Do Opponents of Health Reform Want People to Die?

by Reihan Salam

That’s the theory advanced by reporter-blogger Ezra Klein, and it’s an interesting view. 

In reality, people don’t like to talk about health-care reform in terms of lives because it seems, on some level, unfair. It sounds almost like an accusation of murder. That’s common rhetoric when talking about wars but not social policy.

But it isn’t an accusation of murder. It’s a statement of benefits. And there are iterations in which the costs could outweigh the benefits: The money could do much more good elsewhere, say, or the regulations would thoroughly impede medical innovation. That’s an argument worth having, but it should be had. As it is, we talk about the costs in very specific terms and the benefits in very abstract terms. That biases the discussion toward the opposition and against, well, the 150,000 or so people whose lives would be saved by by this bill.

Which is a bit strange, in the scheme of things. Medicare saved lives. Medicaid saved lives. The health-care coverage that costs the average worker more than $13,000 saves lives. That’s why we shoulder these expenses. And health-care reform will save lives, too. That’s why we’re doing it. That’s why we’re thinking of spending $900 billion on it. 

I really like using these stark terms. It clarifies the debate. The first question that leaps to mind is whether or not the insured population have different characteristics. Of course, the Institute of Medicine paid careful attention to this fact. Nevertheless, it’s important to keep in mind that in Britain, where the NHS has been in place for sixty years, mortality levels vary considerably by income, though of course the dispersion is lower than what you see in the United States. 

Another obvious rejoinder is that there may well be lower cost ways of saving the same or indeed a larger number of lives. If we really did argue the issue in this terrain of number of lives saved, I have to say — I’m pretty confident that we could do much better than $900 billion for 150,000 lives, particularly if we are entirely indifferent to the impact on total employment, economic growth, and personal freedom.

Raising the tax on alcohol is one straightforward measure that would be revenue positive and would save a nontrivial number of lives. Sharply raising the requirements for getting a driver’s license and increasing the gas tax could serve as another low-hanging fruit, win-win measure, as would low-cost traffic calming initiatives. 

Other mortality-improving measures: delaying the age of eligibility for Social Security, investing $3 billion in biogerontological research, expanding the network of community health clinics, facilitating the rise of Minute Clinics and other low-cost alternatives to traditional primary care physicians. Reducing the rate of medical errors could involve discouraging the consumption, or rather the overconsumption, of medical care. 

With a budget of $300 billion, could you save 150,000 lives over ten years through a combination of these and other measures? Because so many of these programs represent revenue enhancements, I suspect that we could get there.  

Apart from being the essential, go-to guide to the health reform debate, Ezra is a reliable guide to the thinking of sober progressives on a wide range of issues. I highly recommend reading him regularly. 

The Agenda

NRO’s domestic-policy blog, by Reihan Salam.