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 “Overwhelming scientific evidence shows that lack of insurance is
sometimes deadly,” co-author Dr. David Himmelstein, a professor at
the City University of New York’s Hunter College School of Public
Health, said in an email.
Based on findings from a variety of large studies, Americans without
health insurance faced 40 percent higher odds of dying during the
study periods than the privately insured, the report published in
the Annals of Internal Medicine found.
“Being uninsured is deadly,” co-author Dr. Steffie Woolhandler, a
Hunter College health policy professor, said in a phone interview.
“That was the conclusion from a 2002 Institute of Medicine report.
The evidence that’s accumulated over the last 15 years actually
strengthens the Institute of Medicine’s conclusions.”
Since the institute, an independent panel of experts, issued its
2002 report, new studies have examined the impact of health
insurance on mortality. Woolhandler and Himmelstein reviewed the
more recent research and found that having private insurance, when
compared to being uninsured, reduced the odds that Americans would
die during the studies by as much as 29 percent, Woolhandler said in
a phone interview.
But Bernard Black, another researcher who’s looked at the issue,
questioned the methodology used in most other studies and attacked
the new report’s conclusions as “completely invalid.” Almost all the
studies compared uninsured to privately insured Americans and
excluded people with public insurance.
“It’s not a proper research design,” Black, a professor at
Northwestern University’s Pritzker School of Law in Chicago, said in
a phone interview. “The core mistake – let’s take the sick people
out of the equation.”
Woolhandler called Baker’s view “clearly an outlier.” Most of the
researchers removed publicly insured Americans from their analyses
because people frequently go on public insurance when they become
disabled, and therefore, including the publicly insured would muddy
the results and fail to clarify whether having insurance kept people
alive, she said.
Consequently, researchers generally have compared uninsured people
to privately insured people while trying to control for variables
that might impact mortality, such as poverty and health status, she
said.
It would be unethical to study the question by randomly insuring
some Americans and not others. But a lottery for insurance in Oregon
did create something akin to the gold standard of a randomized
controlled trial.
In 2008, the state held a lottery and allowed poor, healthy,
uninsured adults to sign up for Medicaid. For every 10,000 people
who enrolled in the health insurance program, 13 lives were saved,
the study found.
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The results were not statistically significant, although Woolhandler
said she believes that was because the study had too few subjects.
But, she said, “If you save 13 lives for every 10,000 people you
insure, for me, as a doctor, that’s really meaningful.”
On Monday, the American Medical Association registered its
opposition to the proposed Republican Senate healthcare bill. If
enacted, the physicians’ group said the legislation would make it
harder for low- and middle-income Americans to afford healthcare and
would violate the precept of “first, do no harm.” (http://bit.ly/2tN3udt)
While most researchers believe loss of coverage would result in more
deaths, the question of mortality benefits from insurance remains
unresolved for Black. “It’s not like I’m saying there is no effect,”
he said. “I’m saying we don’t know, and let’s go look.”
The question of mortality is not the only question facing members of
Congress as they consider reforming healthcare, said Dr. Matthew
Davis, a professor at Northwestern University’s Feinberg School of
Medicine.
“Even before this study, members of Congress – and the American
public who elected them – already have a strong personal sense of
the value of health insurance,” he said in an email.
“I have had uninsured patients who were grateful they survived a
health problem even though they did not have coverage, but I have
never had a patient who told me that the reason they survived is
that they were uninsured,” he said.
The Senate's healthcare proposal aims to undo former President
Barack Obama's signature healthcare law, which has provided coverage
to 20 million Americans since 2010. The bill would repeal the 3.8
percent net investment income tax on high earners and would phase
out Obamacare's expansion of the Medicaid program for the poor.
SOURCE: http://bit.ly/2fazTFW Annals of Internal Medicine, online
June 26, 2017.
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