Paul Krugman argues in that “the only way to understand the refusal” of some states “to expand Medicaid” under Obamacare “is an act of sheer spite” done solely for the purpose of hurting the poor, with the cost being “gratuitous hardship for some of our most vulnerable citizens”, including death, with “about 19,000 a year” slated to perish as a result.
He has made this claim before. In October last year, he wrote in a column titled “Death by Ideology” 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”. He asserted 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 is, he insisted, a “fact”.
But as I pointed out then, the problem with Krugman’s argument is that if you go to the study he was relying on,
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.
John C. Goodman tackles Krugman’s latest repetition of his dishonest claim, for which he this time cites a RAND Corporation study:
Let’s begin with Krugman’s claim that the failure of the states to expand Medicaid will cause 19,000 deaths a year. This number comes from an extrapolation by RAND Corporation researchers of a study by Katherine Baicker and her colleagues finding association, but not causation, between Medicaid enrollment and reduced mortality. What Krugman doesn’t tell his readers is that Baicker was the lead author of a more recent and much more careful study of the issue involving the Oregon Medicaid experiment. That study found no effect of Medicaid (versus uninsurance) on health! Further, the Oregon study is consistent with most of the serious literature on this subject, including a very famous study by the RAND Corporation itself.
Surely Krugman must know this. If he doesn’t, he could easily discover it on his own or by walking down the halls at Princeton and asking his colleagues in the economics department.
On another note, Krugman also admits in this column that the young and healthy will be forced under Obamacare to subsidize the costs of health care for the sick, commenting:
Right-wingers are hyping this observation as if it were some kind of shocking surprise, when it was, in fact, well-known to everyone from the beginning of the debate.
And he is right. This is not a surprise. It was one of the main purposes of Obamacare, the injustice of it and perverse incentives it creates notwithstanding (see my post “The Predictable Rising Costs of Premiums Under Obamacare”). Of course, commentators like Krugman knew this, but just didn’t see fit to mention the fact when writing to laud the so-called “Affordable Care Act”, which is precisely why it is a surprise to many people, like anyone who believed the blatant lies from people like Barack Obama and Nancy Pelosi that everyone’s health insurance premiums would be reduced by the Act. Of course, for anyone to point out the fact that the public was misled and lied to by Obamacare supporters is, in Krugman’s book, “hyping” the issue.
Watch Obama repeatedly lie that everyone’s yearly premiums would be reduced by an average of $2,500 per family under the Act:
Watch Pelosi say that “everybody will have lower rates and better care” under Obamacare:
Watch White House spokesman Jay Carney, who apparently didn’t get the memo, still repeating the lie that Obamacare “addresses the costs and lowers the costs, long-term, of health care”.