All of their analyses start with an article by Megan McArdle. The article basically asserts that there isn't evidence to prove that a significant number of people without health insurance die from lack of insurance. This assertion conflicts with a 2008 report from Urban Institute that estimated that 20,000 people die from lack of health insurance every year. The problem with the Urban Institute study, according to McArdle, is that it is an observational study instead of an experimental study, which would be much more expensive and labor intensive. Also, the 2008 study did not take into account many confounding variables, such as the fact that those without health insurance are more likely to be poor, smokers, less educated, obese, etc. McArdle has a whole list of why the previous statistics claiming that lack of health insurance causes more deaths is biased (anyone is Statistics will find numerous examples of things we've studied).
She then discusses a study done using more than 600,000 subjects. The study, which measured and controlled many factors, concluded that there was no significantly elevated risk among the uninsured. McArdle also throws in assertion that lack of health care is not necessarily responsible for more deaths than health care itself, citing an estimate that around 80,000 people die from infections that result from medical treatment. At the end of the article, McArdle talks about how leaving tens of millions of Americans without health insurance violates our sense of equity, which correlates strongly to this weekend's worksheet that has us both analyze the importance of equity and grade the execution of equity in America's economic system in comparison to other trade offs.
As far as other opinions go:
Matt Yglesias, in this post, cites conflicting evidence and claims that there is not evidence to overturn the "principle that has strong theoretical support."
Tyler Cowen, in Marginal Revolution (scroll down until you reach "Clarification on heath care" and "How many people die from lack of health insurance" is more indecisive. He believes McArdle to have compelling arguments and evidence, but intuitively believes that lack of health care should make a difference. His logic is that if it is this difficult to reach the conclusion that people die from lack of health care, then any deaths from lack of health care do not occur in a large enough number to be significant.
I have to admit that McArdle's article made many compelling arguments as far as the bias in the previous statistical students. By the end of the article, I was practically convinced. I thought her analysis of the effects of the confounding variables was very logical. The assertion that going on Medicare at 65 doesn't reduce the risk of death, and that there is no discontinuity in the mortality rate, was also a logical and convincing argument countering the belief that having health insurance reduces death.
Yet, I also find myself skeptical that lack of insurance really makes no difference in health. Reading Austin Frakt's post refuting McArdle's article reinforced the seemingly more logical conclusion that having health insurance must somehow impact mortality.
Basically, just like most of these posters, I can't come to a definitive conclusion with all of the conflicting evidence presented. I imagine that this cyber-exchange between these bloggers will continue over the next few days and I will definitely be reading to see if anyone presents any utterly convincing arguments.
Thoughts? Comments? Does health insurance reduce death rates? Is McArdle way off, or is Yglesias in denial?
More reading:
Megan McArdle's response to Yglesias and Frakt: here
1 comment:
Wow. HS seniors are writing these posts? Very impressive.
Anyway, keep an eye on my blog. A lit review is forthcoming that will illustrate that McArdle read the published research very selectively. Given that, her claims and conclusions are not to be taken seriously.
-Austin Frakt
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