Thursday, March 25, 2010

Specific Predictions For Health Care Reform

Megan McArdle has been writing a lot recently about the effects that Obamacare will have on American medical and financial well-being, and one of the things she's been demanding is testable predictions from progressives about the positive impact of the bill. Progressives have been hammering the idea that lower U.S. life expectancies, as well as higher rates of morbidity and infant mortality, are clear indicators that we needed a universal health care system. If in fact our lagging statistics in those indicators were due largely to a lack of universal coverage, they ought to improve dramatically over the next 30 years. With few exceptions (e.g. Nicholas Kristof's absurd contention that there will be significant increases in life expectancy as a result of the passage of this bill), very few progressives seem willing to go out on a limb and actually make predictions.

I'll make a few (hey, unlike journalists and healthcare bloggers, I don't have professional credibility to worry about). In the long run confounding factors that make it hard to evaluate actual cause-and-effect on many metrics will have come into play, so I'll state them partially in the form of negations of predictions that won't happen.

1.)The bill will probably save a number of lives, but the number will not be high enough to make an appreciable difference in life expectancy. Unless, that is, it somehow has the unintended benefit of causing young people to stop dying due to accidents, substance abuse and violence in numbers that, compared to those of other developed countries, are disproportionately high. Although I don't think there's a way to measure it, I suspect that the bill may also cost us some lives due to unintended and unfortunate economic consequences.

2.)There will be no statistically significant increase in infant mortality figures. That is, unless we start writing off rather than trying to bring to term high-risk pregnancies, and deal with the disproportionately high rates of malnutrition, substance abuse among pregnant women, etc. among our economic underclass (doing so is a goal libertarians and progressives ought to be able to cooperate on in my opinion).

3.)There will be no statistically significant decrease in morbidity, or particularly in rates of chronic conditions associated with poor diet and exercise habits (i.e. heart disease, obesity, etc.) unless Americans stop washing down quadruple cheeseburgers with 32 oz. sodas and eating pop tarts for breakfast, and/or stop watching TV for three hours a day and actually start exercising.

4.)The number of bankruptcies caused by medical expenses will go down somewhat, perhaps even precipitously. This is a good thing. As McArdle points out in the linked piece, however, this could have been achieved much more easily and cheaply.

5.)The bill will not contain costs for individuals. Medical services will continue to increase rapidly in cost due to greater demand from an aging population and expensive new products hitting the market (the prices of which will be further inflated due to new taxes on medical devices and medium-sized businesses which are passed on to consumers). For people who are already insured the mandates will increase the rate of premium increases, if they have any effect at all.

6.)The true cost of the program to the U.S. government over 10 years is going to be $2 trillion or more, not the $940 billion that's being touted. When you factor in the so-called "doc fix" to Medicare reimbursement rates that was rumored to be the price of A.M.A. support for Obamacare, it's already well up over a trillion, so I have 95% confidence in this prediction. Whatever the benefits of the bill are (and you'd have to be either intellectually dishonest or obtuse to deny that there will be some, perhaps even significant ones), they are not going to be worth the price we pay for them.

7.)Liberals will engage in goalpost shifting that would make Iraq war apologists proud rather than admit they were wrong if predictions #1-#6 are born out.

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