In his latest column, Paul Krugman criticizes Mitt Romney for saying that people don’t die because they don’t have insurance, even while acknowledging that “hospitals are required by law to treat people in dire need, whether or not they can pay.”
But, he argues, even though some people cannot pay, “fear of huge bills can deter the uninsured from visiting the emergency room even when they should. And sometimes they die as a result.” He offers no evidence to support this assertion.
Then he says: “More important, going to the emergency room when you’re very sick is no substitute for regular care, especially if you have chronic health problems. When such problems are left untreated — as they often are among uninsured Americans — a trip to the emergency room can all too easily come too late to save a life.”
That’s a fair point, but then he goes on to say that “overwhelming evidence” shows that “insurance is indeed a lifesaver, and lack of insurance a killer”, that “there’s no real question that lack of insurance is responsible for thousands, and probably tens of thousands, of excess deaths of Americans each year.” This, he adds, is a “fact” that Romney ignores.
Tens of thousands of Americans die each year because they are uninsured? What is Krugman’s evidence for this? He writes that “states that expand their Medicaid coverage, and hence provide health insurance to more people, consistently show a significant drop in mortality compared with neighboring states that don’t expand coverage.”
Can we find evidence for his claim that tens of thousands of Americans die each year because they are uninsured at his link? He links to Ezra Klein in the Washington Post, who blogs about “a study in the New England Journal of Medicine, published Wednesday, finding Medicaid expansions to be associated with lower state death rates.” Klein says, “The expansion states saw their mortality rate for for the all adults in the state – not just the new Medicaid patients – drop by 6.1 percent.” He quotes the study saying, “Our results correspond to 2840 deaths prevented per year in states with Medicaid expansions, in which 500,000 adults acquired coverage.” Then Klein writes, “Put differently, expanding Medicaid to 176 people would be expected to save one additional life.”
One, there is nothing in Klein’s post suggesting that tens of thousands of Americans die each year because they are uninsured. Two, notice that Klein is stating that the Medicaid expansion was the cause of the decline in mortality. There’s just one problem with that, which is that if you go to the study, you’ll find that the authors themselves rightly pointed out that it would be a fallacy to imply from the correlation that there is causation. They state explicitly: “Most important, our analysis … cannot definitively show causality” (emphasis added). They point out the fact that rates of insurance coverage and access to care also increased in the expansion states for high-income persons and that there was “a significant mortality reduction among nonelderly adults that was independent of” the association between expansion and the decrease in mortality rates. They also suggested that “states may choose to expand Medicaid when their economies are thriving, and economic prosperity broadly improves coverage and access, which could produce a spurious association between eligibility expansions and health”, although their “analysis of mortality was adjusted for a comprehensive list of economic measures … and the results were not changed by these covariates.” They state that “the fact that mortality changes were largest in expected subpopulations offers some reassurance that we have isolated the effect of Medicaid expansions. Nonetheless, we cannot rule out other, concurrent trends that may have confounded our results. In conclusion, our results offer new evidence that the expansion of Medicaid coverage may reduce mortality among adults, particularly those between the ages of 35 and 64 years, minorities, and those living in poorer areas.”
So what’s my point? It’s that Paul Krugman takes a study that concludes that “Medicaid coverage may reduce mortality among adults” and turns that into a “fact” that “lack of insurance is responsible for thousands, and probably tens of thousands, of excess deaths of Americans each year.” And then he has the chutzpah to criticize others for intellectual dishonesty.
Oh, one more thing: Don’t vote for Mitt Romney or Barack Obama.
For more on Krugman’s intellectual dishonesty, check out my book Ron Paul vs. Paul Krugman: Austrian vs. Keynesian economics in the financial crisis.