David R. Henderson  

Matt Yglesias: Health Insurance Doesn't Affect Mortality

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In comparing Bush on Hurricane Katrina and Obama on ObamaCare, Matt Yglesias writes:

The administration and the Democratic Party writ large had very high aspirations for the Affordable Care Act, viewing it as a legacy-defining major pillar of the American welfare state that would massively improve the lives of millions of people. If they can't make the basic infrastructure work, none of that will happen and it'll be a huge failing. But even in the worst case, they're not going to get anyone killed. That's a big difference.

Excuse me? In the worst case, where they don't get the infrastructure working and so millions of people will lose health insurance, they're not going to get anyone killed? How could that be? Surely some of the millions who lose health insurance will die without it. Maybe not many. But not "anyone?" Hard to believe.

HT to Bob Murphy.

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COMMENTS (22 to date)
Ben writes:

Isn't that statement roughly consistent with the Rand health insurance experiment and the findings from Oregon so far? That health insurance doesn't really affect morality? I guess Oregon finds differences in mental health.

Andrew_FL writes:

That's rather odd given the accusation was thrown around that opponents of the ACA didn't care if people died without free health "insurance." Did not a (still sitting!) Congressman say that opponents wanted people to die quickly?

But Bush didn't get anyone killed by not going above and beyond FEMA's mandate in the Aftermath of Katrina. That's just a flat false and ugly accusation, based on a fundamental misunderstanding of the concept government's responsibility. It is actually quite appalling Yglesias would insinuate or flat out state otherwise. By such "logic" one must conclude that any time anyone dies anywhere and the government doesn't stop it, they "caused" the person to die.

There was a pretty high profile claim by a cancer survivor in California recently, Edie Littlefield Sundby, that she was going to lose her health insurance and/or her doctor thanks to Obamacare. She seemed to think it might cost her her life.

Not to mention that FEMA did its job pretty well during Katrina in states not named Louisiana. The failures there were mostly of the Mayor of New Orleans and the (then) Democrat Governor.

A better comparison of the shortcomings of Obamacare would be with McDonalds--also due to rolling out new products without proper preparation. McDonalds is admitting its errors and moving quickly to remedy their situation.

But then, McDonalds can't mandate that people buy their burgers.

MingoV writes:

Yglesias mistakenly assumes that the failure of ACA infrastructure will cause a reversion to the status quo ante. That cannot happen because Cortez-Obama scuttled half the status quo ante ships. The best that could happen is repeal of the ACA and an attempted reversion to the previous state. Many people still will pay higher premiums for policies with higher deductibles and copays, but that will be a better outcome than continuation of the ACA debacle.

David R. Henderson writes:

Isn't that statement roughly consistent with the Rand health insurance experiment and the findings from Oregon so far?
Possibly Oregon, but not RAND. In the RAND experiment, none of the 4 groups went without health insurance.

Chris Koresko writes:


If you're interested in the Oregon study, there are a couple of good EconTalk podcasts on it. I remember the results being pretty preliminary, but it looked like they weren't finding much benefit associated with Medicaid. I think the results for private insurance are better, but mt knowledge in this area is pretty thin.

Chris Koresko writes:

Actually the whole Bush/Katrina Obama/ACA comparison looks pretty shaky.

If Bush had lobbied hard for the first year of his presidency to bring a major hurricane to Lousiana, argued that there were 50 thousand Louisianans who didn't have street-sweeping services and needed strong wind to blow their debris out to sea, promised that "If you like your house you can keep your house. Period." and that the storm would stimulate the economy, and spent an enormous amount of tax money to get ready for it, only to have New Orleans flood, and then claimed that, "What I said was, if you like your house you can keep it, if it's not substandard, or subsided.", then it'd be a pretty fair comparison.

libfree writes:

It makes you want to scream. I don't know how many people claimed that my opposition to the ACA would kill X number of people and that the blood would be on my hands. If you took that view, you have to believe that Obama is killing people. In reality, I doubt lack of insurance is killing anyone. Its even possible that not going to the doctor or hospital might keep you alive longer.

Andrew_FL writes:

@Chris Koresko-I Just want to thank you, because that was one of the best comments I have ever read.

Foobarista writes:

Yglesias may be too young to remember Katrina, but some of us actually do, and the main failures were due to Mayor Nagin and Governor Blanco, who both didn't do jack to prepare for the hurricane until it was far too late. (And it didn't help that New Orleans blew its dike money on corruption instead of, you know, maintaining dikes...) Bush and others tried to get them off their duffs, start evacuations, and other preparations, but they refused, and short of putting the state under martial law, there wasn't much the feds could do until asked by local and state officials. There's that whole federalism thing...

I have no love for Bush himself, but he got an amazingly raw deal in the whole Katrina nonsense. If there was a "fiasco" in Katrina, it was hyper-sensationalized media coverage that actually hurt relief efforts and likely did get people killed.

Comparing it straight up with the - genuine - O'care fiasco is truly bizarre, although the political effects will likely be similar, and do merit comparison.

Methinks writes:

Whoa! Not going to get anyone killed?

Weren't we only a few years ago meant to soil ourselves because a tiny minority of the population (0.5% pr 1.5 million people) either had to pay higher premiums or were denied insurance?

Now we are meant to shrug off 15 million people losing insurance they wanted and could afford in the hope that they will eventually be able to buy far more expensive...um... I'll just call it "insurance" to avoid getting kicked off this blog...with a tiny network of providers and much higher out of pocket expenses that will be paid whether or not you face a major illness?

The Obamacare network is tiny. Providers don't want to sign on because it's such a headache and reimbursement rates are so low. Fellow commenter, Jon Murphy, will have to travel at least half an hour to a hospital that accepts it because the only hospital in his town won't. In fact, there is only one already overtaxed hospital in his entire region that will accept Obamacare. And that goes for all the practices that are associated with those hospitals. If someone in his town has a heart attack, they better hope they can tolerate the half hour ride to Manchester because otherwise that person will either die on the way or face a $10,000 bill from the local hospital.

Free lunches bankrupt and kill.

Methinks writes:

By the way, my point is that even if they get the infrastructure hobbling along, Obamacare will kill. Just like the NHS in Britain, it will impoverish and kill.

RickC writes:

@libfree I was just looking into this the other day and in fact, 195,000 to 200,000 people die every year in the U.S. from preventable medical errors and hospital acquired infections. So yes, sometimes you might stay healthier by staying away from doctors and hospitals. Third leading cause of death in the U.S.!


Methinks writes:


Obamacare will make that statistic look awesome. The NHS hospitals (for which the equivalent will be Obamacare hospitals here) kill even more people.


E. Barandiaran writes:

Tom Maguire has a good analysis of Yglesias's statement. See


Insight writes:

Not according to Obama:

"This is life-or-death stuff. Tens of thousands of Americans die each year just because they don’t have health insurance"


HH writes:


The above link is a piece by Matt Yglesias where he says:

"Lack of insurance is associated with low-quality health care which is associated with enhanced risk of death."

ThomasH writes:

I thought the flawed "rollout" of the Iraq War would have been a better comparison

ZDC writes:

@Ben: "That health insurance doesn't really affect morality?"
- Now that would be an entertaining study, The Effects of Health Insurance on Morality, Do Low Deductibles Make for Good People?

There is undoubtedly a correlation between the possession of health insurance and mortality, however that by no means implies causation. Poor people are less likely to have health insurance, and also have generally higher mortality rates; however, any assertion that the lack of health insurance is the direct cause of this higher mortality is weak at best, and likely indistinguishable from background statistical noise (unless employing poor methodology).

Not having health insurance does not exclude one from medical care. A previous poster provides a convenient example (from which they draw an incorrect conclusion), mentioning the anecdotal story of some cancer patient who was going to lose her insurance and therefor her doctor whereby she would 'die'. As in any case, the lack of insurance does not exclude them from care, and therefore, is not in any way causative in their death. Sure, not having health insurance may result in higher direct (personal) costs for them to receive care, but even without insurance, they're still free to pay for (or petition for charitable giving of) said care. A person without health insurance, but with sufficient financial resources (or even without financial resources simply by showing up at an ER), can still access said care. I know of many wealthy people who eschew health insurance because it's less of a hassle to pay out of pocket for any care they seek, and statistically they have mortality rates better than that of the general population.

Therefore to suggest that the lack of health insurance is causative of higher rates of mortality is ignorance at best, and political pandering at worst. Inability to pay for healthcare may lead to acquiring less of it (although the no-pay frequent fliers at many an urban ER would argue otherwise), which may lead to worse health and higher mortality. Health insurance is a financial tool, just like life insurance or auto insurance. Unfortunately, the term has been bastardized and is often misused, co-opted as a convenient political code-word for redistributionist policy.

mm writes:

wait- you mean people only die when the evil GOP won't extend coverage- BUT if Democrat incompetence causes millions lose coverage NO one dies?

Nathan Smith writes:

I wonder if in due course there will be a website entitled "Obamacare Body Count."

Hazel Meade writes:

Katrina was a natural disaster. This is MAN-MADE.

To me, a more apt comparison would be to the man-made famines caused by communism. Once again we see an attempt to force huge swaths of the economy to behave according to a master plan and the result is catastrophic dysfunction. How many times do we have to stick our hand in the fire to learn our lesson?

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