Life and death

LIFE AND DEATH…. When people talk about why health care reform is necessary and why the dysfunctional status quo is unsustainable, the list of reasons includes plenty of obvious bullet points: tens of millions of uninsured, medical bankruptcies, spiraling costs, deficit reduction, undermined businesses and entrepreneurship, putting America at a competitive disadvantage, etc.

One of the most morally unambiguous arguments often goes unsaid: if health care reform fails, more Americans will die.

It sounds overdramatic. Overwrought. Something “serious” people aren’t so supposed to say.

But the data is hard to ignore. Ezra Klein reports today on the Institute of Medicine’s “detailed methodology for projecting the lives lost due to lack of insurance.” The figures point to at least 150,000 American deaths this decade, not including bankruptcies and/or people who are suffering but haven’t died.

We’re very comfortable talking about the financial cost of health-care reform. We’re less comfortable talking about the human benefits. But the fact that health insurance saves lives isn’t controversial…. All this is intuitive. The uninsured are less likely to seek early care. They are less likely to get good care. They are less likely to return for follow-up care. They are less likely to be able to afford the maintenance of chronic conditions. At its most basic level, that’s what this is all about. That’s why people have been fighting for universal health care for almost a century now. That’s why this matters, and why the basics of the bill — subsidized access to health-care insurance — are so terribly important. This is life and, well, death. Lots of it, in fact.

It’s why, before this year, seven presidents have tried to reform the broken system — we have a medical system that saves lives, but too few Americans have access to it and too many Americans are kicked out of it when they need it. We pay too much and get too little. Ezra added:

[T]hose who would be so cavalier as to close the door because of the public option, or the Medicare buy-in, or the absence of either thing, should think long and hard about those numbers.

I could imagine a cost-benefit analysis that judges the whole bill worth it, or the whole bill not worth it. But it is very, very hard to imagine a cost-benefit analysis in which small policies operating on the margins and promising to save small-but-measurable amounts of money are worth more, in either direction, than the hundreds of thousands of people who will be saved — not to mention spared bankruptcy, and lifted from chronic pain or impairment — by the rest of the bill. The areas of controversy have become very slight given the magnitude of the underlying bill.

I’m reminded of a poignant piece Chris Bowers wrote a couple of weeks ago, effectively arguing that this comes down to the plight of the uninsured, and the thousands of Americans who die every year because they lack coverage. Even without a public option (or Medicare buy-in), the Democratic plan would vastly improve this national embarrassment.