• Catch Up

    Some notes to bring you up to date on the latest blogosphere dust up I’m involved in:

    Megan McArdle has a new post relating to her Atlantic Monthly piece on health insurance and mortality and reaction to it. I’m not going to pick it apart. Also, she and I have been conversing in the comments to my prior post. It is clear that our differences won’t be resolved through dialog, nor did I expect they would be. But the debate is thought provoking and potentially educational, if one keeps clear what is sound evidence and what is opinion, which is no easy task.

    At the heart of it all are these questions:

    • Do we need to know to some level of certainty to what degree health insurance prevents death before deciding how to extend coverage to more Americans or whether we should do so at all?
    • What is that level of certainty?
    • How sure are we that level of certainty is achievable?
    • Or, in order to act is it sufficient to know that lack of insurance increases mortality even if we can’t be as precise as we might like about numbers of lives?
    • Is mortality the only relevant measure?
    • If we judge the cost per saved life too high does that mean we should reduce overall taxpayer liability by covering fewer people (saving fewer lives) or by redoubling efforts to increase cost-efficiency of care delivered?

    Reasonable people can disagree about the answers to these questions.

    • Her analysis is itself an over simplification of the issue. She wants a hard number to calculate how many lives would be saved, while ignoring that individual health would also affect other individuals in their lives.

      For example, I want her to calculate the add on of proper health care that creates healthy adults and the affects on childhood obesity, mortality that causes poverty, bankruptcy, etc.

      I am sure she will point out the difficulty I outline is exactly the point she is making, but it seems to me she is just demanding what she knows is unknowable to support a position to do nothing.