Genre: Opinion/Argumentation

Have you noticed that The New York Times editorial page is becoming increasingly strident, increasingly emotional and increasingly irrational? Here is Paul Krugman in last Monday's column: Mr. Romney and Mr. Ryan...want to expose many Americans to financial insecurity, and let some of them die, so that a handful of already wealthy people can have a higher after-tax income. No, that's not a misprint. The Republicans actually want to let some people die so that they can reward their rich friends. It's not an isolated comment either. Under the heading "Death by Ideology," Krugman actually lists all of the ways in which a President Romney would proceed to kill people. For example: Mr. Romney wants...to repeal ObamaCare and slash funding for Medicaid -- actions that would take insurance away from some 45 million nonelderly Americans, causing thousands of people to suffer premature death. And their longer-term plans to convert Medicare into Vouchercare would deprive many seniors of adequate coverage, too, leading to still more unnecessary mortality. [M]any, and probably most, older Americans -- would be left with inadequate insurance, insurance that exposed them to severe financial hardship if they got sick, sometimes left them unable to afford crucial care, and yes, sometimes led to their early death. So what, you may ask, is the basis for all this vitriol? Krugman is writing about health care -- a subject about which he has proved time and again he knows virtually nothing. On this occasion he lets loose with this bold assertion: The overwhelming evidence, however, is that [health] insurance is indeed a lifesaver, and lack of insurance a killer...there's no real question that lack of insurance is responsible for thousands, and probably tens of thousands, of excess deaths of Americans each year. Krugman claims to have reviewed the economics literature. If he has, then he is an embarrassment to the economics profession, despite his Nobel Prize. Then again, if he claims to have done so but really hasn't, I suppose that's equally embarrassing. (And remember, while all this is going on he is invariably calling everyone who disagrees with him a liar.) Let me briefly set the record straight. Some studies actually have claimed that tens of thousands of people have died prematurely because they lacked health insurance. But these studies were not done by economists and were never accepted in any credible, peer-reviewed social science journal. They are basically junk science and they have been thoroughly discredited on several occasions, most notably by Richard Kronick , an economist who served in the Obama administration and actually helped design HillaryCare. Kronick writes that "there is little evidence to suggest that extending insurance coverage to all adults would have a large effect on the number of deaths in the United States." I'll get to the children below. In general, the economics literature has found no evidence that lack of health insurance has any substantial effect on mortality. Prof. June O'Neill, former director of the Congressional Budget Office, thoroughly investigated this issue and found that among Americans above 250% of poverty, lack of health insurance does not affect mortality. Below 250% of poverty, people without health insurance have an 11% higher probability of dying. But the probability drops to under 3% when you take into account demographic differences in the two populations. In fact, it is likely that the differential probability would disappear altogether with a complete inclusion of all the demographic differences between the two groups. (See her PowerPoint slides .) The most recent evidence on children comes from a paper posted by the National Bureau of Economic Research. It looks at the effects of Medicaid on mortality and finds: Medicaid insurance leads to a substantial decline in mortality in older black children. It has no effect on white children. It has no effect on children -- black or white -- in states with the most Medicaid expansion. The last finding is the most important. Krugman claims that by expanding Medicaid, ObamaCare will save thousands of lives and that by repealing ObamaCare, Romney would cause thousands of people to die. The evidence says otherwise. Paul Krugman deserves the Nobel Prize for his clear thinking and advocacy of free trade.  But on health care issues, he is a rank amateur. Mr. Romney and Mr. Ryan...want to expose many Americans to financial insecurity, and let some of them die, so that a handful of already wealthy people can have a higher after-tax income. This assertion seems rather melodramatic. Why does an advanced "free society" have to become a cradle- to-grave welfare state? There isn't enough money in the country to insure every person's financial security . For all long as there have been people on this Earth, they have had to collaborate and fight for security. A "handful of already wealthy people" cannot do anything about that. They certainly cannot alleviate the suffering of millions of people. However, they do make for a handy scapegoat when one political party is willing to undercut the future of the American economy for a few more years in power. Paul Krugman's communications and demeanor seem to reveal an angry man. Wonder what makes a man who expresses such confidence in his own capacity and virtue to be so angry. Fear? Insecurity? Sad for him, unhelpful for the rest of us. John, You do us a service by continuing to cover the excesses of Krugman. Apart from a psychological study, there is little reason to pay his political views any attention. Yet, since it is important to know what the opposition believes, even if it is as foolish and wrongheaded as Krugman has allowed his views to become. Thus, a sincere thanks for continuing what must be an unpleasant task. Dr. Goodman, the data from the "Oregon Medicaid Experiment" also supports the point you make here. Other than increased health care utilization and expenditures, the only effect of Medicaid coverage that objective data in the study shows is a decrease in medical collections from credit report data. The authors specifically say, regarding Medicaid beneficiaries in the study, "Currently our only objective health measure is mortality, on which we were unable to detect an effect." and "...it does not appear to reduce their risk of bankruptcy (at least in the first year)...". Is it safe to assume that you expect the data from Oregon to continue to show no effect on mortality in the coming years, or has self-selection in the enrollment process created a sample with such poor health status that there will be some effect on mortality? Apologies if that is a false dichotomy or a leading question I hate to break it to Mr. Krugman, but the death rate will be 100% no matter who is president. I know Obama promised that the seas would lower once he became president, but even he never promised immortality. Maybe he's saving that for his second term. The problems with the conflicting results in studies of premature mortality of the uninsured are partly due to measuring a fairly uncommon event (death under age 65) in a very large group (the uninsured). Nevertheless, numerous studies have demonstrated that premature death due to lack of insurance is a very real phenomenon. The study in children suffers from the fact that, fortunately, death in children is quite rare, and those that do occur often are from conditions in which medical interventions are ineffective, so insurance status would not have made an easily measurable difference. Innumerable other studies have demonstrated the great value of Medicaid and CHIP in children beyond that of preventing death. Richard Kronick is a highly credible and well respected researcher. His study failed to demonstrate that insurance prevents deaths, but he controlled for illnesses that individuals were aware of, yet did not control for those that the uninsured are less likely to be aware of, such as diabetes, hypercholesterolemia and hypertension. Thus his adjustment for baseline health status, ignoring these common conditions, could easily have resulted in the negative findings. Those of us who have been in practice for decades have many anecdotal accounts of uninsured individuals delaying their health care, resulting in lethal outcomes. Although anecdotes do not meet the test of scientific validity, we still mourn those lives lost by individuals who told us that they didn't come in earlier because they were broke and uninsured. We should make every effort we can to remove financial barriers to health care. Neither Romney nor Paul Ryan have proposed anything that can be called "cuts" in Medicaid. They have proposed reforms that would potentially greatly improve access to health care by the poor covered by the program, with the program costing far less as scored by CBO because of the improved incentives and efficiency, just exactly as the 1996 reforms of AFDC caused costs of that program to decline by 50% from where they would have been under prior trends, while incomes of the poor formerly on the program were documented to increase by 25%, and poverty among them declined precipitously. It would be an abuse of the English language to say that those 1996 AFDC reforms "slashed" or even cut AFDC/TANF. Similarly, it is an abuse to say that the same reforms of Medicaid would "slash" or "cut" the program. Medicaid with the reforms proposed by Romney/Ryan would be better for the poor than Medicaid today, especially as it will be under Obamacare. Similarly, Medicare under the reforms proposed by Romney/Ryan would be better for seniors than Medicare under Obamacare. Krugman abuses his positions to push juvenile quality Marxism. Krugman got his Nobel Prize for economic geography. It is his job to see patterns among socioeconomic and spatiotemporal lines. As for his work on healthcare.. people tend to find what they're looking for. If it makes you feel better, Obama got one of those Nobel thingies too. Don M., I don't think you need a government takeover of health care or the expenditure of trillions of dollars to screen for diabetes, hypercholesterolemia and hypertension. Thus even if what you say has some merit Kronick's study remains just as valuable. All true, but still disappointing that Romney dismisses the very real problem of the uninsured/underinsured with the blithe statement that they can go to the ER for emergency care. Is he really that clueless? While I agree that Krugman is WAY out of his area of expertise on the issue of health insurance, the suggestion that lack of access would have no impact on mortality is absurd on its face. Divine intervention would be required to make that so. Of course if you REALLY believe this, Mr. Goodman, you could always show us by dropping your own and your family's health insurance. What? Not quite THAT sure, are you? I enjoyed the exchange between Krugman and Mary Matalin a couple of weeks ago. I would have loved to know what was going through Carville's head as he sat between them. http://www.youtube.com/watch?v=KfjNNBfRm\\...