You’re Going to Die (And Obamacare Can’t Stop That)
Posted by Enrique on 10.24.2012
It's almost over, dear readers. In just a few short weeks, the 2012 campaign will be over and either Barack Obama will have been elected to what will surely be a disastrous second term, or Mitt Romney will be elected to what will surely be a disastrous first term. But at least those of us that live in "swing" states won't have to see the damn ads anymore. I envy those of you who live in most of the U.S.
Although there isn't any meaningful difference between the two clowns running for POTUS, one slight variation is that Romney has said he will work to repeal Obamacare. Whenever the issue comes up, defenders of Obama and of the concept of universal healthcare often make the argument that if Obamacare is repealed, people will die.
If I might make a controversial observation: we're all going to die. Whether or not we have health insurance has a lot less to do with human mortality than you have been led to believe.
Of course, Obamacare has its defenders, who invariably make emotional appeals that this blasted 2,000 bill that not one single person has ever read is the only thing keeping many of us from death's door. Just before the second presidential debate, Newsweek's Jonathan Alter appeared on MSNBC trotting out this over-used trope.
"If Obamacare is repealed, more people are going to die for lack of health insurance, depending on the outcome of this election." You can hear it in his voice, he sincerely believes this stuff.
Granted, Alter is an unserious has-been writing for a publication that barely exists. The New York Times is still a fairly serious publication, with some fairly serious writers (Paul Krugman notwithstanding). Nicolas Kristoff is usually tolerable, but last week he turned out this sorry tale about a friend of his who is dying of cancer, who supposedly won't die if Obamacare stands, or who would have been better off if universal healthcare existed in the U.S.
Kristoff says, "Strip away the sound and fury of campaign ads and rival spinmeisters, and what's at stake in this presidential election is, in part, lives like Scott's… If you favor gutting ‘Obamacare,' please listen to Scott's story." The story itself is full of nuance, and it's unclear how Obamacare would have prevented Scott from getting cancer, or even have helped him obtain insurance coverage. But it's another example of how blithely influential opinion-makers peddle this "Obamacare = Life" twaddle.
Perhaps the most infamous example of this genre was the Obama campaign ad from a few months ago in which a former steelworker blamed Bain Capital and Mitt Romney for his loss of employment, health insurance, and his wife's subsequent demise.
In all these cases, the underlying implication is that a lack of health insurance is tantamount to a cause of death – that surely, people with health insurance will seek treatment more frequently, serious illnesses will be caught earlier, and people will live longer. The argument is appealing because there is a certain logic to it. But it's a faulty, ignorant sort of logic that reduces a complex and terribly over-regulated healthcare system to a false premise – that health insurance makes you live longer.
This is the same kind of ignorance that prolongs wrong-headed and frankly idiotic economic policies – and healthcare reform proposals are at their core economic policies. I'm reminded of arguments in favor of raising the minimum wage. Although there is ample evidence that raising the minimum wage hurts low-skilled workers because it prices them out of the job market, plenty of people think such increases help them. It seems intuitive – if the minimum wage is higher, poor people will have more money. The reality is poor people will have fewer job opportunities, but if you're ignorant, you won't understand that.
A similar ignorance is behind this argument that the availability of health insurance prolongs life. While it is certainly desirable to have insurance in America's severely distorted healthcare market, it does not follow that access to health insurance is the difference between life and death. Here are a few reasons why.
Having health insurance isn't the same as being healthy
This is actually fairly obvious, but it bears repeating. Even if you have health insurance, it's not the same as making lifestyle choices that tend to extend one's life. Although smokers are typically penalized with higher rates, just having insurance won't prevent a cigarette devotee from getting lung cancer. Having health insurance also can't make you visit your physician for routine checkups, maintain an exercise regimen, or stick to a diet. Just as having seat belts in your car won't necessarily make you a more cautious driver, having health coverage is far from a guarantee that individuals will make responsible health choices.
Just because health coverage is available does not mean people will obtain it
Buying insurance on the individual market is often too expensive, but even when people can afford individual coverage they may choose not to buy it – no matter what the Supreme Court says about the individual mandate. The sad story of Kristoff's friend Scott actually reinforces this point: "Let's just stipulate up front that Scott blew it. Other people are sometimes too poor to buy health insurance or unschooled about the risks. Scott had no excuse." This was a guy who could have afforded insurance, but didn't buy it. How then is Obamacare supposed to have prolonged his life?
As for Obamacare's individual mandate, there appears to be no enforcement mechanism. Thus plenty of people will make the same choice Kristoff's friend Scott did and forgo purchasing health insurance, even in a subsidized market. Speaking of which…
There is little evidence that subsidized health insurance produces better outcomes
It's enticing to believe that people with health insurance will seek preventative care, or have better clinical outcomes. But there is no evidence that the availability of health insurance, particularly in vulnerable populations, actually improves health. A recent study of Medicaid patients (low income by definition) in Oregon found no clear connection between insurance coverage and improved health. This Medicaid study is the only one of its kind, and certainly it isn't unimpeachable. But the fact that it didn't find a connection between subsidized coverage and better health should give Obamacare supporters pause. At the very least, it seriously undermines the premise that they take for granted – that Obamacare will save lives.
Even if you believe access to health insurance can save lives, Obamacare won't accomplish that
For the big finish, here's the part where I tell you that even if there was rock solid proof that the availability of health insurance results in better health outcomes…Obamacare will not expand access to health insurance. Obviously, any more regulations on healthcare on top of the insane regulations that already exist can only serve to drive up costs, which reduces availability. In addition, a mandate that essentially creates endless demand without addressing supply – healthcare is not an unlimited resource – would only result in shortages.
In his latest column, Robert Samuelson highlights another unintended consequence of Obamacare's perverse incentive structure. Since Obamace it requires firms with 50 fulltime employees to provide health coverage to those workers, but not to part-time employees. Therefore, many employers are either creating more part-time positions, or cutting hours from current workers. That's universal coverage for you.
If it's any comfort to Obamacare defenders, there are plenty of reasons to believe that if Obamacare is repealed, it won't actually result in more deaths than would have happened otherwise. In fact, there are plenty of reasons to believe it Obamacare will actually make healthcare and insurance less accessible. If guys like Alter and Kristoff are actually concerned about people dying for lack of health insurance, they should consider the numerous ways that Obamacare will make coverage harder to obtain.