Harvard study finds nearly 45,000 excess deaths annually linked to lack of health coverage

Lack of health insurance now more lethal

One American now dies every 12 minutes from lack of health insurance.

FOR IMMEDIATE RELEASE
Sept. 17, 2009

Contacts:
Steffie Woolhandler, M.D., M.P.H.
David Himmelstein, M.D.
Andrew P. Wilper, M.D., M.P.H.
Mark Almberg, Physicians for a National Health Program, (312) 782-6006, mark@pnhp.org
David Lerner or Karmen Ross, Riptide Communications, (212) 260-5000

A study published online today estimates nearly 45,000 annual deaths are associated with lack of health insurance. That figure is about two and a half times higher than an estimate from the Institute of Medicine (IOM) in 2002.

The new study, "Health Insurance and Mortality in U.S. Adults," appears in today’s online edition of the American Journal of Public Health.

The Harvard-based researchers found that uninsured, working-age Americans have a 40 percent higher risk of death than their privately insured counterparts, up from a 25 percent excess death rate found in 1993.

Lead author Dr. Andrew Wilper, who worked at Harvard Medical School when the study was done and who now teaches at the University of Washington Medical School, said, "The uninsured have a higher risk of death when compared to the privately insured, even after taking into account socioeconomics, health behaviors and baseline health. We doctors have many new ways to prevent deaths from hypertension, diabetes and heart disease — but only if patients can get into our offices and afford their medications."

The study, which analyzed data from national surveys carried out by the Centers for Disease Control and Prevention (CDC), assessed death rates after taking education, income and many other factors including smoking, drinking and obesity into account. It estimated that lack of health insurance causes 44,789 excess deaths annually.

Previous estimates from the IOM and others had put that figure near 18,000. The methods used in the current study were similar to those employed by the IOM in 2002, which in turn were based on a pioneering 1993 study of health insurance and mortality.

Deaths associated with lack of health insurance now exceed those caused by many common killers such as kidney disease.

An increase in the number of uninsured and an eroding medical safety net for the disadvantaged likely explain the substantial increase in the number of deaths associated with lack of insurance. The uninsured are more likely to go without needed care.

Another factor contributing to the widening gap in the risk of death between those who have insurance and those who don’t is the improved quality of care for those who can get it.

The research, carried out at the Cambridge Health Alliance and Harvard Medical School, analyzed U.S. adults under age 65 who participated in the annual National Health and Nutrition Examination Surveys (NHANES) between 1986 and 1994. Respondents first answered detailed questions about their socioeconomic status and health and were then examined by physicians. The CDC tracked study participants to see who died by 2000.

The study found a 40 percent increased risk of death among the uninsured. As expected, death rates were also higher for males (37 percent increase), current or former smokers (102 percent and 42 percent increases), people who said that their health was fair or poor (126 percent increase), and those that examining physicians said were in fair or poor health (222 percent increase).

Dr. Steffie Woolhandler, study co-author, professor of medicine at Harvard and a primary care physician in Cambridge, Mass., noted: "Historically, every other developed nation has achieved universal health care through some form of nonprofit national health insurance. Our failure to do so means that all Americans pay higher health care costs, and 45,000 pay with their lives."

She added: "Even the most liberal version of the House bill would have left 17 million uninsured, according to the Congressional Budget Office. The whittled down Senate bill will be worse — leaving tens of millions uninsured, and tens of thousands dying because of lack of care. Without the administrative savings only attainable through a Medicare-for-all, single-payer reform — real universal coverage will remain unaffordable. Politicians are protecting insurance industry profits by sacrificing American lives."

Dr. David Himmelstein, study co-author and an associate professor of medicine at Harvard, remarked, "The Institute of Medicine, using older studies, estimated that one American dies every 30 minutes from lack of health insurance. Even this grim figure is an underestimate — now one dies every 12 minutes."

"Health Insurance and Mortality in U.S. Adults," Andrew P. Wilper, M.D., M.P.H., Steffie Woolhandler, M.D., M.P.H., Karen E. Lasser, M.D., M.P.H., Danny McCormick, M.D., M.P.H., David H. Bor, M.D., and David U. Himmelstein, M.D. American Journal of Public Health, Sept. 17, 2009 (online); print edition Vol. 99, Issue 12, December 2009.

A copy of the study, along with a state-by-state breakout of excess deaths from lack of insurance, is available at http://www.pnhp.org/excessdeaths

Physicians for a National Health Program (www.pnhp.org) is a research and educational organization of 17,000 doctors who support single-payer national health insurance. To speak with a physician/spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

Source: Physicians for a National Health Program

A full text copy of the study, published in the American Journal of Public Health is here (PDF).

A state-by-state breakout of excess deaths from lack of insurance, is available here (PDF)

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More From Dr. Steve:

There are 11 million Americans with chronic physical illnesses like heart disease, diabetes and asthma are not getting the medical care they need because they don’t have health insurance. The uninsured have higher rates of stroke and cardiovascular disease deaths. The American Cancer Society found that uninsured cancer patients are nearly twice as likely to die within five years as those with private coverage.

Overall, the United States has the highest rate of so-called "amenable" mortality among 19 OECD countries; that's 101,000 fewer deaths per year if we were as good as the average of the top three. But forget studies and just think for a moment. It matters if you got the mammogram last year, or get "treated" in the ER for untreatable metastatic breast cancer today. It matters if you if get your lipids checked and started on statins five years ago because you have coverage, or get "treated" in the ER for your fatal heart attack today. Let me be a little bit more clear. This attitude by right wing Republican idealogues is not just delusional, it is homicidal. They are justifying the deaths of tens of thousands of Americans. That is the equivalent of seven 9/11's per year, year-in and year-out.

Hospitals are getting killed financially in part because of the dumping of care into emergency rooms. They are closing ERs all over the country because of this. Meanwhile wait times in the ER are up even for the critically ill. This is not new news. Everyone who knows anything about health care in the country knows this.

And let's not forget that half of personal bankruptcies are linked to health care costs (admittedly the studies on this predate the mortgage crisis; though of course right-wing free-market fundamentalist privatization and deregulation led to that disaster too). Of course that includes lots of people "with" health insurance from the same private for-profit health insurance companies

BILL MOYERS - Single Payer Health Insurance

Public Citizen's Dr. Sidney Wolfe and Physicians for a National Health Program's Dr. David Himmelstein on the political and logistical feasibility of health care reform.

Bill Moyers Interview with Dr. Sidney Wolfe and Dr. David Himmelstein

"Washington's abuzz about health care, but why isn't a single-payer plan an option on the table? Public Citizen's Dr. Sidney Wolfe and Physicians for a National Health Program's Dr. David Himmelstein on the political and logistical feasibility of health care reform."

Video and Transcript here

Ways to Reduce the Cost of Health Insurance

David Himmelstein, Associate Professor of Medicine at Harvard University, testifies at a hearing investigating ways to reduce the cost of health insurance for employers, employees and their families on April 23, 2009.

Dr. McCanne tells us:

The definitive legislation on health care reform that will be supported by the Democratic leadership in Congress has not yet been written. This important testimony by PNHP’s David Himmelstein confirms that single payer reform is still in play, in spite of dismissive comments by many of those involved.

Instead of sitting back and observing the process, it is imperative that we intensify our efforts to deliver the single payer message. The physical and financial health of the people of our nation depend on it.

Transcript of Dr. Himmelstein's testimony:

Health, Employment, Labor, and Pensions Subcommittee Hearing
United States House of Representatives
Committee on Education and Labor
April 23, 2009

Testimony of David U. Himmelstein, M.D.

Mr. Chairman, members of the Committee. My name is David Himmelstein. I am a primary care doctor in Cambridge, Massachusetts and Associate Professor of Medicine at Harvard. I also serve as National Spokesperson for Physicians for a National Health Program. Our 15,000 physician members support non-profit, single payer national health insurance because of overwhelming evidence that lesser reforms will fail.

Health reform must address the cost crisis for insured as well as uninsured Americans. My research group found that illness and medical bills caused about half of all personal bankruptcies in 2001, and even more than that in 2007. Strikingly, three quarters of the medically bankrupt were insured. But their coverage was too skimpy to protect them from financial collapse.

A single payer reform would make care affordable through vast savings on bureaucracy and profits. As my colleagues and I have shown in research published in the New England Journal of Medicine, administration consumes 31% of health spending in the U.S., nearly double what Canada spends. In other words, if we cut our bureaucratic costs to Canadian levels, we’d save nearly $400 billion annually — more than enough to cover the uninsured and to eliminate copayments and deductibles for all Americans. By simplifying its payment system Canada has cut insurance overhead to 1% of premiums — one twentieth of Aetna’s overhead - and eliminated mounds of expensive paperwork for doctors and hospitals. In fact, while cutting insurance overhead could save us $131 billion annually, our insurers waste much more than that because of the useless paperwork they inflict on doctors and hospitals.

A Canadian hospital gets paid like a fire department does in the U.S. It negotiates a global budget with the single insurance plan in its province, and gets one check each month that covers virtually all costs. They don’t have to bill for each bandaid and aspirin tablet. At my hospital, we know our budget on January 1, but we collect it piecemeal in fights with hundreds of insurers over thousands of bills each day. The result is that hundreds of people work for Mass General’s billing department, while Toronto General employs only a handful — mostly to send bills to Americans who wander across the border. Altogether, U.S. hospitals could save about $120 billion annually on bureaucracy under a single payer system.

And doctors in the U.S. waste about $95 billion each year fighting with insurance companies and filling out useless paperwork.

Unfortunately, these massive potential savings on bureaucracy can only be achieved through a single payer reform. A health reform plan that includes a public plan option might realize some savings on insurance overhead. However, as long as multiple private plans coexist with the public plan, hospitals and doctors would have to maintain their costly billing and internal cost tracking apparatus. Indeed, my colleagues and I estimate that even if half of all privately insured Americans switched to a public plan with overhead at Medicare’s level, the administrative savings would amount to only 9% of the savings under single payer.

While administrative savings from a reform that includes a Medicare-like public plan option are modest, at least they’re real. In contrast, other widely touted cost control measures are completely illusory. A raft of studies shows that prevention saves lives, but usually costs money. The recently-completed Medicare demonstration project found no cost savings from chronic disease management programs. And the claim that computers will save money is based on pure conjecture. Indeed, in a study of 3000 U.S. hospitals that my colleagues and I have recently completed, the most computerized hospitals had, if anything, slightly higher costs.

My home state of Massachusetts recent experience with health reform illustrates the dangers of believing overly optimistic cost control claims. Before its passage, the reform’s backers made many of the same claims for savings that we’re hearing today in Washington. Prevention, disease management, computers, and a health insurance exchange were supposed to make reform affordable. Instead, costs have skyrocketed, rising 23% between 2005 and 2007, and the insurance exchange adds 4% for its own administrative costs on top of the already high overhead charged by private insurers. As a result, one in five Massachusetts residents went without care last year because they couldn’t afford it. Hundreds of thousands remain uninsured, and the state has drained money from safety net hospitals and clinics to kept the reform afloat.

In sum, a single payer reform would make universal, comprehensive coverage affordable by diverting hundreds of billions of dollars from bureaucracy to patient care. Lesser reforms — even those that include a public plan option — cannot realize such savings. While reforms that maintain a major role for private insurers may be politically attractive, they are economically and medically nonsensical.

Can US Achieve Meaningful Healthcare Reform Within For-Profit System?

Debate between Dr. David Himmelstein of Physicians for a National Health Program and Len Nichols of the New America Foundation.

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