By John C. Goodman
Saturday, October 20, 2012
Have you noticed that The New York Times editorial page
is becoming increasingly strident, increasingly emotional and increasingly
irrational? Here is Paul Krugman in last Monday's column:
Mr. Romney and Mr. Ryan…want to expose many Americans to
financial insecurity, and let some of them die, so that a handful of already
wealthy people can have a higher after-tax income.
No, that's not a misprint. The Republicans actually want
to let some people die so that they can reward their rich friends. It's not an
isolated comment either. Under the heading "Death by Ideology,"
Krugman actually lists all of the ways in which a President Romney would
proceed to kill people. For example:
• Mr. Romney wants…to repeal ObamaCare and slash funding
for Medicaid — actions that would take insurance away from some 45 million
nonelderly Americans, causing thousands of people to suffer premature death.
• And their longer-term plans to convert Medicare into
Vouchercare would deprive many seniors of adequate coverage, too, leading to
still more unnecessary mortality.
• [M]any, and probably most, older Americans — would be
left with inadequate insurance, insurance that exposed them to severe financial
hardship if they got sick, sometimes left them unable to afford crucial care,
and yes, sometimes led to their early death.
So what, you may ask, is the basis for all this vitriol?
Krugman is writing about health care — a subject about which he has proved time
and again he knows virtually nothing. On this occasion he lets loose with this
bold assertion:
The overwhelming evidence, however, is that [health]
insurance is indeed a lifesaver, and lack of insurance a killer…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.
Krugman claims to have reviewed the economics literature.
If he has, then he is an embarrassment to the economics profession, despite his
Nobel Prize. Then again, if he claims to have done so but really hasn't, I
suppose that's equally embarrassing. (And remember, while all this is going on
he is invariably calling everyone who disagrees with him a liar.)
Let me briefly set the record straight. Some studies
actually have claimed that tens of thousands of people have died prematurely
because they lacked health insurance. But these studies were not done by
economists and were never accepted in any credible, peer-reviewed social
science journal. They are basically junk science and they have been thoroughly
discredited on several occasions, most notably by Richard Kronick, an economist
who served in the Obama administration and actually helped design HillaryCare.
Kronick writes that "there is little evidence to suggest that extending
insurance coverage to all adults would have a large effect on the number of
deaths in the United States." I'll get to the children below.
In general, the economics literature has found no
evidence that lack of health insurance has any substantial effect on mortality.
Prof. June O'Neill, former director of the Congressional Budget Office,
thoroughly investigated this issue and found that among Americans above 250% of
poverty, lack of health insurance does not affect mortality. Below 250% of
poverty, people without health insurance have an 11% higher probability of
dying. But the probability drops to under 3% when you take into account demographic
differences in the two populations. In fact, it is likely that the differential
probability would disappear altogether with a complete inclusion of all the
demographic differences between the two groups. (See her PowerPoint slides.)
The most recent evidence on children comes from a paper
posted by the National Bureau of Economic Research. It looks at the effects of
Medicaid on mortality and finds:
• Medicaid insurance leads to a substantial decline in
mortality in older black children.
• It has no effect on white children.
• It has no effect on children — black or white — in
states with the most Medicaid expansion.
The last finding is the most important. Krugman claims
that by expanding Medicaid, ObamaCare will save thousands of lives and that by
repealing ObamaCare, Romney would cause thousands of people to die. The
evidence says otherwise.
Paul Krugman deserves the Nobel Prize for his clear
thinking and advocacy of free trade. But on health care issues, he is a rank
amateur.
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