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Friday, April 13th 2007

Burreaucracy Kills?

Does health care bureaucracy and regulation contribute to more deaths than a lack of health insurance (via Health Care BS via Kevin MD)?

The argument in the Cato policy analysis goes like this,

  • Increased income is associated with decreased mortality
  • When you pay for this health care regulation you take money out of society, and decrease individual’s incomes
  • Therefor you must increase their moratlity

A variety of studies have established a trade-off between income income and mortality: as income rises, mortality falls because people are able to purchase more health and safety. The best of these studies control for prior health status. The median estimate of four such studies shows one statistical death for every $7.6 million reduction in societal income (in 2002 dollars). This implies that $169 billion in health services regulation costs could itself induce upwards of 22,000 deaths a year.

Dr. Conover goes on to compare this figure to the 18,000 lives America’s uninsured problem claims every year per the Institute of Medicine.

As seen through my blog, my opinion is clear: may single payer burn in hell. There, my side is declared for.

And now I can say what I think. This is one of the most tenuous cause and effect association I’ve ever read.

Even I, with my incredibly limited knowledge, can front some obvious objections.

First, the explanation of income and mortality is a GROSS oversimplification. For instance, as linked and spelled out in this blog, it is pretty well established that lower income, independent of access, equates with lower health care usage. For instance, lower income Britons use the NHS less than Britons with higher incomes. A contribution to their disease burden and increased mortality.

The point is, this probably has to do with complicated cultural issues, education issues, health literacy issues, which cannot be solely corrected merely by reperfusing the costs of health care regulation back in as societal income. A major pothole in Dr. Conover’s cause and effect roadmap to increased mortality via increased health regulation.

Second, I find problems with the implication that health regulation costs more lives than lack of insurance. Even if we buy Dr. Conover’s figures, clearly health regulation saves lives as well. For instance, no one will be taking Acroxia in this country because of health care regulation. A lack of insurance doesn’t save anyone’s life.

The comparison should be: 18,000 v. 22,000 – X

And who can sit here, even hating government regulation and even without a peer reviewed study in their lap, and not imagine that X is a pretty significant number of people?

I have another problem. This is a problem with Health Care BS‘ analysis of the Cato policy paper. Not only does the Cato policy analysis only tangentially relate to the effects a single payer system would have on health care expenditures but in a broader sense Health Care BS’ post is an example of attempts to obtusify (and yes I just (transiently) “verbed” the word obtuse) the finances of single payer; which I think is a real problem for opponents of increased government intervention in health care.

Look, most of the time life really is “just this simple.” We can bad mouth the methods by which it achieves such but single payer clearly lowers health care costs and increases health care access for those on the lowest end of the income spectrum.

And this is coming from a guy who keeps shouting about how Americans shouldn’t ask for handouts when their poor lifestyle choices are contributing to increased health care costs (my pet peeve issue for anyone who reads this).

The simple facts just don’t bear it out. And I know America is “unique” and we’re not the rest of the world. But com’n, it really is this simple.

Even with my outrage, and admittance, of other unique contributions to America’s runaway health care costs, there is no way I can look a single payer or socialized medicine proponent in the eyes and not agree that the government controlling all health care expenses would lower health care expenditures…even in this country.

I think opponents of single payer should stick to the more defensible arguments against it. Straying from rationing and access talk only weakens the argument against single payer.