How Many Lives Will Obamacare Save?

Sarah Kliff analyzes the Romneycare study the came out a couple days ago:

The new Harvard study estimates that for every 830 people the Massachusetts insurance expansion covered, one additional life was saved. This was a 2.9 percent decrease in the mortality rate compared to similar counties that did not have insurance expansions. … It’s hard to know whether the health care law will lead to similar gains elsewhere. Massachusetts has more doctors per capita than any other state, which could mean it was easier for people to see a doctor once they gained insurance coverage. But there’s also the possibility of even bigger gains outside of Massachusetts, where states are starting from a lower insured rate than the Bay State did in 2006. If the coverage expansion effects more people outside of Massachusetts, that could mean even more deaths prevented elsewhere.

Michael F. Cannon feels that the cost is too high:

Even if [Romney care has saved lives,] this Annals study also suggests that success has come at a very high cost. The authors estimate that “for approximately every 830 adults who gained insurance [under RomneyCare], there was 1 fewer death per year.” If we assume the per-person cost of covering those 830 adults is roughly the per-person premium for employer-sponsored coverage in Massachusetts in 2010 (about $5,000), then a back-of-the-envelope calculation suggests that RomneyCare spent $4 million or more per life saved. The actual figure may be much higher if we include other costs incurred by that law. The World Health Organization considers a medical intervention to be “not cost-effective” if it costs more than three times a nation’s per-capita GDP per year of life saved. This in turn suggests that RomneyCare would have to give every person it saves an average of nearly 30 additional years of life to meet the World Health Organization’s criteria for cost-effectiveness. Given that the mortality gains were concentrated in the 35-64 group, that seems like a stretch.

As an economist might put it, this means there are likely to be policies out there that could save a lot more lives than RomneyCare does per dollar spent.

Bill Gardner counters:

Cannon believes that there are policies that would deliver more benefit than Romney- or ObamaCare. If you are a critic of the ACA and this is what you believe, Cannon’s argument obligates you to do that better thing with the money. This poses an acute test for leaders in the 24 states that refused the ACA’s expansion of Medicaid. How many of those states refused to expand Medicaid, but then did nothing else for the health of their uninsured? If politicians in those states just refused the money and let the poor die, they do not have standing to make Cannon’s criticism about paths not taken.

Second, is it just to worry about the cost of health insurance only when we are considering insuring the poor? 55% of the US population had employer-based health insurance in 2011. Because this benefit isn’t taxed, this meant that 55% received a large subsidy for their insurance, including many affluent people. (And I’m sure Michael Cannon hates this, probably more than I do!) If you oppose the expansion of Medicaid, you should also favor the taxation of employee health benefits. Otherwise, you are arguing that we can afford to subsidize the health insurance of the rich, but that it costs too much to do it for the poor.

Sprung sees no viable alternatives to Obamacare on the horizon:

Those who don’t like the ACA can fairly argue that there are better models for extending affordable health insurance to all. … It’s noteworthy, though, that there are almost no Republican elected officials who have proved willing to commit to actual legislation that would purport to “replace” the ACA with an alternative that could make a credible claim to extend health insurance to as many uninsured Americans as the ACA does. Senators Coburn, Burr and Hatch rolled out the outline of such a plan — which looked a lot more like an opening bid to reform the ACA to conservative specs than actual replacement — and their colleagues studiously ignored it.

Suderman worries that Romneycare and Obamacare are unsustainable:

[I]t’s worth remembering that for the past several years, the price tag in Massachusetts has looked unaffordably expensive. In a 2011 review of the state’s health reform published in Health Affairs, a team of researchers looked at the results of the program over the same time frame measured by the new study. What they found was more coverage, more utilization of care—and costs that could not be supported over time. Not in Massachusetts. Not anywhere. “The pre-2010 status quo is not a sustainable option for Massachusetts or the nation,” the report said. Around the same time, state health officials were also describing the program’s costs as unsustainable, warning that, if left unchecked, they will crowd out everything else the government needs to do. Some reforms have been put in place by then, but even still, cost-containment is a challenge—in part because more coverage has led to greater use of care.

McArdle’s bottom line:

I haven’t changed my beliefs radically: I still basically think that health insurance improves mortality rates, but that that improvement is unlikely to be huge if you can get results like Oregon. However, after [Monday’s] report, I’ve revised the probability of “huge benefits” upward, and you should do the same. And beware of those who are only willing to revise their beliefs in one direction.