13 Mar 2014 No, 45,000 People Do Not Die Annually Because They Are Uninsured

There were a number of issues I wanted to address during the Senate hearing at which I testified Tuesday, but for which time did not permit.

One was the claim that 45,000 Americans die each year because they lack health insurance.  Senator Bernie Sanders (I-VT) made that claim at the beginning of the hearing, as did Dr. Danielle Martin in this exchange with Senator Richard Burr (R-NC):

The basis for that statistic is this study that appeared in the American Journal of Public Health in 2009.  The study is, in technical terms, garbage.  The authors of the study noted insurance status of a group of people in 1993.  They followed up in 2001, checking whether they were dead or alive.  They found that the group who had been uninsured in 1993 had a higher mortality rate than those who were insured, and from that they calculated that 45,000 people die each year due to lack of insurance.

There was only on problem, which the authors noted near the end of the study:

Our study has several limitation.  NHANES III assessed health insurance at a single point in time and did not validate self-reported insurance status. We were unable to measure the effect of gaining or losing coverage after the interview.

In other words the authors had no idea how many people uninsured in 1993 subsequently acquired health insurance.  Someone who was uninsured in 1993, got insurance in, say, 1996, and then died in 2000—well, it would be pretty hard to attribute his death to being uninsured, wouldn’t it?

The authors try to pull a fast one with the very next sentence: “Point-in-time uninsurance is associated with subsequent uninsurance.6”  In other words, they are suggesting that if a person was in uninsured in 1993, he was likely to be uninsured as well in 1996.  And that’s what you would take away if you didn’t look at the study in the footnote.

That study was titled “Health insurance coverage and mortality among the near-elderly.”  Here’s what it says:

Among adults who were uninsured in 1992, the proportion of respondents who reported being publicly or privately insured rose progressively in the ensuing four surveys (46.6 percent, 58.4 percent, 66.1 percent, and 74.5 percent), as nearly half reached age sixty-five and became eligible for Medicare by 2000.

Thus, people who are uninsured at one point in time are more likely to be insured in subsequent years. It would be more accurate to say: “Point-in-time uninsurance is associated with a subsequent increase in insurance coverage.”

Final note:  Two of the authors of the study purporting to show that 45,000 people die annually due to a lack of insurance are none other than David Himmelstein and Steffie Woolhandler, founding members of the single-payer advocacy group Physicians for a National Health System and authors of other dubious studies. This particular study, though, isn’t even worth the bites it is sucking up in cyber-space.

And for more on the lack of insurance and mortality debate, see this post by John Goodman.

UPDATE:  Apparently Michael Hiltzik of the Los Angeles Times buys into the bogus 45,000 statistic as well.

UPDATE II: Apparently so does Adam Mordecai of Upworthy.