No, Obamacare Repeal will Not kill tens of thousands

Repealing Obamacare will kill 24,000 people a year! No, 36,000! No, 43,000! The tax cuts are blood money!

There is more than a little hyperbole about the overhaul of Obamacare proposed by the House and the Senate, and the rhetoric about tens of thousands of deaths is not a bad example. The numbers are inflated, the studies are cherry-picked, the uncertainties are ignored, the context is dismissed, the framework is laughably distorted.

No one really knows what effect health-insurance coverage has on overall health. You can’t just compare the health of insured people to that of uninsured people, since there is an enormous host of confounding variables. Some of these can be controlled for — the fact that the uninsured are poorer and younger, for instance — but many cannot be. It seems quite likely, for instance, that people who choose not to buy health insurance are in general less health-conscious than the rest of the population, that they are more willing to take risks, or that they have worse impulse control. All this seriously diminishes the utility of observational studies, which are the easiest types of studies to conduct.

Slightly better than observational studies are natural experiments, where some external factor determines, in this case, which people get health insurance and which don’t. The experiments most commonly cited in defense of the argument that repealing Obamacare will substantially increase mortality are natural experiments: One study compared mortality in states that expanded Medicaid in the early 2000s to states that didn’t; another study compared mortality in Massachusetts counties before and after Romneycare to mortality in control counties in neighboring states. The former study gives rise to the figure of 43,000 deaths; the latter study to both the 24,000 and 36,000 figures (which differ because they use different estimates of the effect of Obamacare repeal on coverage). But of these two, it is the Massachusetts study that has generated the most media coverage. When people talk about the lives saved by Obamacare or the lives threatened by Paul Ryan and Mitch McConnell, they are usually referring to the Massachusetts study. Benjamin D. Sommers, who was involved in both studies, told Vox that the Massachusetts one was more relevant.

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