Ruminations, December 27, 2009

Health insurance lives saved vs. lives lost

The Institute of Medicine, the health branch of the National Academy of Sciences, issued an analysis that concluded 22,000 lives were lost in 2006 due to a lack of health insurance. Many proponents of the new health care proposals are projecting their figures across 10 years and estimating that the new Congressional health care bill will save, conservatively, 150,000 lives over 10 years.

Although this analysis is speculative, it is an interesting and worthwhile exercise to examine the potential effect of health insurance on longevity. Rather than focusing on the dollars and cents side of the health care debate, perhaps adding an additional balance sheet focusing on lives would be worthwhile.

Saving 22,000 lives per year is based upon 30 million of people who are currently uninsured obtaining insurance and thus being able to afford to see their doctors once a year. If 30 million more people will go to their doctor once a year and, according to some estimates, a doctor and an assistant (nurse, physician’s assistant, or another doctor, etc) can see and examine 2,000 people per year (one visit per person). That means we’ll need 30,000 new medical professionals to see 30 million people. Where will they come from? They won’t materialize from thin air. With current staffing levels, regardless of insurance, we won’t have enough medical professionals to see these people. So maybe, unless or until we can expand our medical professionals, the 30 million people currently uninsured still won’t be able to see a doctor and 22,000 lives we estimated that would be saved will be lost anyway.

While accepting the estimate of 22,000 lives saved in one year, let’s consider the number of lives that the new health care bill may cost. For instance, won’t cutting nearly $500 billion from Medicare over 10 years have an adverse affect on the life spans of 46 million seniors? That’s an average cut of $10,000 per person over 10 years. It seems that by reducing health care by that amount, for a group whose earning power is limited and whose advancing years makes their health precarious enough without the cuts, will contribute to the lives lost count. Will it contribute to the premature death of more than 150,000 over ten years? Could be.

And, while we are on the subject of saving lives, there is no doubt that American medical innovation over the last decades has saved millions of lives. In fact, it is so advanced and superior, that, according to Deloitte & Touche, last year 400,000 people came from foreign lands to get health care in the United States. They came from all over including places such as Canada and Great Britain, where national health care is provided gratis. Why did they come? Not to save money, that’s for sure. They came because they wanted innovative health care that was unavailable in their home countries. Many, including those with diverse political perspectives as liberal former Clinton Labor Secretary Robert Reich and conservative Fox commentator John Stossel, believe that a new health care system will not provide new innovations and, consequently it may cause a number of premature deaths that innovation could have saved.

 So, on balance, will the new health care bill in Congress save lives? Maybe not.

Lieberman and anti-Semitism

The last two members of the Democratic caucus fell into line last week and supported the Democrats health care bill. Joe Lieberman (I, CT) and Ben Nelson (D, NE) voted to end debate on the bill and proceed towards its passage.

The left has been almost apoplectic on the about Joe Lieberman (I, CT), who threatened to join Republicans and filibuster the Senate Health Care bill. But when Lieberman’s objections to the “public option” and to the provision to allow people under 65 to apply for Medicare were met, he withdrew his filibuster threat and supported the bill. Lieberman had held out on principle. And by mollifying Lieberman, the Democrats were able to secure his support. But the left still treats him as a traitor.

Ben Nelson (D, NE), the last hold out, came back to the party-line when he was offered a $100 million subsidy for his Nebraska voters and tax breaks for Nebraska insurance companies. After he came back, the left treated him like a hero.

You can agree or disagree with Nelson and Lieberman but can you hold a mercenary in higher regard than a man who stands on principle?

It doesn’t seem so for many of the left. Rosa DeLauro (D, CT) says, “I'll say it flat out, I think he [Lieberman] ought to be recalled." MoveOn.org has raised one million dollars so that when Lieberman “comes up for re-election, we'll make sure we send him home for good.” Michael Moore demands that Connecticut recall Lieberman and wants to punish Connecticut for electing Lieberman by means of a boycott. MSNBC news commentator Keith Obermann said that Lieberman was “embarrassing humanity.” And the Susan G. Komen breast cancer foundation has been pressured to sever relationship with Lieberman’s wife, Hadassah.

Is there something else at work here – something other than political opposition? When people oppose President Barack Obama, some of Obama’s supporters are quick to state or imply that the reason for the opposition to Obama is racism. Could one conclude that the reason for the strong opposition to Lieberman is anti-Semitism?

First of all, let’s set aside the lunatic fringe that will always be with us. There is no doubt that there is a small group of people who don’t like Lieberman because he is a Jew – just as there exists a small group of people who don’t like Obama because he is black. Small fringe groups, however outrageous their beliefs, are of little concern; when the group gets large or influential, that’s when it bears watching.

In Lieberman’s case, the left has other reasons to dislike him. In 2006, Lieberman returned from a fact-finding trip to Iraq and declared the war not only winnable but worth fighting. This infuriated the left and, at the Connecticut Democratic state Convention, instead of nominating the incumbent Lieberman, anti-war candidate Ned Lamont was nominated for senator. Lieberman then had the effrontery, in the eyes of the left, to run for senator as an independent against a party-line Democrat – and he won.

In 2008, Lieberman spoke at the Republican National Convention and endorsed Republican John McCain.

While many on the left urge rapprochement with Cuba, Lieberman has remained strongly anti-Castro.

And, while a significant portion of the American left leans toward Palestine in the Israeli-Palestinian controversy, Lieberman is strongly pro-Israel.

So the resentment of Lieberman for opposing the party orthodoxy has been building. Was the Health Care kerfuffle the tipping point? Is it a knee-jerk reaction to dismiss Lieberman detractors as anti-Semites? Let’s explore that notion.

There still is a remnant of anti-Semitism in the United States and some of it by seemingly responsible public figures and politicians who should know better. Former Senator Fritz Hollings (D, SC), for example, implied that President Bush initiated the war on terror in order to appease Jews.

While anti-Semitism in the United States is not at the levels it had been in the 1930s, it still exists. In November 2005, the U.S. Commission on Civil Rights issued a Campus Anti-Semitism briefing report (http://www.usccr.gov/pubs/081506campusantibrief07.pdf) that said, “Indeed, anti-Semitism and anti-Israelism flourish on college campuses because of the energetic focus of a determined minority and their willingness to dedicate themselves to this cause.” If that was and is the case, we don’t need to wonder that the attitudes of people who have been subjected to academic precepts of anti-Semitism made to sound intellectual will become anti-Semites themselves.  

But according to the Commission, it is a small group of determined activists that foment anti-Semitism on campus. And who is it that leads political groups? Small groups of determined activists.

One of the Commission’s major findings is that “The assault on Jewish nationalism is embedded in the ideology of the left” and that "Anti-Semitic bigotry is no less morally deplorable when camouflaged as anti-Israelism or anti-Zionism." As was pointed out above, Lieberman strongly supports Israel.

Former Soviet dissident and Israeli government official Natan Sharansky stated that “One of the major difficulties in grappling with the new anti-Semitism is the ease with which it can be denied. Unlike in the past, post-modern anti-Semitism no longer exclusively involves such phenomena as violence against the Jews, sporting swastikas and burning synagogues. While these phenomena do indeed exist and are even increasing, especially in Europe, today they form only part of the problem.”

So, is opposition to Lieberman anti-Semitism camouflaged as politics or is it legitimate political opposition? It’s probably both. There is no doubt Lieberman has, overall, a liberal voting record. But liberal-versus-conservative voting records are hard to measure; the big issues for the left over the past year have been the war in Iraq, the presidential election and health care. Lieberman has, at times, opposed the left on all three.

Just as Lieberman has taken principled stands to oppose the left, it is fair to say that many on the left are taking principled stands in opposing Lieberman. Some of that opposition may be anti-Semitism camouflaged in principle and some, when it is expressed with venom and rancor, may not be camouflaged but blatant anti-Semitism.

The conclusion? It’s worrisome.