Mitt Romney signing Massachusetts’ health reform bill in 2006.
One of the many, many, many points of disagreement between Obamacare supporters and critics is over whether the new law will save lives. Supporters say that of course it will, pointing to stories about how people who got insurance stopped putting off surgery or skipping needed medicine. Opponents claim that the uninsured can get life-saving treatment in emergency rooms, and if they have worse health outcomes it’s for other reasons.
As for actual data, estimates for the effect of insurance on mortality have been all over the place. At the high end, a study done by researchers at Harvard medical school found that 45,000 people die each year because they lack insurance. On the other end of the spectrum, a study by Richard Konick at UCSD found no different risk of dying between the uninsured and those with employer-sponsored health insurance. That study is an outlier though– the overwhelming majority of studies have shown at least some connection between having insurance and better health.
However, none of those studies was a randomized controlled trial (RCT). In an RCT, they would take a bunch of uninsured people, randomly give some of them health coverage, and then see if there was any difference in the mortality rate between the two groups over time. It’s really the only way to prove that health insurance is the cause of improved health, and not something else that those without insurance tend to have in common. (The uninsured are more likely to be low-income, black or latino, and/or unemployed– all things that are also associated with worse health.)
So why hasn’t there been a study like that? The challenge, as Harold Pollack, a professor of social service administration at the University of Chicago, points out, is that deaths among the non-elderly are rare. For adults between the ages of 25 and 64 in the U.S. (the group most likely to be uninsured) the mortality rate is less than 0.4 percent. To detect a change in such a small figure would require a massive study with hundreds of thousands of participants across the country over many years. Such an experiment would be too expensive and impractical, but researchers may have found the next best thing in Massachusetts.
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