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."
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.
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