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The Infuriating Bad Faith of Arguments That Health Insurance Doesn’t Improve Health Outcomes

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It’s like, how much more McArdle could this be?

Republicans want to kill you. Worse than that, they want to kill you so that they can give your money to rich people who don’t need it.

Why, yes. This is entirely accurate. Well, actually, “you” should be replaced with “poor people” — the typical McArdle reader isn’t very likely to have their access to healthcare being put at risk. To continue:

If you’ve been reading social media over the last week, that’s the main message you’d take away. It started when the Senate released its long-awaited health-care bill, the culmination of nearly a decade’s promises to repeal and replace Obamacare. This bill was not so much a repeal as an adjustment, and not so much an adjustment as a tweak. But it did propose to eliminate most of the taxes used to fund Obamacare, including the reviled individual mandate. And alter the funding structure of both Medicaid and the premium subsidies to make them somewhat less generous. So obviously: Republicans want to kill you. Their rich donors need your bodies to use as mulch on their diamond plantations.

McArdle think she’s engaging in hyperbole when, in fact, she’s describing the BCRA. It takes more than a trillion dollars in health care funding, mostly for the poor, and gives most of it back to the very rich in a tax cut. The consequences of the cuts will be preventable death, suffering, and financial ruin.

And the thing is, in the rest of a fairly long column, she doesn’t really rebut this, just repeats some Roy-like nonsense about how under the BCRA insurance is a “sweet deal” for the poor which completely ignores the deductibles that would make insurance completely worthless. Here’s the thing: you can’t massively reduce subsidies without massively reducing the number of poor people without insurance, because (although McArdle doesn’t seem to understand this) poor people don’t have any money, let alone 6 grand a year to spend on co-pays. But, then, really a more than trillion dollar cut is just a “tweak.”

One approach, which McArdle has used in the past, is to claim that that the BCRA’s massive reductions in spending and hence in the number of people with insurance are no big deal because insurance doesn’t really have any value. Friend of the blog Avik Roy:

The Senate bill includes and refines the best part of the House bill: its reforms of Medicaid, the dysfunctional government-run health care program for the poor whose enrollees have no better health outcomes than the uninsured.

Ross Douthat — who at least opposes BCRA — makes the claim vaguer and applicable to all insurance:

The best conservative health policy analysis proceeds from the controversial but, I think, correct perspective that much health spending is wasted and that people do not value or benefit from insurance as much as liberal technocrats presume.

The stronger, more specific version of the claim leans heavily on cherry-picking one study about Medicaid in Oregon, which 1)by its nature could not have demonstrated that Medicaid was no better than being uninsured and 2)did no such thing in any case.

Anyway, there is more than one study out there. Does the evidence support the incredibly implausible idea that being insured does little or nothing to improve health outcomes? Of course not. The evidence is overwhelming that people on Medicaid benefit substantially from having insurance. The best evidence indicates that upwards of 30,000 people a year will die preventible deaths if BCRA becomes law. So, while it might sound like Swiftian hyperbole, “Senate Republicans will make poor people suffer and in some cases die to pay for an upper-class tax cut” is, in fact, entirely accurate.

What’s particularly infuriating is that this ridiculous speculation is being engaged in by people who will never themselves be without good insurance. None of these people are going forego anything but ER care the rest of their lives. Conveniently, if Republicans succeed in passing this unspeakably appalling bill, “being uninsured — is it really bad for your health?” is an experiment that will be carried out on other, less privileged people. And if it turns out that lacking insurance leads to pain and suffering and death, as the evidence actually indicates, well, they owe you a coke! (Note: offer of a coke will not be honored, moocher.)

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