Real Death Panels

Remember those death panels, how the ACA was going to kill lots of Americans (especially your grandmother)? I’m still enraged at the idea, goverment just killing old people. Terrible thing, and the outrage about them on the right was a wonder to behold, one of Sarah Palin’s heroic fact-free moments.
Killing young people, though, is another story, and Republicans are generally fine with it.   About 13 million people under 65 would be eligible for expanded Medicaid in the states that are refusing it (9 million live in the states that have signed up).   Since Massachusetts expanded health insurance to everyone, the death rate there, already below the national average, has fallen by about 3%, and the finding (attributing it mainly to health insurance expansion) seems pretty solid, especially as it makes sense theoretically.  After all, what people do when they have insurance is get health care when they’re sick, and what health care does when you’re sick is usually to make you better, and being sick is what most people die from, duh.   The national death rate is about 3% per year for ages 20-64 (the Medicaid expansion potential beneficiaries), so a 3% reduction would save about one in a thousand of those people.
Now there’s a real bunch of death panels: Republican state governments. The people denying their citizens this insurance are happy to kill 130,000 people over the next ten years to prove how conservative and grownup and serious they are (not to mention improving the character and self-reliance of the survivors and anyway, a lot of those poor people vote Democratic every extra year they’re alive).  That’s probably an underestimate, because being insured gains more life-years among the poor, and the non-expansion states are mostly poor, like the whole South.  Haven’t heard from Sarah about this, but I’m sure she’ll be on the case with all four grizzly bear feet.

Author: Michael O'Hare

Professor of Public Policy at the Goldman School of Public Policy, University of California, Berkeley, Michael O'Hare was raised in New York City and trained at Harvard as an architect and structural engineer. Diverted from an honest career designing buildings by the offer of a job in which he could think about anything he wanted to and spend his time with very smart and curious young people, he fell among economists and such like, and continues to benefit from their generosity with on-the-job social science training. He has followed the process and principles of design into "nonphysical environments" such as production processes in organizations, regulation, and information management and published a variety of research in environmental policy, government policy towards the arts, and management, with special interests in energy, facility siting, information and perceptions in public choice and work environments, and policy design. His current research is focused on transportation biofuels and their effects on global land use, food security, and international trade; regulatory policy in the face of scientific uncertainty; and, after a three-decade hiatus, on NIMBY conflicts afflicting high speed rail right-of-way and nuclear waste disposal sites. He is also a regular writer on pedagogy, especially teaching in professional education, and co-edited the "Curriculum and Case Notes" section of the Journal of Policy Analysis and Management. Between faculty appointments at the MIT Department of Urban Studies and Planning and the John F. Kennedy School of Government at Harvard, he was director of policy analysis at the Massachusetts Executive Office of Environmental Affairs. He has had visiting appointments at Università Bocconi in Milan and the National University of Singapore and teaches regularly in the Goldman School's executive (mid-career) programs. At GSPP, O'Hare has taught a studio course in Program and Policy Design, Arts and Cultural Policy, Public Management, the pedagogy course for graduate student instructors, Quantitative Methods, Environmental Policy, and the introduction to public policy for its undergraduate minor, which he supervises. Generally, he considers himself the school's resident expert in any subject in which there is no such thing as real expertise (a recent project concerned the governance and design of California county fairs), but is secure in the distinction of being the only faculty member with a metal lathe in his basement and a 4×5 Ebony view camera. At the moment, he would rather be making something with his hands than writing this blurb.

7 thoughts on “Real Death Panels”

  1. These really aren’t death panels, because the mythical versions (and the ones insurors and others have actually run) have been about denying care to increase profits or reduce costs. The people who benefit from medicaid expansion (in the states where governors and legislators don’t want citizens to suffer and die unnecessarily) are above the poverty level. They’re gainfully employed. They’re taxpayers. They generate economic activity. Letting thousands of them die every year will reduce revenues and damage the economies of the states where expansion has been rejected. This is about killing people not even (ahem) for profit but for animus and the perception of political gain. (I guess you could argue that political gain is equivalent to personal profit for the politicians in question, even if not for the state whose agents they legally are.)

    Does anyone know how the ACA is written with respect to states whose governors or legislatures change their minds after the effective date of the law? Because if accepting a late decision to accept Medicaid expansion requires action by congress, the odds of that happening are not good.

    1. Paul:
      Do you happen to have any links handy that give the distribution of the Medicaid population in terms of employed/unemployed/disabled? I thought this would be easy to find but am having trouble finding an online database with this information.

      Many thanks if you can point me in the right direction!

  2. Which would you rather do: die on your feet or live on your knees?

    Give me liberty or give me death!

    Even the Nazis did not force the Jews to designate their primary care doctors!

  3. I thought the complaint was that the red states already got more than their share of money from the federal government.

    1. They do, but we blues are mostly okay with that. Helping out people who got it rough is kind of our thing. Only reason we ever mention it is to tweak the redstaters who make a big thing about their rugged individualism while they're gorging themselves on government benefits.

      We don't lie awake nights, tormented by the thought that some government program or other might be working for the benefit of people we hate. It's an error to assume that your enemy has the same motivations you've got.

  4. We should bear in mind that those who opposed the Medicaid expansion generally describe themselves as "pro-life."

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