Killing the uninsured

This is a friends’ response to my blog post about the futility of expecting the government to fix out healthcare crisis:

“Just saw that an Annals of Internal Medicine analysis shows that for every million uninsured people, 1300 will die earlier than they otherwise would. The republican bill will lead to 22 million uninsured, per the cbo. That’s a lot of needlessly dead people.”

Allow me to try once again to explain what I mean when I say (1) the government can’t fix this, and (2) much of this is overblown crap designed to get you to think the other side is made up of horrible, horrible people.  Like me.

My little city has a pretty impressive poverty rate.  That sucks.  But one up side (it’s not easy to find an upside to a high poverty rate) is that we have very good data.  This is extremely important, because if we cannot figure out what is really going on, we are going to have a helluva time fixing it.

One thing we have figured out is that people in poverty have really bad healthcare results.  They have more complications, more morbidity, more mortality than people who aren’t in poverty.  So these people die at a much higher rate than their more well-to-do neighbors.  Their hypertension, their diabetes, their congestive heart failure, their asthma, their chronic issues go untreated.

These people don’t have insurance.  But that’s not why they do so crappy.  They do poorly for a lot of reasons: unhealthy diet, less exercise, less preventive care, less access to medicines, less education about disease processes.  It’s multifactorial, and though the conditions correlate with a lack of insurance, it’s not the insurance that is the issue.  Even if these people had the best insurance on the planet, none of these other factors – the real world problems – would change.

And that’s one of the reasons Obamacare was not working.  It wasn’t ever going to affect the root cause.  Poverty is the root cause, so that’s what we have to fix.

This is what the information sited by my well-meaning friend is based on: looking at the historical death rate in uninsured vs. insured.  But there is very little evidence to show that insuring previously under-resourced patients did anything to chance their care.  And there is ample evidence to show that it did nothing, because that is precisely why the insurance exchange products failed. The under-resourced people that suddenly found themselves with insurance simply continued to use the ER for their healthcare – with similar results.  But now insurance companies had to pay the bill.  Remember, the hope is that we take care of people better, not just pay the bills (and using the ER as your regular doctor is not the answer).  Nothing proposed so far is really addressing the fundamental issue.

Those 1300 per million people dying without insurance?  Without changing the way they live and the way they are taken care of, they will die just the same.

Am I saying it’s a good idea to dump a bunch of people off insurance plans, and to cut Medicaid funding?  No.  But when you understand that neither is the answer, then it also becomes hard to justify pouring money into a hole – something we have become quite adept at.  The government subsidization of insurance is a bad idea.  The government creating it’s own non-profit insurance company that competes with private insurance?  That’s more like it.

Disagreeing with a policy that isn’t working is not a bad thing, even if the intention of the policy is to help others.  Pouring money into a hole in the name of public assistance does more harm than good.

With our city’s high poverty rates, the local medical system is going to be hit hard by reduced Medicaid finding. So what are we going to do about it?  I will tell you:  we are going to figure it out. After all, necessity is the mother of invention. And I feel a little home-grown invention coming on.

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