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Death by Statistical Error: Does Being Uninsured Really Kill?

If past cycles are any indicator, we are about due for another round of studies showing that being uninsured kills. Headlines will abound, commentators will wring their hands, and anyone who opposes ObamaCare will be portrayed as an insensitive killer.

The good news is that the majority of the supposed deaths due to a lack of health insurance are statistical artifacts. Unlike deaths from government health care, which has been extensively documented to cause harm to the seriously ill, the elderly, and the newborn, the deaths due to a lack of health insurance are usually conjured out of data sets using a variety of statistical tricks.

Here’s a simple checklist for cutting the number of deaths down to size:

1. Does the study interview people only once and then assume that they remain uninsured? If so, it will likely overstate the fraction of people who die because they don’t have health insurance. Relatively few people remain uninsured for more than a year.

2. Does the study track how people died? If not, it probably overstates the number of deaths due to a lack of insurance. Younger people are more likely to be uninsured. Younger people are also more likely to die from homicide, something that health insurance has nothing to do with. If homicides or accidents contribute to the higher mortality in the uninsured group, it is not reasonable to claim that their higher mortality is due to a lack of health insurance.

3. Does the study control for different the differences in social and economic status between the insured and the uninsured groups? All work to date suggests that people who are uninsured differ from the privately insured in ways that are likely to independently increase mortality even in people with coverage. For example, the uninsured are more likely to be high school dropouts, more likely to smoke, less likely to have ever worked, and less likely to be married. All of these characteristics are associated with higher mortality whether or not someone has health insurance.

So, does having health insurance reduce mortality or not?

Current estimates suggest that if it does, the effect is small, likely smaller than the deaths from the lower incomes created by the higher taxes needed to ensure everyone in American using the Massachusetts-like plans in the ObamaCare bills. 

June and Dave O’Neill, in a paper on the uninsured written for the Employment Policies Institute, conclude that “lack of health insurance is not likely to be the major factor causing higher mortality rates among the uninsured.”

Doyle, in a comparison of survival for Wisconsin motor vehicle accident victims who were uninsured or covered by a private plan found that the uninsured were more likely to ride a motorcycle and crash in the middle of the night. Controlling for that, he found that their mortality rate was 1.5 percent higher, except in hospitals with a religious affiliation.

When A Tax is Not A Tax: President Obama Joins Orwellian World of Colorado Democrats

The Baucus bill calls the fine for not complying with its individual mandate to buy health insurance an "excise tax."

President Obama must have gone to school with Colorado Democrats.

This weekend, President Obama told George Staphanopoulos that the Baucus excise tax is really not a tax because to say you "have to take a responsibility to get health insurance is absolutely not a tax increase." [link]

This year the Colorado legislature, which is controlled by Democrats, decided that a measure which makes hospitals send a fixed percentage of billed patient charges to state government was not a tax either, and Colorado's Democrat governor, Bill Ritter, signed the bill.

The Colorado Constitution forbids tax increases without a vote of the population. The state needed money, a tax increase would have gone down in flames, so elected officials simply renamed a tax a "fee."

In Colorado, it appears that paying the state extra when you need hospital care absolutely isn't a tax increase either.

As Colorado Democrats and President Obama have discovered, life is much easier for elected officials who don't worry about the plain meaning of words or, apparently, the Constitutions and statutes that contain them.

Medical Malpractice? Government Protects Itself: Private physicians hung out to dry

If you are a patient harmed by medical malpractice by a private physician, you can recoup substantial sums for both economic damages and pain and suffering in most states.

If you are a patient harmed by the same sort of medical malpractice at a government affiliated hospital or health center, you may not be able to recoup anything regardless of the injuries done to you. State immunity statutes give special protections to physicians who are employed by government entities. They hang private physicians, and their insurers, out to dry.

In Colorado, liability limits for physicians working for the University of Colorado Hospital are $150,000 per claimant, with a $600,000 maximum for any event that harms multiple people. Claimants must give notice within 6 months of discovering injury.

Private physicians performing the same service and making the same error would be liable for up to $300,000 for pain and suffering. There is no limit, if a judge agrees, on economic damages. Claimants have up to two years to file after the date the injury and its cause were known.

Physicians employed by the federal government enjoy special malpractice protection under the Federal Tort Claims Act. There is a 2 year statute of limitations and the agency employing the physician gets to settle or dismiss the claim. People who have their claims dismissed must sue the United States, not the individual physician, and are required to do so in federal district court. They are denied a jury trial, the Department of Justice will litigate for the government, and claims are paid out of a congressionally appropriated fund.

Even patients rights laws like EMTALA are interpreted differently for private and public hospitals. In 1999 a federal hospital run by the Indian Health Service failed to diagnose an acute infection even though the patient went to the emergency room numerous times. The patient died. The family sued under EMTALA. The court ruled that the government had sovereign immunity and that EMTALA did not apply to the government.

Presumably, governments feel that patients get adequate protection under sovereign immunity laws. If that is the case, they should lower health care costs for everyone by extending the same protection to private physicians.

Pelosi’s Fairy Tale: Unlimited Benefits, No Premium Increase

Nancy Pelosi, Speaker of the U.S. House of Representatives, displayed her vast knowledge of health insurance, life, the universe and everything one August day in Denver (as reported by Face the State, an online newspaper covering Colorado):

Pelosi promised any federal health care legislation would not add to the federal deficit, but also said that under a government-sponsored plan there would be no limit to the benefits paid out to any individual.

“Under this legislation, your premiums will be capped, but your benefits will not,” Pelosi said. “Don’t be afraid of the facts.”

Unlimited benefits, no premium increases, no borrowing. What’s left?

Taxes.

Or, as Democrats in Colorado prefer to call them, fees. Fees on health care services, income, property, cars, energy, internet telephones, gasoline, driving, working, purchasing, saving, eating, drinking… 

Does Banning School Snacks Increase Smoking?: A Report from the High School Underground

When school opened, students in one Colorado high school found that it had caved in to the demands of the Nutrition Nazis. Henceforth, only healthy foods would be offered on school property.

The problem is that Nutrition Nazi approved foods are generally low in calories and unpopular rather than pathogen free and a reasonable part of an overall balanced diet. Nutrition Nazis also seem to forget that a normal weight active teenager can require up to 3,000 calories a day. Seriously athletic teens can require 6,000 calories a day. For many teens, staying alert and functional also requires consuming food at frequent intervals throughout the day.

Getting 3,000 calories takes a lot of eating. At 566 calories, the Footlong Sweet Onion Chicken Teriyaki sandwich has one of the highest calorie counts in the Subway sandwich line. A Big Mac has about 540 calories. Roughly the same calories can be obtained from 10 cups of raw carrots, 4 containers of light nonfat yogurt, 4 cups of 2% milk, 2 Snickers bars, or a cup of granola.

What’s a starving teen to do? Here's how one teenager at that school reports that the students are coping with its misguided food policies:

All there is in the vending machines is flavored water. It isn’t filling. School lunches are terrible, and now the only other choice is to spend $7.00 on a Subway rabbit food sandwich lunch. It costs too much. You can try to go off campus, but lunch is only 45 minutes, and the school is pretty isolated.

So, to reduce hunger cravings and save money, an increasing number of people are going outside to smoke at lunch.

Parents who believe that food is less dangerous to health than cigarettes can only hope that the black markets that deliver illegal drugs on this school district’s buses rapidly expand into school day food delivery.

Save Justin’s Health Insurance

As this short (1:16) video points out, Justin has health insurance and does just fine in a state where government doesn't run health care. In Massachusetts, where government does run health care, Justin would be a lawbreaker subject to heavy fines.

The problem? His policy doesn't meet the bureaucratic standards of the Massachusetts credible coverage regulations. He has chosen a $5,000 deductible so that he can pay lower premiums. In Massachusetts, bureaucrats have decreed that the maximum allowable should be $2,000.

Automobile Insurance Costs More Than Health Insurance

Massachusetts Governor Deval Patrick understands your pain. Via Hot Air, Howie Carr of the Boston Herald reports that Massachusetts is “not your father’s welfare state.” Even though health insurance has been getting all the press, Governor Deval Patrick understands that car owners can be underinsured, too.

With Massachusetts having solved the problem of health care underinsurance by providing away free health insurance to people who can't afford it,  Governor Patrick is now addressing the Massachusetts fiscal crisis by increasing the budget for a program that gives donated cars to welfare recipients. The cost to repair, license, register, and insure the donated cars reportedly runs about $6,000 each. This includes AAA membership, coverage that the program has determined no comprehensively insured car owner can be without.

Help for the underinsured car owner makes sense because in many states car insurance costs more than health insurance. In metro Denver, Allstate Insurance’s online quote page suggests that the company would charge roughly $870 a year to provide its most basic coverage for a five year old Honda Civic driven by a 26 year old man with only one ticket in the last five years.

People who can’t afford a Denver health insurance policy certainly can’t afford to insure their cars. Online quotes for metro Denver health insurance start as low as $37.00 a month for a 26 year old in good health start. For $77.84 a month, only $64 a year more than the basic auto policy, one can get a health savings account qualified policy from Humana that limits medical expenses to $3,500 a year and includes drug coverage.

The results are clear. Progressive thinkers who believe that health insurance is too expensive for working people must also admit that they can't afford car insurance either.

A Colorado Chamber of Commerce Prescribes Health Care

Add the South Metro Denver Chamber of Commerce to the list of organizations that claim to know what kind of health care you should have and how you should be required to finance it as long as it serves their selfish interests.

It knows this even though it is woefully ignorant of basic facts about health care. It repeats the canard that the US is 29^th in infant mortality, quotes the discredited WHO health system rankings to say that US health care is 37^th in the world, and promotes the Commonwealth ‘D’ ranking even though its health systems rankings have been shown to be ideologically biased and of questionable value. [link. For debunking of these ‘facts” see this, this, this, and this.]

In designing its health plan, the Chamber has apparently been talking to the same kind of people that advised Mitt Romney as he proceeded to complete the wrecking job on Massachusetts health care begun by the disastrous insurance reforms of 1996.

The Chamber’s fix for what ails you is—wait for it—a new bureaucracy.

In Colorado it will be called the Colorado Health Care Authority. It will have the legal power to define value in health care, decide what people should and should not know about health care, and tell patients, physicians, and hospitals what to do. Think of it as NICE with regulatory powers. [link]

If people don’t comply with the Authority they can be fined, lose their drivers license, or be forced into providing free labor for public service groups.

Under the plan, the government will provide all preventive care. Apparently the Chamber is ignorant of the fact that people in government controlled health systems typically get less preventive care than people in private care. Preventive care increases overall expenditures while lowering individual risk. Government run health plans, which invariably seek to cut costs, are not particularly concerned with individuals.

For other kinds of care, the Chamber will require individuals to purchase health insurance defined by government from the private or quasi-private insurers that make up some of its membership. All insurers will be required to issue policies designed by government at government controlled prices to everyone. Everyone will be assigned a gatekeeper provider, rebranded as a medical home.

Those who are really ill and require relatively expensive and technologically advanced treatment will be forced to get care from a publicly administered catastrophic plan. Given that health plans run by governments typically elect not to provide advanced and expensive treatments for people with serious illnesses, the Chamber’s plan is a death sentence for many people with difficult illnesses.

Like Pilate, the Chamber members seek to wash their hands of the terrible consequences of their proposal. They piously intone that individuals should be responsible for their own health care even as they force people out of privately provided health insurance that works fairly well into government systems known to provide poor care at high cost.

At the same time the Chamber seeks to force people to purchase the products of some of its members, it proclaims that businesses must be free of any health care compulsion in order to remain competitive. [link]

Government in the Health Insurance Business

What would it really cost to have government in the health insurance business insuring people under a voluntary government run health plan? For Colorado, the answer is $8,547 for each of the 6,400 previously uninsured people that could be expected to sign up. That's $8,574 a year in addition to the Medicaid expansion costs built into the most forgiving assumptions possible.

For that kind of money, just 6,400 uninsured people, out of an estimated total of 115,600, would sign up for the government plan.

In short,  the government plan is a lousy deal in any state with reasonable regulation of private insurance. In Colorado, average annual 2007 premiums in the individual insurance market were $2,537 for individual coverage and $5,446 for family coverage. The premiums for the government plan were limited to $225 per person per month to make it affordable, or $2,700 a year.

Proponents say the government plan is a deal because it will offer so much more coverage. Never mind that most of the uninsured are healthy and that  finding a physician or dentist willing to accept Medicaid/SCHIP’s heavy compliance costs and ridiculously low payments can be a lifetime project.

Plan proponents who thought that $225 a month was too much for some low income workers proposed funding it via a "fair" premium of an additional 8.1 percent income tax on all members. The problem? Colorado’s median Colorado household income is $55,517 meaning that the plan is a lousy deal for the majority of households in the state, making it likely that even fewer would participate. Funding via an additional income tax increased program costs to $761.1 million, a mere $118,924 per newly insured uninsured person.

These estimates may be wildly optimistic. In Maine, Dirigo Health managed to enroll just 3,146 people in its unsubsidized plans. Monthly premiums were $365 in a state with unreasonable health insurance regulation and in which government theoretically had a lot of power to constrain health care costs.

Those who claim that government can do health insurance better than the private sector should take a look at the real world results in states that have done it.

April Fool: Colorado Healthcare Affordability Act

In a stunning example of the legislative fecklessness, the Colorado House of Representatives has voted to impose a secret tax of up to 5.5 percent on sick people, arguably violating the state Constitution in the process.

The tax will raise private sector health care costs by more than $600,000,000 a year by placing a “fee” on all hospital patient revenues. The money goes into a slush fund shared by hospitals and the state Department of Health Care Policy and Finance. Hospital revenues from sources other than patients are not taxed.

The bill ensures that the “fee” will be kept secret by making it illegal for hospitals to show the “fee” as a line item on anyone’s hospital bill.

To the rest of the world such “fees” are known as provider taxes.

In Colorado, such taxes are “fees” because the Colorado Constitution clearly states that the state must have voter approval, in advance, for “any new tax, tax rate increase, mill levy above that for the prior year, valuation for assessment ratio increase for a property class, or extension of an expiring tax or a tax policy change directly causing a net tax revenue gain to any district [defined as the state or any local government, excluding enterprises].”

The Democrats who control Colorado state government know very well that the electorate is in no mood to approve tax increases. As long as the "fee" fig leaf works for them, they figure they can ignore the voters.

The bill uses money from the sick tax to expand Medicaid, pulling in pregnant women up to the state’s median income and the disabled with household incomes of up to almost $90,000 for a family of four. If national figures are any guide, many of these people will drop private insurance to use the public program.

The bill is heartless in that it specifies that people lured into the Medicaid expansions can be summarily dropped from the rolls or have their benefits cut whenever the funds collected by the provider tax are insufficient. They are insufficient when there isn't enough to reimburse hospitals for 100 percent of their cost in caring for people on state medical assistance programs and pay the cost of complying with whatever the state is pleased to call quality initiatives. The funds from the sick tax must also be sufficient to reimburse the state Department of Health Care Policy and Financing for administrative costs including, in what appears to be an earmark, payments to an unnamed group facilitator.

Hospitals have historically played fast and loose with costs—charging the uninsured unimaginable amounts and producing bills that are so unreliable that a whole industry exists for the sole purpose of examining them for errors and inflated charges.

The legislature proposes to protect taxpayers from traditional hospital dishonesty about costs by creating an advisory committee that will almost certainly be controlled by hospitals. The Committee will determine what costs are by reviewing documents provided by hospitals. Those documents will not be open to public inspection.

After inspecting the secret documents, the committee will make recommendations concerning what the tax should be, which hospitals should get payments from the fund, and how much those payments should be. Different hospitals can be taxed at different rates, offering a variety of avenues through which pressure can be applied to hospitals that fail to adequately support the party line.

To add insult to injury, differential tax rates can be imposed that could drive patients from efficient hospitals to inefficient ones. The bill lets the state tax different hospitals at different rates, and leaves payouts to hospitals entirely at the state’s discretion. An efficient hospital that does not play ball with bureaucrats could be targeted with high taxes, making its overall costs higher than an inefficient one with good lobbyists.

Naturally, the people who introduced this monstrosity are claiming that adding more than $600,000,000 annually to hospital bills will make health care more affordable: the title of the bill is the Colorado Healthcare Affordability Act.