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Thursday, October 22, 2009

Grayson Death Number is Fiction

Alan Grayson, Democratic Congressman from Florida, is building his claim to fame on the accusation that 45,000 Americans die each year from lack of health insurance. Grayson even has started a website to count the dead. Grayson bases this number on a study released by Harvard Medical School and the Cambridge Health Alliance which more than doubled previous estimates.

This number, however, is fiction.

I guarantee that almost none of the politicians, pundits, pro-Obamacare groups, or bloggers spouting this number have read the actual study. Instead, they almost certainly have relied on a press release summarizing the study, which paints the conclusions as medically and scientifically certain.

It took some digging, but I located a pdf. copy of the actual study in the archives of the American Journal of Public Health. The 45,000 figure (actually 44,789 in the study) is completely speculative based upon a series of assumptions, and the exclusion of substantial unknowns, to create the appearance of medical and scientific certainty where none exists.

This is a document intended to be used as a political talking point. Here is what the authors say:
"Despite widespread acknowledgment that enacting universal coverage would be life saving, doing so remains politically thorny. Now that health reform is again on the political agenda, health professionals have the opportunity to advocate universal coverage."
The authors go through statistical assumptions and methodology, based on mortality data from 1986-1994, adjusted using mathematical modelling to 2005 census data. Let's be clear, this study is a mathematical model, not a collection of actual death data.

The authors, however, do not do the two things which would put their model in political perspective: Compare the current system to specific Democratic proposals, or compare the current system to systems with nationalized health care.

Rather, the authors compare the current system to the perfect universal coverage scenario without taking into account the rationing of health care services which necessarily will occur in their universal coverage scenario. The authors assume, without stating, that there would be no diminution in health care services to those currently insured.

In reality, even Democratic proposals include Medicare cuts and other health care cost containment proposals which will diminish care to the elderly and other groups who currently have no such limitations.

By excluding the reality of limited societal health care resources, the study loses any legitimate value in the political debate.

The authors also acknowledge that there is much they do not know, which would affect their analysis. Here are some of the limiting factors which the authors acknowledge call into question the certainty of the study:
  • "NHANES III [the 1986-1994 data which was used for modelling purposes] 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."

  • "Earlier population-based surveys that did validate insurance status found that between 7% and 11% of those initially recorded as being uninsured were misclassified."

  • "We have no information about duration of insurance coverage from this survey."

  • "Unmeasured characteristics (i.e., that individuals who place less value on health eschew both health insurance and healthy behaviors) might offer an alternative explanation for our findings. However, our analysis controlled for tobacco and alcohol use, along with obesity and exercise habits."
The simple statement which is true is that the authors of this study cannot say to a reasonable degree of medical certainty that 44,789 people -- or any specific number of people -- die annually from lack of insurance. This study would not be admitted in court as proof of anything.

All the authors can say is that they have made certain assumptions and statistical calculations, have excluded certain limiting uncertainties, and did not consider the realities of limited societal health care resources; and if you do the math the way the authors did the math, you will get the number 44,789.

The authors also cannot say, and do not attempt to say, that fewer people will die under any of the Democratic health care proposals currently under consideration.

This document, like so many mathematical models, is fiction. The beauty of mathematical modeling is that is has a ring of certainty which is illusory; just ask all the people expecting this to be the worst hurricane season ever, or the mathematical finance geniuses who almost brought down the world economy because their models failed.

Alan Grayson and others with a political agenda have placed this piece of fiction in the non-fiction section. It's time to put it back where it belongs.

UPDATE: Michelle Malkin has a good article exposing the backgrounds of the authors of this study. They are partisan, pro-single payer advocates. I was not aware of their backgrounds, but the wording of the study as analyzed by me supports the conclusion that the numbers were crunched to reach a desired result. And these are the people who want to run our health care system. Ugh.

Related Posts:
Hoisting Alan Grayson By His Own Fuzzy Logic
Obama's Fox News Diversion
Strong-Arming Your Doctor

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  1. ¬Careful, professor. Unauthorized fact checking could cause you to incur the ire of this administration and result in tangential lawsuits and attacks in the sanctioned media including fabricated statements you’ve made in the past.

    In the meantime, is anyone surprised? And, does it matter? Because very few will ever know about it. You can bet this is one tree that will fall in near silence in the forest of mis-information.

  2. In the middle of Grayson's speech, the White House emailed a correction - the CORRECT numbers are 450,000 people a day dying from lack of healthcare. That's why something has to be done NOW!

  3. Here is what he's doing:

    He knows he is going to lose next time around. Its a traditionally Republican district, and even in the midst of the 2008 election night disaster, the local GOP was laughing about how that was one seat they'd be getting back next time around.

    He's making a stink to become a movement leader. Create a name, a lot of buzz, be a warrior for the left. He'll go down swinging in a race that he knows he's going to lose (his seat and healthcare), and be declared a martyr like Max Cleland. The Left will make him a hero.

    He isn't insane, this is a deliberate career move. He wants to be the new Howard Dean. And giving him attention is exactly what he wants.

  4. Like all public control issues, propoganda is easy to hide in a study. Remember when the public service ads used to say people died because they weren't wearing seat belts? I doubt one death certificate said seat belt non use was a cause of death, but injuries sustained in a car accident were. I didn't wear my seat belt at all growing up, and I am still alive.

    The same with health insurance and the confusion over a piece of paper, and live people taking care of you. So, you get a paper from the government saying you have health insurance. It does not guarentee you will get the care you need when you need it, just that in the mathematical sense there is a probability.

    Mathematics is not cut and dried as many Americans who don't have more than basic math skills don't understand. Like climate change, the outcome of the function machine of statistics depends on the inputs and assumptions. For example, if I decided to size a floor beam based on either too light of loads or too heavy, I will either be dangerous to whoever walks on the floor, or spend way more in material and money than needed. The math is easy, it is the assumptions that are hard.

  5. More importantly, no one ever anywhere has ever died "from lack of insurance." At worst, they died from lack of care- which are two different things. I can have really crappy insurance which doesn't pay for needed care- and I might die from lack of care. Contrariwise, I might be independently wealthy and able to buy the best care for myself without insurance at all.

    When we look at their methodology and numbers we are implicitly validating their assumption that someone can die just because they don't have insurance- when, in fact, it is illegal in the USA not to provide life-saving care based on ability to pay (or inability as the case may be).

    So, to reiterate, just as there was no Baucus bill- no one can die from being uninsured.

  6. Your internet skills must be pretty weak. I found a PDF of this study in about ten seconds through the magic of Google.

    Yes, AllenG, some people have died from lack of health insurance--because they could otherwise not afford to pay. And it is not illegal in the US to refuse non-emergency life-saving treatment (e.g., chemotherapy) based on inability to pay. The law requires only treatment needed to stabilize patients faced with imminent death.

    There is nothing wrong with this study, and it probably gives a fairly accurate estimate of the number of Americans who die each year because they have no health insurance.

  7. How many people have already died from the stupid laws already passed? Bet is is more than 45k.

  8. Is SJ a subcriber to the American Journal of Public Health? You could get a copy of the study online if you're a member. Otherwise there is a press release linked by Organizing for Conneticut available at Physicians for a National Health Program. The group promotes single payer nationalized health care. The study doesn't compare outcomes with those on public insurance it finds those with private insurance having better outcomes which is quoted and then ignored by PNHP:

    Lead author Dr. Andrew Wilper, who worked at Harvard Medical School when the study was done and who now teaches at the University of Washington Medical School, said, “The uninsured have a higher risk of death when compared to the privately insured, even after taking into account socioeconomics, health behaviors and baseline health. We doctors have many new ways to prevent deaths from hypertension, diabetes and heart disease — but only if patients can get into our offices and afford their medications.”

    The study is also promoting getting not only everyone insured but in for treatment. None of the bills proposed gets everyone insured, none drive down costs. While many balk at the idea of mandating coverage for the young (who are the subject of the study) there is no guarantee if they had it they would use it for preventive treatment. Look at the primary causes of death for those under 65, 435,000 die from tobacco use while 365,000 die annually from poor diet and inactivity. Presumably these people are mostly insured but insurance didn't save them.

    Most hospitals and care facilities don't deny treatment on the basis of ability to pay. There are good people working in these facilities who are slandered constantly to promote an agenda. Social workers find coverage, charities exist to cover treatments and fees are written off or negotiated constantly to provide care. The bottom line is you can't always lead a horse to water and you definitely can't make them drink.

  9. Let me see, I live in a country with "universal healthcare". What so few realize is that the cost of going to the doctor is getting more and more expensive. If I was to go to my GP right now I have to find $60. I get back a rebate of about $34 from our Medicare. If I see a specialist for my arthritis, well the gap is even more substantial and the amount up front is $110+ since it depends upon the specialist that I need to see. On top of those costs are the costs of pharmaceuticals, and since I am not entitled to a health care card then I need to be able to pay the co-payment of $32.90 for medicines on the PBS and anywhere up to and over $129 for other medication.....

    Now, my father died as a result of a stroke. He received adequate care up until the time of his death. To this day it upsets me that at the end of his life the doctor at the nursing home gave him "medication" for "pain" and then he just slipped away.....

    In the case of my sister, in this world of universal healthcare, the doctors were neglectful. She went to them because she was bringing up her food, and any fluid she tried to consume. She had cancer and they failed to diagnose it until 6 weeks before her death. Likewise my cousin lived 6 weeks after his cancer diagnosis. In fact a lot of people that I once knew living in this land of universal healthcare have died as a result of cancer.....

    Death is inevitable. Whether or not we have medical insurance makes very little difference. Government interference in our doctor/patient relationships has in fact meant higher and higher costs each year. The interference regulates what the health funds can insure and the actual gaps. The govt determines whether a woman under 50 can have breast screening. The same for the Dexxa scan for osteoporosis - by this I mean whether it is covered by Medicare. Yet the govt is willing to pay out for abortion on demand and it has been paying for IVF treatment.

    My point? Easy. Whilst health insurance cover will pay for some things, inevitably it cannot stop any of us from dying.

  10. SJ, if Medicare and Medicaid don't cover these situations, then what exactly have I been paying taxes for all these years? Hasn't that (providing a minimum of care for those who cannot afford it) been, you know, kinda the whole justification for their existence? I mean, they are both going bankrupt and are saddling future generations with mountains of debt--we're getting something out of them, right?

    BTW, I like the "non-emergency life-saving treatment" line, particularly how pretty much anything from cancer to bad eating habits can fit under it. People are sometimes denied free treatment for things that might one day kill them. Maybe. Because we can't really be sure, because it isn't terminal right now. But it might be, one day.

    I'd be a lot more convinced about liberal caring/concern/sincerity on these matters, if they were ponying up their own money to create charities for these people in need. If these huddled masses are keeling over left and right from a lack of care, then why aren't you guys acting on your own? Why wait for all of us? Lead by example.

  11. The argument I keep hearing is that America's life expectancy is so much worse than other countries, and the reason is that of the universal coverage.

    I just read a study:
    that reports native born children have a 26% higher odds of obesity than immigrant children.

    Thus our lower life expectancy (if it is true)could be due to crimes, MVC, or in this case Obesity.

    The American lifestyle rather than the American system is to blame.

  12. @SJ- No. They didn't die from lack of insurance. They died from whatever ailment killed them (heart disease, cancer, diabetes, etc.) Not having insurance made it harder to get care- which I'll grant you.

    But, just as if I die from a heart attack when I have a car accident- the car accident didn't kill me; the heart attack did.

    This is important because what people like you (and this Administration, and Rep. Grayson) are saying is that if we got these people health insurance they wouldn't die (or, at least, not as soon).

    The only way to make sure everyone has coverage is to nationalize health care (since, even with an insurance mandate, you can't force any insurance to cover any person- if nothing else, the insurance co. can just quit the business). And, given the stunning successes in GB, Canada, and elsewhere, you're not actually going to increase these peoples chances that way, either.

    I'm not saying people don't need help getting health care; I'm saying the Government is the worst, least effective way to make sure people get that care is by having the government in charge of such help. Whitness any disaster in history- private help always arrives and is better organized than government help.

  13. We should start a website that counts how many people die from being sick and tired of batting this topic around.

    Providing health care can never be a for profit endeavor as long as you value human life over money. The anti-abortion CONS and the anti-capital punishment LIBS could all learn a lesson from the other's pro-life stance. Compromise is in there somewhere.

    Get real.

  14. Listen to Alan Grayson and learn the truth, not to the right-wing lies and distortions by the Fox Noise pundits spouting the (R) failed, unregulated, greed-corrupted, capitalist propaganda.

  15. An agenda for the Dems could be/ to charge ahead as the stronger team/ than Insurance Company Republicans./ The Dem agenda needs “Dirty Harry,”/ not Reid as a “Mr. Rogers,” it seems,/ to get the caucus from Lieberman/ and have the leader of the party/ be Alan Grayson, by all means,/ with national health for everyone.

  16. limerickwriter,

    Have you any argument to make, or are you just trolling?

  17. Drs. David Himmelstein and Steffie Woolhandler, also directed a study claiming that 2/3 of the bankruptcies in 2007 were related to medical bills.

    This article written by a Manhattan Institute fellow in Real Clear Markets shoots down that concept.

    Megan McArdle makes mince meat of the "death without insurance" idiocy.