12 February 2010

Insurance ramble

Twitter | mattyglesias

Do rightwingers really believe that US health insurance has no mortality-curbing impact?
(1) I'm not rightwinger, nor would I speak for them.

(2) I can only assume Yglesias is responding to the discussion sparked off by this McArdle post on how many people die from lack of health insurance. Read the whole thing, but she opens and closes with:
It's a contentious question, but curiously, one that doesn't get debated nearly as fiercely as things like "how many uninsured people are there?" I find that surprising, because after all, we don't necessarily care whether people are marked by some survey as "insured" or "uninsured"; we care whether there is preventable suffering in the world.


That doesn't mean I'm prepared to say that no one dies from lack of insurance. The data is messy, and the studies often contradict each other. Intuitively, I feel as if there should be some effect. But if the results are this messy, I would guess that the effect is not very big. At minimum, I think we should be pretty cautious about stating that we know how many people die from lack of insurance. We don't, and worse, we may never.
I agree with Cowen that "I don't view it as incumbent on me to come up with the final answers in this debate or even a provisional stance. It's incumbent on the people pushing coverage plans to make the case for what they are doing and so far they haven't."

All that said, Yglesias is asking a pretty spurious question.  The matter isn't "does health insurance impact morality, yes or no?"  It's not a boolean issue.  The question is "how much does health insurance impact morality?"

The most generous study McArdle found, which she presents good reason not to trust, reported 45,000 annual deaths from lack of insurance. In 2008, the latest year for which I have data, 37,261 people died from motor vehicle accidents.

If we could take half of the bazillions of dollars proposed to extend insurance to more people and instead build everyone an autonomous driving robot that would eliminate fatalities from car accidents we would come out way ahead.*

The goal isn't to get people health insurance, it's to keep people alive.

* Obviously that's not a serious proposal.  But it should be.  It would make cars much more efficient and reduce commute times.  Win-win-win.  One day we're going to look back on the days when you had to pilot your own vehicle and wonder how people put up with such barbaric meniality.

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