.
The assertion that Obamacare saved no lives is bogus, because it totally disregards this obvious and predictable demographic factor. Oren Cass is either a nincompoop or a propagandist. I’m guessing the latter, because he also cranks out propaganda on climate change and social policy.
@Greg:
Then – any reduction in access to health insurance cannot/should not be held responsible for any increase in the death rate? Q.E.D.
Can’t have it both ways.
aca is a federal physician/hospital reimbursement plan not a medical delivery plan.
@Jay, #3:
Yes, indeed, you actually could have it both ways.
A predictable increase in the overall death rate will result from an increase in the median age of the population. That is, people will be dying at a higher rate when a higher percentage of the total population is elderly.
The degree of that increase could be either higher or lower than predicted, owing to some secondary factor; for example, because of greater or lesser access to medical care.
Statisticians are in the business of analyzing complex sets of data and figuring such things out. Sometimes the truth turns out to be different than what was imagined or expected.
@Greg:
Which is why the death rate was trending DOWN prior to Obamacare? Was the Baby Boomer cohort youthening rather than aging for that 5 year period?
Which must be what you meant by:
If the Republicans want to make any changes to the changes foisted upon us by the Democrats, it will kill millions, if not billions of people – and how dare you question that!
But if statistics show that Obamacare just might not be all it was promised to be (do we need to go over the ‘Keep your plan; Keep your doctor; Save $2,500 per family assurances again?), why, that’s due to ‘secondary factors’, not the actual, predicted (by Republican’s anyway) impact of the throwing a wrench into the gears of what was a pretty decent system.
Perfect? No. Better than what we have now?
Well, let’s take a quick look at some of the other ‘secondary effects’, shall we:
So, the government MANDATES that citizens purchase health insurance – and the insurance companies wind up losing money?
As Ronald Reagan said “I’m from the Government and I’m here to help!”
Or, as Yakov Smirnoff would say “What a Country!”
And – referring to just one small part of the leviathan which is Obamacare, the electronic records requirement:
(link corrected)
And that one is from Obama’s home town paper!
Unless of course, you’re a liberal, in which case no amount of failure can prove the original concept/idea/policy was in any way, shape or form incorrect, ill advised or just plain wrong.
Top men are on it! Top men!
As the saying goes ‘if you torture the data long enough, it will confess to almost anything’.
And if that doesn’t work, fake it and hide/refuse to release the unmodified files.
I’m sure they have requested Michael Mann’s ‘help’ with their ‘analysis’…
@Greg: This is like you liberals arguments about gun rights. A correlation between a gigantic spike in gun purchases and a drop in crime cannot necessarily be made, but more guns DAMN SURE hasn’t caused more crime. The same with Obamacare; perhaps you can’t blame Obamacare for a higher death rate, but it doesn’t seem to be making everyone’s lives better, does it? Higher premiums, higher deductibles, shrinking services and loss of providers is what Obamacare has brought us.
Forgive us if we don’t take the “predictions” of liberals very seriously. You can’t predict what premiums will do, how many will take coverage, what the cost of health care will do or the overall success of such a law. Furthermore, you cannot predict how violent the populace will become if concealed or open carry is passed, when the earth will be destroyed by rising temperatures or the destruction of the nation if Trump is elected. In other words, it is widely recognized that your liberal emotional predictions do not represent reality.
I still await from all you whiny liberals why you did not protest when the CBO scored Obamacare as leaving 30 million uninsured while costing a mere $2 trillion extra. Wassup wid dat?
@Jay:
All liberals care about is having someone to blame. They can make all the promises th ey want and never have to worry about being called to accounts because they can blame Republicans, Russians, Bush, Trump, gun owners, white people… whatever. It helps to have a corrupt liberal media to carry on that mantra.
So, as predicted, almost to the most minor detail, Obamacare fails and SURPRISE!! Democrats blame Republicans.