Death on the Installment Plan - Harold Pollack - POLITICO Magazine
Like many other liberal health-policy wonks, I’ve written a lot about the value of health reform in improving access to preventive care, protecting people against crippling medical debt and improving people’s physical and mental health.
I haven’t written much about how better access to health care can actually save lives. The argument for the Affordable Care Act, President Obama’s signature health-care-law, doesn’t ride on this. Moreover, the connection between health insurance and mortality is really hard to pin down, even if insurance truly has strong protective effects. The uninsured in America are mainly non-elderly adults. Deaths are really rare in this population, on the order of 0.4 percent per year. according to an Urban Institute study. Real-world randomized clinical trials—even those with thousands of patients—are just too small and too brief to reliably determine how much we might reduce mortality by extending coverage to the uninsured.
On Monday, though, a beautiful study was published in Annals of Internal Medicine that provides some of the best data we have connecting health coverage to saved lives. It’s changed my thinking, too. I’m more confident than I was last week that the ACA will save many thousands of lives every year.
Ironically, the study examined the impact of the bipartisan insurance expansion enacted in Massachusetts in 2006—a.k.a. “RomneyCare,” which provided the basic model for the ACA. Three of the best researchers in the business—Benjamin Sommers, Sharon Long and Katherine Baicker examined a decade’s worth of mortality data in Massachusetts counties, comparing trends to those found in carefully chosen comparison counties in other states. This wasn’t a randomized trial, but it was the next best thing, tracking the experiences of hundreds of thousands of people for years before and after the enactment of Massachusetts’ reforms.
Results: Reform in Massachusetts was associated with a significant decrease in all-cause mortality compared with the control group (−2.9%; P = 0.003, or an absolute decrease of 8.2 deaths per 100 000 adults). Deaths from causes amenable to health care also significantly decreased (−4.5%; P
Limitations: Nonrandomized design subject to unmeasured confounders. Massachusetts results may not generalize to other states.
Conclusion: Health reform in Massachusetts was associated with significant reductions in all-cause mortality and deaths from causes amenable to health care.
Primary Funding Source: None.