Three researchers, Benjamin D. Sommers, M.D., Ph.D., Atul A. Gawande, M.D., M.P.H., and Katherine Baicker, Ph.D. have reviewed the past ten years of research on the effect of insurance on mortality and financial stability in the New England Journal of Medicine.
Here are the highlights:
Mortality
9
Overall, the study identified a “number needed to treat” of 830 adults gaining coverage to prevent one death a year. The comparable estimate in a more recent analysis of Medicaid’s mortality effects was one life saved for every 239 to 316 adults gaining coverage.29
Cost effectiveness
Are the benefits of publicly subsidized coverage worth the cost? An analysis of mortality changes after Medicaid expansion suggests that expanding Medicaid saves lives at a societal cost of $327,000 to $867,000 per life saved.29 By comparison, other public policies that reduce mortality have been found to average $7.6 million per life saved, suggesting that expanding health insurance is a more cost-effective investment than many others we currently make in areas such as workplace safety and environmental protections.29,54
It seems that Medicaid is extremely cost efficient in buying longer lives. I speculate that part of the resistance is that the cost of Medicaid is extremely explicit while regulations can be more easily hidden off budget. I also speculate that there is a sympathetic beneficiary differential.
Medicaid versus private payer
there is no large quasi-experimental or randomized trial demonstrating unique health benefits of private insurance. One head-to-head quasi-experimental study of Medicaid versus private insurance, based on Arkansas’s decision to use ACA dollars to buy private coverage for low-income adults, found minimal differences.11,19 Overall, the evidence indicates that having health insurance is quite beneficial, but from patients’ perspectives it does not seem to matter much whether it is public or private.47
This is telling me that if we are to expand cost efficiently, we should expand Medicaid as much as possible.
Go read this article. It is only eight, double columned, pages that is easily accessible and clearly written.
And then go call the Senate.
Betty Cracker
LOL! But thank you for summarizing it; those are important facts to have on hand!
Elizabelle
Thanks, David. I will read it. 8 pages on such an important topic is doable.
Happy to have two Dem senators: Kaine and Warner of Virginia. So, gonna call the North Carolina senators, because used to have a driver’s license from there, and will use the address and zip code.
MomSense
You know another value of having insurance? Not having the stress and worry of being without insurance hanging over your head all the time.
You find a lump and you try and talk yourself out of getting it checked because you don’t have the money to pay for all the testing let alone treatment if they find something.
This is the life the Republicans want to sentence us to again. They are cruel beyond belief.
low-tech cyclist
I also have 2 Dem Senators (Maryland). Called them on Tuesday to thank them for being part of the denial of unanimous consent to all the usual Senate crap. And now that we know a bit more about what the Senate bill’s like, I’m going to call them today to note particularly objectionable crap in the bill (the gutting of Essential Health Benefits*), and thank them for their opposition.
*Sure, if you’ve got a pre-existing condition, the Senate bill still requires that insurers sell you a policy at the same price as everyone else’s. It just doesn’t need to cover your condition.
Betty Cracker
@Elizabelle: You’re right — important topic and worth a read, I’m sure. I just find it adorably wonky that DA would call an 8-page, double columned document on insurance in the NEJM “short.” Thank goodness we have him to summarize!
David Anderson
@Betty Cracker: Have you read NEJM articles before? :)
This article is almost Health Affairs-ish in length and readability.
D58826
David Are you the ghost writer of this letter to the Senate leadership :-)
It seems to me that there are some things that no one change change, except maybe a bit at the margins):
1. even if we bend the medical cost cure down, medical care costs will continue to grow. Trumpcare will not repeal the increase in the cost of living.
2. Medical costs will grow because of new and more expensive treatments. Sure we can limit the increases but we can’t stop them .
3. For a party that claims to be pro-life the GOP seems totally oblivious to the fact that the population is growing, which of course leads to more medical care usage/costs (somebody has to pay for all those babies getting born).
4. People are living longer.
5. The baby boomers are retiring which is boosting Medicare costs.
6. People at all ages but esp. over 60, are living longer with more expensive medical issues.
7. one of the fastest growing cohorts are the +80’s many of them with expensive medical issues and/or living in a nursing home.
You can make all of the changes to Medicaid/Obamacare that you want but these facts will not go away. You can make all of the changes to Soc. Sec/Medicare (I’m sure the next target for Yurtle and ZEGS) but these facts will not go away. You can call it what you will but unless these programs keep pace with the size of the population, and the associated medical care costs,people will suffer and die needlessly.
This is a rather strange outcome for a party that claims to be Christian and pro-life. What it does do is reveal that at it’s heart the only religion the GOP cares about is the almighty buck for the one percent. And they really do not care about any ‘life’ in a pro-life sense. Trumpcare will result in poor women being less healthy when they get pregnant. That will result in higher risk pregnancies for both the Mom and the baby (I believe the much reviled Cuba has a better maternal/infant mortality rate than many poor communities in the US). Trumpcare will result in reduced well-baby care for poor families. When they get around to gutting SNAP families will have access to less food which will impact their health. Americans with unavoidable health issues like autism, CF, MS, etc will have less access to the need care. Even if an American has a healthcare issue that he has some control over, like opoid addition, does that make him somehow less deserving of medical care. And of course Granny will be at risk of being kicked out of her nursing home.
The GOP has a very strange definition of being brothers and sisters in Christ. If the GOP definition is the right one then I’m going to start prarying to the pine tree in my backyard.
nytimes.com/interactive/2017/06/21/us/politics/document-Medicaid-HPs-Letter-to-McConnell.html
David Anderson
@MomSense: Amen — insurance (of any type) means less stress
smintheus
This year I could be one of those people. Required two months of tests, a trip to ER and several days in the hospital, until I finally (?) got a diagnosis for my strange, occasionally terrifying symptoms: three tick-borne diseases, 2 of them potentially fatal if untreated, all of them curable if diagnosed quickly enough. Prior to the ACA, I probably would have decided we couldn’t afford open-ended testing for a random grab bag of odd symptoms, and just tried to tough them out…even though I already suspected a tick disease.
Insurance is obviously a life safer. We don’t debate whether lives are saved by spending money on firefighters, we just do it because common sense dictates it. Why is health care different from fire care?
Villago Delenda Est
But…but…if there is no difference from the patient’s perspective in private vs. public, and economically it makes little difference, then perhaps the private vs. public debate isn’t about utility, but ideology!
Ya think?
The GOP must go the way of the NSDAP and the CPSU.
Oblivion.
Villago Delenda Est
@D58826: The GOP is composed of brothers and sisters of Mammon. Evangelical “Christians” reject the teachings of Jesus.
Ghost of Joe Lieblings Dog
@smintheus:
‘Why should I pay for your fire to be put out?’ is a very Republican question, and I’m sure it’s being focus-grouped.
StringOnAStick
@smintheus:
Or any other kind of insurance, really. We live in the Denver area, and the entire eastern side of the Rocky Mountains in CO is a well known ‘Hail belt”, meaning roof, car, and general stuff-destroying hail storms happen frequently here. The one in late May this year is the most expensive one yet as far as insurance costs go ($1 billion the last I heard); each most recent massive storm is “the most expensive yet” because every year there is more stuff to destroy thanks to population growth. If the insurance pool was limited to just CO or just this region of CO then the premiums would be too high for most to afford; obviously the banks holding those mortgages would never stand for that, since the risk is spread out over all the other parts of the US that the insurance companies cover. The same is true for tornado or hurricane damage: the risks are spread over the whole country even though large swaths of the US are rarely or never subject to these risks (GCC could make me a liar here, which is one thing property insurers are nervous about even though they support R politicians who claim it’s all a hoax).
That’s the argument I use when people bitch about the ACA: insurance works best with a large pool paying into it. For everything but health insurance, people can see this. The insurance companies being able to force the creation of small groups for health insurance was/is a great way to charge more for premiums by not spreading the risk to a larger group. Why is that OK for health insurance but obviously not OK for all other kinds of insurance?
D58826
@Ghost of Joe Lieblings Dog: Ah maybe so that it doesn’t spread to MY house. Hard concept for the GOP to understand. They insist that illegal aliens be denied medical care. Now the issue of immigration status aside, but the TB bacillus doesn’t really check birth certificates. It will infect an America whose ancestors got off the boat at Plymouth Rock as well as the illegal alien who snuck into the country yesterday. Best way to prevent the real Murkin from getting infected is to be sure that the illegal alien gets treatment if he shows up at the ER with TB
D58826
@StringOnAStick:
Move to FLA. Problem solved. Oh wait there are those pesky hurricanes. Never mind
Burnspbesq
So those data support a claim that taking 24 million people off coverage would lead to 100,000 deaths.
One. Hundred. Thousand.
Cause of death; Republican greed.
There’s your soundbite.
D58826
@Burnspbesq: I’ve seen that number as 43k. But for a party that has such a love of zygotes and wants to force grieving parents-to-be to have a funeral and get a death certificate I would think that 1 life would be to many.
But this is the party that has no problem with gun violence until they are at the buisiness end of the gun