Estimates of the Uninsured: Worse than Useless

Every time there is any movement to change health policy at the federal level, I hear estimates that “X million people will lose their insurance under the Republican plan” or that “Y million people gained insurance under Obamacare.” I think these are useless statistics. It’s not like being uninsured implies zero access to health care. People with no coverage and no assets get tons of free treatment all the time. If you’re homeless with no health insurance policy and no money but you go to the ER suffering a heart attack, you will get an angioplasty for free. Conversely, people in other developed nations with “universal healthcare” often have long waits to see a doctor. Often they want a treatment but are told “no.”  Also, as I’ve pointed out before, coverage status just doesn’t appear to correlate well with actual health outcomes. It’s not like those millions of people who got coverage under Obamacare suddenly got healthier. (Are there any empirical estimates of the effects of the ACA showing large, positive, unambiguous health effects? If so, please share.) Likewise it’s not likely that they’ll suddenly get sicker once they lose their so-called coverage. (Several examples of "uninsured" Americans consuming more healthcare than their Canadian neighbors here. If you know of a more systematic comparison of this type, please share.)

I’d like to see something more meaningful than a count (really an estimate) of how many Americans “gain” or “lose” coverage under some health policy proposal. I’d rather see an estimate of wait-times, perhaps broken down by covered versus not-covered. Or an estimate of the likelihood that someone will be treated, or receive some particular treatment. “X million Americans will see their wait-times for an office visit drop by Z-percent.” Or “X million Americans will get Y-percent more MRIs and Z-percent more mammograms.” Ideally this could be turned into a mortality rate estimate, and the estimate could be measured against the actual observed mortality change after the policy passes. The effect of health policy on health outcomes is, after all, an empirical question. We should ultimately have some objective means of deciding whether the policy succeeded or not.

I’m a bit tired of hearing claims that some Republican tweak to the ACA is going to plunge millions of Americans into Dickensian poverty and illness. Not that I’m defending the Republicans or any particular proposal they’ve put forth. (If I were to put forth my own proposal, it would be far more radical and go a lot further than anything the GOP has proposed.) Rather I just don’t think that health policy has that strong an effect on actual health outcomes.