Health insurance and mortality

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Wilper et al. reported in September 2009 that lack of health insurance causes as many as 45,000 deaths per year in the U.S. (See Andrew P. Wilper, Steffie Woolhandler, Karen E. Lasser, Danny McCormick, David H. Bor, and David U. Himmelstein, Health Insurance and Mortality in US Adults, Am J Public Health, Dec 2009; 99: 2289 - 2295).

The study involved 9,004 subjects and was based on a single interview done with each study participant between 1988 and 1994. The interviews elicited a variety of self-reported information related to health, including insurance status. The interviewees were followed until 2000, when mortality status was determined. The researchers report that the death rate was 40% higher among those who did not have health insurance at the time of interview.

Faulty science

  • Uncertain insurance status. The researchers assumed that study subjects lacking health insurance at the time of the interviews did not subsequently gain or regain insurance coverage. In fact, a study subject could have received health coverage the very next day after the interview and this would not have been considered by the researchers.
  • Assumed causality. The researchers essentially assume that lack of health insurance at the time of interview is the causal factor in the deaths that occurred. No data was gathered to back up this assumption.
  • Self-reported data. None of the data collected during the interviews from study subjects, including insurance status, was verified by the researchers.
  • Weak statistical association. The study result is statistically weak, i.e., a relative risk of 1.4, which falls below the strength of association threshold of 2.0.
  • Cherry-picked time frame. The peculiar date-of-death cutoff (the year 2000 as opposed to any other year), raises questions as to whether the study time frames were selected to produce the desired result.
  • Attributable risk. The 45,000 deaths figure is an attributable risk calculation that is inherently flawed.

Special agenda

  • Author David Himmelstein is a well-known single-payer health insurance advocate. He the founder of Physicians for a National Health Program. No disclosure of Himmelstein’s bias or association is made in the study or the media release. See Bill Moyers’ interview with Himmelstein at [1].
  • Lead author Andrew P. Wilper, was funded by the Department of Health and Human Services ─ i.e., the pro-single payer Obama administration -- to do the study.
  • The study was submitted for publication on March 16, 2009 -- two months into the Obama administration.
  • The study will be published in the American Journal of Public Health -- a politicized journal that often camouflages its biases under the cover of “public health.”
  • The study comes with a media-handy state-by-state analysis of the death toll attributed to lack of health insurance.
  • President Obama said in his recent address to a joint session of Congress on health care reform that,
    Everyone in this room knows what will happen if we do nothing. Our deficit will grow. More families will go bankrupt. More businesses will close. More Americans will lose their coverage when they are sick and need it the most. And more will die as a result. We know these things to be true. [Emphasis added]


Conclusion

The purpose of this study was to provide supporters of single-payer health insurance with a scary statistic or factoid concerning the alleged impact of uninsurance. The statistic, however, is not credible since it provides no evidence that uninsurance was a significant factor in any death.

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