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March 30 2010

Show Me the Outcomes!

Nicole Kurokawa Neily

One of the top reasons cited as the need for health care reform was the number of lives that would be saved through expanded coverage. A study by the Harvard Medical School released in September 2009 found that 45,000 people die in the U.S. every year (one every 12 minutes!) due to lack of health insurance. Such a thing, we were told, cannot stand in a country as wealthy as America. We had to act, because to not do so would be unconscionable. Oh, the horror! 

It’s likely that outrage from this report played a role in convincing politicians that expanded coverage the uninsured was the most important end goal (not driving down costs in the long-term, or the sustainability of reforms.) Just this week, the President even admitted that adjustments will need to be made to “further reduce costs.” I’m a little late to the party on this one, but my friend Megan McArdle over at The Atlantic made several excellent points last week regarding health care reform that bear repeating.

If you quoted Himmelstein et al's 45,000, obviously you should be expecting deaths to fall by at least 25,000 a year, very conservatively.  If we don't see such improvements, then those studies were wrong. And if you won't commit to saying that you expect such a sizable reduction in our mortality rate, then you were wrong to cite them.

I mean, maybe we say that there are a bunch of combo benefits: we reduce bankruptcies by a third, save five thousand lives a year, get some harder-to-measure morbidity benefits, and so on.  But there have to be some measurable benefits.  If this helps families stave off financial ruin, we should see a meaningful and sustained reduction in the number of bankruptcies.  If it improves health, that should show up in life expectancy.  If it doesn't, then the bill doesn't do what you said you expected it to do.  That's valuable information!  Not so much about you, as about health care bills.

If you don't think that any of the effects of this bill will be large enough to measure and hopefully, large enough to justify the price tag of this bill, then I have to ask two questions:

1)  Why the hell are we spending $200 billion a year, plus the mandated spending by individuals and employers on premiums, plus the new money the states will have to spend on Medicaid? 

2)  Why on earth did you bring up all these apparently irrelevant statistics? 

I'm all for accountability for beliefs.  That's how you make your beliefs better. That's why I want to see all the people who threw around all sorts of theatrical arguments commit to what they are actually reasonably willing to predict will happen.  Then explain why the outcomes that they are actually confident enough to predict justify spending about $2000 for every household in the country.

We’ve already begun to see predictions unravel over the bill’s impacts (Carrie addressed how prices are expected to rise for young people, and there’s been a fair amount about how businesses are about to be smacked with new costs). I hope the politicians – and pundits! – take up McArdle’s challenge to prove their policy decision was the right one for the country. Hmmm… perhaps states were intended to be laboratories of democracy to try this stuff out

Independent Women's Forum is an educational 501(c)(3) dedicated to developing and advancing policies that aren’t just well intended, but actually enhance people’s freedom, choices, and opportunities. IWF is the sister organization of the Independent Women’s Voice.​
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