More on Health Insurance – $674K to save a life?

Here is an article on CNN’s website about a recent study of death rates for uninsured people. The authors of the study highlighted in the article claim that 45,000 deaths occur each year in the US due to individuals being uninsured. Two of the authors of the study are long-time advocates of single payer health care, with several articles published in the American Journal of Public Health over the last 15 years. The abstract of the AJPH article states

Results. Among all participants, 3.1% (95% confidence interval [CI]=2.5%, 3.7%) died. The hazard ratio for mortality among the uninsured compared with the insured, with adjustment for age and gender only, was 1.80 (95% CI=1.44, 2.26). After additional adjustment for race/ethnicity, income, education, self- and physician-rated health status, body mass index, leisure exercise, smoking, and regular alcohol use, the uninsured were more likely to die (hazard ratio=1.40; 95% CI=1.06, 1.84) than those with insurance.

In simple terms, a 40% higher mortality rate is suggested for those who are uninsured, all other things being equal. The CNN article cites other data:

Other studies have indicated that the uninsured are at greater risk of mortality than the insured. A 2007 study from The American Cancer Society found that uninsured cancer patients are 1.6 percent more likely to die within five years of their diagnosis than those with private insurance. In 2002, the Institute of Medicine estimated that lack of health insurance caused about 18,000 deaths every year

So, a different estimate says 18,000 deaths per year are caused by lack of health insurance. And the real shocker for me was that there is only a 1.6 percent difference between the 5 year cancer survival rates for the insured as compared to the uninsured.

If we use the higher number of 45,000 deaths per year attributable to lack of health insurance, and the CBO’s estimate of $239B additional deficit for the cost of HR 3200 over the 10 year period of 2010 to 2019, we can say we will save 450,000 lives at that cost. Taking $239B over 10 years and dividing by 450,000 we will incur a debt of $530,000 per life saved.

That’s insane.

The $239B deficit is arrived at by the CBO assuming that Congress will push to realize all of the cost savings claimed by the bill. We know that reality will not meet those rosy projections. And, the study CNN sites that claims 45,000 lives are lost per year due to a lack of health insurance uses the 45.7 million figure for the uninsured in the US. This figure is from the US census bureau – and includes the information that 9.7 million of the uninsured are illegal aliens. So, if we truly limit HR 3200 to legal US residents, the number of lives saved will be reduced by 20% – driving the cost of saving lives up to ($239B divided by (450,000 times 36/45.7) to $674,000 per life.

I realize that this money is expected to result in health benefits of more than just lives saved – that good health has a value. But we have to be able to do better than one live saved for every $674,000 of debt we take on.

Compare this to the estimated 99,000 deaths from Health Care Associated Infections (deaths resulting from infections contacted while hospitalized) calculated in a 2002 CDC study:

The estimated deaths associated with HAIs in U.S. hospitals were 98,987: of these, 35,967 were for pneumonia, 30,665 for bloodstream infections, 13,088 for urinary tract infections, 8,205 for surgical site infections, and 11,062 for infections of other sites.

This information was highlighted in the article I mentioned in an earlier post. Implementing procedures to save three times as many people (or more, if you use the 18,000 deaths per year figure) is “essentially cost free.”

I am not suggesting that we should not reform health care. And, I am not suggesting that we use legislation to force hospitals to follow these procedures. The notion of Congress writing medical procedures is scary. I am trying to make the point that, as laudable as the goal of saving lives is, HR3200 is a horribly wasteful way to do it. And when I read that the Baucus bill is even more expensive, I can only shake my head.

How do all of these numbers hang together? One useful place to begin is with mortality data. The death rate in 2008 for the US was 8.27 people per 1000. In 2006, there were 2,426,264 deaths in the US (CDC data).

The breakdown for those is:

Heart disease: 631,636
Cancer: 559,888
Stroke (cerebrovascular diseases): 137,119
Chronic lower respiratory diseases: 124,583
Accidents (unintentional injuries): 121,599
Diabetes: 72,449
Alzheimer’s disease: 72,432
Influenza and Pneumonia: 56,326
Nephritis, nephrotic syndrome, and nephrosis: 45,344
Septicemia: 34,234

The figure of 45,000 deaths per year amounts to 1.8% of the deaths in the US per year. The lower figure of 18,000 would amount to 0.7% of the deaths in the US per year. The 99,000 lives lost due to infections picked up while hospitalized represents 4% of the yearly deaths in the US.

Let me stress that I realize other health benefits may be realized than just the avoidance of death. But – we want to cede government control of 16% of our economy and add substantially to our national debt for such a paltry set of benefits?

Update –

Here’s President Obama’s interview with George Stephanopoulos from Sunday September 20, 2009. If we get a bill that does all of the good things he says he wants to accomplish at no addition to the debt, then that’s a great thing. But I’m skeptical that a bill that is 80% like HR 3200 can be tweaked to achieve the goal of no addition to the national debt. I use the 80% figure since President Obama says that each of the bills in congress are 80% right.

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