Junk Statistics And The Government's Campaign For More Power

Almost everything you read or see in the press or the media that makes use of statistics is at the minimum wrong and misleading, and at least half is intentionally fraudulent.  The fraud is always of the same sort, namely efforts by the unholy alliance of academics looking to build up their visibility and funding with government officials looking to order people around and grow their bureaucracies and budgets.​

This works because most people are very naive when it comes to statistics.  Admittedly, it's a complicated subject, and you can't know everything.  I majored in math, and took a course in statistics, but I'm certainly not an expert in statistics.  ​However, I do know the one thing of significance.  This is an extremely important thing to know, so I'm putting it in bold:  From an observational or epidemiological study (as opposed to a random double-blind study), Relative Risk of less than about 3 is meaningless, not statistically significant, and no conclusion can be drawn from it.   If you can learn that one principle and internalize it, it will be a real eye-opener in your reading of every day's news.

From the department of "I told you so," let us take up the subject of salt.  I have been saying for years that salt in the diet is not a problem and you should eat as much as tastes good. Why did I say that?  Because I have been looking to see if there is any observational study showing a RR over 2, or a significant random double blind result, and I've never seen it.  QED.  Obviously and as usual, I have all the forces of the great and good know-it-alls arrayed against me.  For example, the Federal government gets into the act through the National Dietary Guidelines, issued jointly by the Departments of Agriculture and HHS.  The World Health Organization of course piles on.  The American Heart Association has totally bought into the anti-salt jihad.​  Mayor Bloomberg of New York has somehow become a national leader on this subject, and just a few months ago, according to the New York Times on February 13, "declared victory" in his national anti-salt campaign by strong-arming 21 food companies (including Kraft, Goya and FreshDirect) into lowering the salt content of their foods.

What evidence have these people had for their campaign?  Essentially nothing -- some very weak observational studies and, according to yesterday's New York Times, "​the well-known fact that blood pressure can drop slightly when people eat less salt [together with] other studies linking blood pressure to risks of heart attacks and strokes [and] models showing how many lives could be saved . . . ."

Pushing back against this ignorance, we have had only a few lonely unfunded amateur individual voices.  On the salt issue, my favorite is John Brignell of the website "numberwatch."​   At a post from 2008 called March of the Zealots, he says this about the salt campaign:

Weirdest of all, but so typical, is the anti-salt campaign. It seems to have no other function than to keep the names of certain professors in the newspapers. The paucity of the evidence offered in contrast to the drama of the claims and the draconian nature of the demanded action is quite startling, but so characteristic of the genre.

Brignell also has this brief write-up to help you understand the concept of Relative Risk.  A couple of useful quotes:​

​"As a general rule of thumb, we are looking for a relative risk of 3 or more before accepting a paper for publication." - Marcia Angell, editor of the New England Journal of Medicine"

"My basic rule is if the relative risk isn't at least 3 or 4, forget it." - Robert Temple, director of drug evaluation at the Food and Drug Administration.

Well, the salt jihad has always been such complete BS that it was only a matter of time before someone took a look at some real data.  A couple of days ago, the Institute of Medicine, at the behest of the Centers for Disease Control issued a report examining the existing evidence.  From the article in yesterday's Times:

In a report that undercuts years of public health warnings, a prestigious group convened by the government says there is no good reason based on health outcomes for many Americans to drive their sodium consumption down to the very low levels recommended in national dietary guidelines.

It's actually worse than that, because some of the recent studies cited actually found adverse health consequences from achieving low levels of salt in the system.​

“As you go below the 2,300 [milligrams of salt per day] mark, there is an absence of data in terms of benefit and there begin to be suggestions in subgroup populations about potential harms,” said Dr. Brian L. Strom, chairman of the committee and a professor of public health at the University of Pennsylvania. He explained that the possible harms included increased rates of heart attacks and an increased risk of death.

You mean that the anti-salt campaign may actually be killing people?  The incredible thing is that the campaigners seem never even to have thought of that possibility.​

OK, you may be thinking, it's stupid, but what's the harm?  You can still get salt and salt up your food if you want (the options aren't quite so good if you are Kraft or Goya).  But salt is only one example out of hundreds of this kind of nonsense, so let's turn to a really important one, the standard for DUI.  Turns out that yesterday's NYT also had an article on that subject.​  Reason: on Tuesday the National Transportation Safety Board issued a recommendation that the states reduce the allowable blood-alcohol concentration from 0.08% to 0.05%.  It's the difference between basically 4 glasses of wine for a man and 3 for a woman putting you over, to 3 and 2.  In other words, it is a proposal to criminalize essentially half the population.  What is the authority of the Federal government to do this?  The answer is that starting with a bill signed by Clinton in 2000 they coerced all the states that previously had a 0.1% standard to go down to 0.08% by threatening to withhold highway funding, and they could well do that again.  This is very serious business.

So what is the evidence?  Drum roll!!!!​

People with a blood-alcohol level of 0.05 percent are 38 percent more likely to be involved in a crash than those who have not been drinking, according to government statistics.  People with a blood-alcohol level of 0.08 percent are 169 percent more likely.

Those numbers sound rather paltry, but "169 percent more likely" (Relative Risk of 2.69) at least approaches the bare minimum of statistical significance, so where did the Times get the "government statistics" they refer to?  They don't say, but a little searching on the internet turns up this collection of academic papers, the first one of which (Compton, et al, no date in the pdf) contains the numbers cited by the Times.  Read the paper if you can stomach it, but it turns out that their raw data only came up with a relative risk of  ​1.57, and then they made a series of adjustments based on assumptions to get to the 2.69.  For example, they made an assumption that there were a bunch of hit and runs that got excluded from the data because the driver was not available to be tested, and that that driver's blood alcohol must be elevated.  In short, they made up the 2.69.  The only data they have is 1.57, and there is good reason to think even that is elevated -- for example, the drinkers may be on average younger and thus less experienced drivers, or may have more propensity to drive with others who distract them.  And by the way, the authors compare the Relative Risk from their data against the results of the previous major study from Grand Rapids in the 60s, which came up with a 1.88 Relative Risk at 0.08% blood alcohol.

Relative Risk of 1.57, or even 1.88?  That is NOTHING!.  For that matter, 2.69 is pretty damn close to nothing.  We're talking here about criminalizing half the population!  Now let's look at quotes in the Times from some of the creeps promoting more government control:

“These tragedies affect both sides,” said Robert J. Sumwalt, one of the board members. He said his wife’s first cousin was killed by a drunken driver who was traveling down a highway in the wrong direction. And his own cousin, he said, goes on Sundays to visit her 21-year-old daughter who was sentenced to 15 years in prison for drunken driving.  Progress is mostly a matter of political will, board members said.

​OK, Sumwalt, are you telling us that the guy who killed your wife's cousin had blood alcohol between 0.05 and 0.08?  Of course not - if he knew the exact BAC and it were useful he would have said it.  And believe me, nobody with BAC of 0.08% is so drunk as to drive down the highway in the wrong direction.  This is just craven use of irrelevant tragedy in aid of a naked power grab for the government.

Well, people, I live in Manhattan, which is the only place in the USA where we don't have to drive home after drinking.  If you are outside Manhattan, it's your issue not mine.  But you had better wake up quickly.​

UPDATE, 7:30 PM:  Just now riding in the elevator here at 787 Seventh Avenue and the news screen  has the headline "People who eat peppers have 50% lower risk of developing Parkinson's."  In other words, yet another one of these phony studies that came out with no statistically significant results and yet is blared around the world as if it means something.  Once you are on to this issue, you start to realize how nearly everything you read is a lie.​

The Campaign To Prevent Government Shrinkage Turns Hysterical

In case you missed it, Monday's New York Times ran an op-ed by David Stuckler and Sanjay Basu entitled "How Austerity Kills."​  The very long (for an op-ed) article occupied fully two-thirds of the real estate on that day's op-ed page.  Stuckler and Basu have just come out with the new book "The Body Economic: Why Austerity Kills," set to issue next week from Basic Books.

Who are Stuckler and Basu, you ask?  According to the description in the Times, Stuckler is "senior research leader" at Oxford, while Basu is "assistant professor of medicine" at Stanford.  ​In other words, they are wannabe big-time academics badly in need of a good dose of publicity to give a jolt to their careers.  No better way to get that than to start with the pet project of the New York Times ("government spending must never be cut!!!!!") and take it to a new level of hysteria.  "If you touch even one dime of the spending, you are killing the babies!!!!!!!"  Surely the Times will give us some valuable real estate to publicize that!  And they were right.

​Before getting to the actual S&B article, we should note that there is a rather obvious problem with the thesis, which is that the most successful economies are consistently those with the lowest levels of government spending as a percent of GDP, and also that the wealthiest economies are the ones with the best health results.  Thus we have the phenomenon of Singapore and Hong Kong, with government spending at 17% and 19% of GDP respectively, seeing their per capita GDPs soar up above that of the U.S., which has allowed its government spending (all levels) as a percent of GDP to grow from the mid-30s to 42% over the past decade and has watched economic growth stall.  Presumably everybody in Singapore and Hong Kong must be dead?  Or consider the comparison of Italy (government spending 50% of GDP) and adjacent Switzerland (government spending 34.7% of GDP).   According to the most recent World Bank data, the life expectancy in Italy in 2010 was 81.7 years, but Switzerland was 82.2 years.  Not much difference, but still what you would expect -- Switzerland is wealthier!  (By the way, Singapore is 81.6 and Hong Kong is 82.9.)

So how exactly would it harm Italy to go from spending 50% of GDP to 34.7% like Switzerland, or under 20% like Singapore and Hong Kong?  Or excuse me, not just harm Italy, but actually kill people, as S&B are explicitly claiming?  If austerity "kills" people, shouldn't Switzerland have a dramatically higher death rate?  Well, according to S&B, you must find the answer by turning to the critically important anecdotal evidence.​

​EARLY last month, a triple suicide was reported in the seaside town of Civitanova Marche, Italy. A married couple, Anna Maria Sopranzi, 68, and Romeo Dionisi, 62, had been struggling to live on her monthly pension of around 500 euros (about $650), and had fallen behind on rent.  Because the Italian government’s austerity budget had raised the retirement age, Mr. Dionisi, a former construction worker, became one of Italy’s esodati (exiled ones) — older workers plunged into poverty without a safety net. On April 5, he and his wife left a note on a neighbor’s car asking for forgiveness, then hanged themselves in a storage closet at home. When Ms. Sopranzi’s brother, Giuseppe Sopranzi, 73, heard the news, he drowned himself in the Adriatic.

Wait a minute, he was 62.  I'm 62!  And I don't take government benefits of any kind.  I guess I must be dead too!​ 

Anyway, at least in this article, S&B don't provide anything other than the assertion that cutting government spending must worsen health outcomes because it's obvious.  They are like the famous 2002 Institute of Medicine study that claimed 18,000 additional annual deaths in the U.S. to people lacking health insurance -- a result now completely undermined by the results of the randomized study out of Oregon.  Needless to say, S&B don't give enough information in their article to enable you to assess their methodology, other than to be sure that there is no sort of randomized study involved., and that they have not bothered to check the rather obvious correlation in world data between lower government spending, greater wealth and higher life expectancy.  Frankly, it's pathetic.

Young Healthy People Should Not Have Health Insurance

A few days ago, in a post entitled "Medical Insurance Is About Asset Protection, Not Health," I Iinked to the report of results from the recent randomized Oregon study of increased Medicaid enrollment -- results showing that providing medical insurance to people leads to greatly increased expenditures on medical care without any demonstrable or measurable improvements in health.  But I did not fully draw out the implications of those results.

If medical insurance does not improve health results, then its purpose is asset protection.  That's a perfectly good purpose -- if you have assets to protect.  But what is the consequence for a young, healthy person with no substantial assets?  Very simple:  you are a fool if you buy health insurance.  If you have some routine medical expenses, pay for them out of pocket, and skip the huge contribution to the old and the sick that you would have to make by buying insurance, let alone the insurance company's overhead and profit.  If you get really sick, show up at a doctor or hospital and demand care.  It will be provided.  They will send you a bill.  You can't pay it.  Offer them what small amount you can pay.  If they don't take it, declare bankruptcy.  In bankruptcy, you will have to give up whatever substantial assets you have (by definition, not much) and then you will get a discharge.  Whether you ended up getting sick or not, you will have saved many years of real money going down the rat hole of health insurance.  A few years, or maybe ten, from now, when you have a spouse and a kid and you're buying a house, it's time to think about medical insurance.

In fact, many young Americans are fully smart enough to make this calculation, which is precisely why we have had the non-problem of 40+ million "uninsured" for many years.   Now enter Obamacare.  Starting January 1, 2014 a minimum level of health insurance is "mandated."  What now?

In case you haven't figured it out, at its heart Obamacare is a scam to force the young and healthy to subsidize the healthcare of the older and less healthy.  If you are young and healthy and think about it for a few minutes, you will realize that you want no part of this.  How to escape?

The good news (as noted here by Richard Epstein) is that it appears that the tax penalties for not having health insurance will be far less than the cost of the health insurance.  The decision is then obvious.   Pay the penalty.

Advocates for Obamacare are starting to figure this out.  Thus, on the same day as my previous post on this subject (May 6) we have one Ezekiel Emanuel writing an extremely bizarre op-ed in the Wall Street Journal entitled "Health-Care Exchanges Will Need the Young Invincibles." If you don't recognize the name, Ezekiel Emanuel is a "medical ethicist," brother of Rahm, and thought to be a major designer of Obamacare.   Emanuel identifies what he sees as the problem:

Here is the specific problem: Insurance companies worry that young people, especially young men, already think they are invincible, and they are bewildered about the health-care reform in general and exchanges in particular. They may tune out, forego purchasing health insurance and opt to pay a penalty instead when their taxes come due.

Actually they're not "bewildered" at all, but rather completely rational and making the obvious and sensible decision.  But Emanuel has what he thinks is the solution:  an appeal to civic duty! 

[W]e need to make clear as a society that buying insurance is part of individual responsibility. If you don't have insurance and you need to go to the emergency room or unexpectedly get diagnosed with cancer, you are free- riding on others. Insured Americans will have to pay more to hospitals and doctors to make up for your nonpayment. The social norm of individual responsibility must be equated with purchasing health insurance.

Well, good luck with that.  Here's a little news for Mr. Emanuel:  The principle of "from each according to his abilities, to each according to his needs" does not work as a method of organizing affairs in human societies.  Also, that principle is the opposite of the principle of "individual responsibility."  So the idea of "equating" a massive wealth transfer from one group to another with "the principle of individual responsibility" is a ridiculous example of doublespeak.  Also, get over that "free riding" nonsense.  If Obamacare (and before it all kinds of other regulations and stupid tax treatment) did not make health insurance ludicrously overpriced for young people, they could and would buy it.  You're trying to scam them, and they are too smart to get taken in. 

Now why (as Mr. Emanuel points out) Obama won the 18-29 age cohort by a 23% margin, I cannot explain.  But I can predict with a great deal of confidence that when called upon to waste several thousand dollars a year each, year after year, in a supposed act of civic responsibility that is really a scam, they are just not that stupid.

Everything The Government Does Is A Form Of Advocacy For Its Own Expansion

From Washington comes the scandal du jour, ​this time that the IRS has targeted "conservative" groups, particularly those using the words "tea party" or "patriots" in their name, for special scrutiny, audits, and other harassment.  In March 2012, following complaints from such groups, the head of the IRS denied to Congress that such things were occurring.   On Friday May 10 Lois Lerner, head of the IRS tax-exempt-organizations division, admitted that it had occurred, and apologized for the conduct, calling it "absolutely inappropriate," but attributing it to low level workers.  Then over the weekend it came out that an upcoming report by the Inspector General of the Treasury Department was going to disclose  that higher ups knew that such targeting was going on as early as June 2011, nine months before the denial to Congress.  Today at a news conference, President Obama decided it was time to deflect the attention elsewhere, and went on record calling the conduct "outrageous."

​Is someone about to uncover the directive from the Obama White House to begin a campaign of tax audits of political enemies and opponents?  I doubt it.   This doesn't come from a particular directive.  This comes from the general overall no-need-to-mention-it-specifically directive, which is that the purpose of government is to always and everywhere advocate for its own protection and expansion.  Mickey Kaus at the Daily Caller calls it:

[Y]ou don’t need direct White House involvement to politicize the IRS, at least for Democrats.  The underlings know what to do! The idea that they are apolitical professionals was always a myth.

​Kaus titles his post "Memories," and helpfully lists, with the aid of a Judicial Watch filing, many of the entities and people revealed to have been subject to IRS audits during the Clinton years:

The National Rifle Association, The Heritage Foundation, The National Review, The American Spectator, Freedom Alliance, National Center for Public Policy Research, American Policy Center, American Cause, Citizens Against Government Waste, Citizens for Honest Government, Progress and Freedom Foundation, Concerned Women for America and the San Diego Chapter of Christian Coalition.

And don't forget this list of instantly-recognizable Clinton-era names: ​

Clinton paramours Gennifer Flowers and Liz Ward Gracen, sexual assault accusers Paula Jones and Juanita Broaddrick, and fired White House Travel Office Director Billy Dale.

​How do you justify engaging in this sort of behavior if you are an IRS functionary?  Easy.  You have the Democratic world view that government spending helps people and more government spending helps people more.  If a group is advocating more government spending to help the old, or the poor, or the homeless, or the children, then obviously that is a charitable purpose.  But a group advocating cutting government spending or shrinking the government?  Obviously that's political!  No tax-exempt treatment for that.  Although many press reports have described the IRS targets as being "conservative" groups, it was actually not just any conservative groups.  For example, groups that support "law and order," or that oppose abortion, are often referred to as conservative.  But those organizations were not the targets of these audits (as least as so far revealed).  Instead, the particular targets of these audits were groups whose main purpose is to advocate for decrease of government spending and shrinkage of the government.

​Kaus also links to David Brooks speaking on NPR last fall, just before the election, attempting to defend BLS bureaucrats who had just put out jobs numbers that were extremely helpful in the president's re-election efforts.  Brooks' take:

They're numbers geeks. They do their jobs. They go home. They're not that political. And I guarantee you the people in the BLS are totally committed to the numbers. If somebody tried to introduce politics in their work, there would be mass resignations and there would be a lot of calls to reporters at various institutions saying this is happening. So I guarantee you, I feel very strongly it's not happening.

He's probably narrowly right, but at the same time unbelievably naive.  Sure the bureaucrats who compile the numbers view themselves as "apolitical," with "apolitical" meaning going along with the universal consensus of Washington that government spending helps people and cutting it harms people.  The problem with the government numbers on virtually everything is not that they are fraudulently compiled within their defined parameters; the problem is that the parameters have been designed such that the numbers will inevitably be useful in the never-ending campaign for bigger government.  Thus GDP statistics are designed so that government spending is defined to increase the economy and cuts to government spending are defined to shrink the economy, even though that is a fallacy; and the poverty rate is designed so that it can never go down; and accounting for social Security and Medicare liabilities is designed to conceal the magnitude of those liabilities from the taxpayers; and so forth.​  The numbers may well be accurately compiled within their definitions, but the definitions are inherently deceptive and frankly, the people who compile them know that full well.

Priorities For The Next Mayor Of New York

Let's get back to why this blog is called Manhattan Contrarian.  The intellectual orthodoxy around here is really completely preposterous.  A couple of weeks ago I covered a forum for the mayoral candidates where the chosen topic of the sponsors was "environmental sustainability.," and where the candidates competed by one-upping each other for the most ridiculous ways to undermine the economy of our city.  Now the Association of the Bar of the City of New York, aka the City Bar, aka the club of the great and the good, has scheduled a mayoral forum for June 6 and, in advance of that, put out an 81 page report of recommended policies for the new mayor.  We'll review that in a minute.

But first, recall that I have had a few things to say already about priorities for the new mayor.  Far and away the number one priority must be dealing with the cost of pensions and other benefits for city workers.  That cost is not just out of control, but set to explode over the next several years, to increase by far more than any tax increases could hope to cover, and to crowd out all other spending priorities.​  For example here, in a post titled "The Mayoral Candidates Are In For A Rude Surprise" I predicted that "there is a very nasty surprise coming down the road for whoever is the next mayor, in the form of vastly increased pension contributions."  In another post titled "State And Local Government Financial Data Are Also A Problem" I did some calculations of the magnitude of the problem.

With that ​in mind, let's consider the City Bar report, available by following a link here.  First, because I know you're dying to know -- Do they even mention the problem of city worker pensions and benefits?  No.  Please, such issues are far beneath the great personnages of the City Bar.  Well, how about the fact that essentially all city workers are unionized and are working with long-expired contracts, refusing to deal with current Mayor Bloomberg, pouring money into the campaigns of the contenders and plotting to cut a deal with a new guy they have just put in office?  No, they don't even mention that either.

So what do they mention?  I'm not saying that I'm against every single one of their many dozens of proposals, but still, it is not an exaggeration to say that this is a complete left wing wish list, mostly not just stupid but also ridiculous.  Many of the proposals call for the expenditure of additional money without the slightest recognition that the money is already spent, let alone that somebody needs to do some prioritization here.​

Let's start with topic II, "Infrastructure, The Environment, And Emergency Preparedness."  You are thinking, they must be advocating for better water and sewers?  Puh-lease.  Topic "A" under Infrastructure is "Continue to Pursue an Ambitious Environmental Agenda," and has five sub-topics, every one of which is about committing the City government to fight the global warming dragon.  ​Continue to Advocate for Municipal, National and Global Action on Climate Change . . . Encourage and Empower New York City Residents and Commuters to Reduce their Carbon Footprint . . . .  Support Energy Efficiency and Renewable Energy . . . . etc., etc. 

How about topic III, Public Safety and Civil Liberties.  Well, the number one issue there is "Continue to Champion Gun Control Measures."  Among the pooh-bahs of the City Bar, the term "civil liberties" actually means the suppression of our Federal constitutional rights.  The pooh-bahs are also completely impervious to evidence that gun control does not work. 

Of course there is a long section on "Access to Justice," otherwise known as spending more money on lawyers, although the crass subject of money is not actually mentioned.  Instead we use soft euphemisms like "Support Initiatives to Decrease the Number of Unrepresented Litigants in Civil Cases."​  If I might suggest a response of a mayoral candidate to a question on this subject, it would be, "Hey, City Bar, that's your job."

Anyway, even as the people who ought to be our civic leaders are completely lost, Mike Bloomberg, for all his faults, has it right on this one.  Presenting his budget last week, Bloomberg warned that "The next mayor has to face the fact that our expenses keep going up . . . ."​  The other source that has it right is the New York Post.  Their lead editorial today is titled "Mayoral Math" and has some of the grim pension numbers.  Try this:

In 2002, for instance, the city shelled out just 34 cents on benefits for every buck it spent on salaries. A decade later, it was laying out 72 cents on the dollar, more than double. By next year, the figure is projected to balloon to 78 cents. At the fire and police departments, the cost of pension and benefits has already outstripped salaries.

An attached chart shows that we are already spending 116 cents on pension and benefits for every dollar spent on active firemen; for police the figure is 104 cents; for sanitation 88 cents; and so forth.  And all those percentages are set to jump to far higher levels based on formulas long agreed to and slowly doing their inevitable destruction through the system.​

I'd say I'm embarrassed by my colleagues at the City Bar, but they are not really my colleagues.  I have long refused to join that organization.  Very few of the big firm partners have followed my lead on that.​

Medical Insurance Is About Asset Protection, Not Health

Before I had this blog I used to talk (my wife would say "pontificate") about my theories to anyone who would listen.  In the health insurance debate leading up to Obamacare a few years ago, one of the points I would make endlessly was that "medical insurance is about asset protection, not health."  Of course, like my famous prediction in the 80s that Communism would shortly collapse, there is no written record of my saying this.  But I do have many witnesses.

Anyway, additional results from a major randomized study out of Oregon are just in, and to summarize the results in one short phrase:  medical insurance is about asset protection, not health.​

Whether medical insurance is about asset protection versus health is a big deal.  ​The argument justifying massive government intervention in health insurance is almost entirely about alleged improvement in health outcomes, as in "By refusing to allow government to provide health insurance for all, you are causing people to die!!!!!!!"  That argument goes away if the health outcomes for the insured and uninsured are basically the same.  A few people (most notably the execrable now Senator from Massachusetts Elizabeth Warren) have made the different argument that government has an interest in providing health insurance even if it is not about health, because lack of health insurance was causing millions of "medical bankruptcies."  But I never understood why that was a good argument for universal medical insurance -- if a person has substantial assets, such as large equity in a house, and chooses not to buy medical insurance, why exactly shouldn't he have to contribute that value to his own medical care before the taxpayers step in?  If you have substantial assets, by definition you can afford insurance to protect the assets.  If you are uninsurable, use your brain and don't keep major assets in your own name.

When I made my point about health insurance a few years ago, the main evidence cited against me was a large study from the Institute of Medicine in 2002 called "Care Without Coverage."   That study purported to show that lack of health insurance led to 18,000 additional deaths per year among the uninsured population.  When I got the Institute of Medicine study, it looked like so much hocus pocus.  There was no randomized trial, but rather a meta-analysis of some hundred or more studies in the medical literature.  There is extensive recognition in the report of numerous confounding factors that I would say make it impossible to come up with any number like the supposed 18,000 additional deaths from any study of this sort.  For example, the insured tend to be wealthier and more educated than the uninsured, and to smoke less.  How to weigh such factors in a study of this type is not a matter of statistics, but rather entirely a judgment call, here made by people who were clear advocates of universal health insurance.  But none of that slowed the authors down from making their highly politicized conclusion, and claiming the imprimatur of the IOM brand for their conclusions.  The report was not funded by the government, but rather by the Robert Wood Johnson Foundation.  That's the Johnsons of Johnson & Johnson -- do you think they might have any interest in increasing government spending on health care?

The run-up to Obamacare in 2009 then led to a frenzy of advocates putting out increasingly imaginary numbers as to the "additional deaths" among the uninsured.  A report from the Urban Institute in 2008 upped the IOM's number to 22,000 additional deaths per year.  If you look at their abstract, the result comes entirely from an assumption that the uninsured have a mortality rate 25% higher than the insured.  The basis for that?  They claim to rely on the IOM's previous hocus pocus.   In September 2009, as the Obamacare bill approached its end game in Congress, Harvard released a study purporting to estimate the additional annual deaths at 44,789.  Again, no randomized study.  This time it is based on an assumption of 40% increased risk of death among the uninsured.  Perhaps we should note that two of the three authors were co-founders of something called Physicians for a National Health Program.

Meanwhile, a guy named Richard Kronick, who had been a senior health policy advisor in the Clinton administration, and became chief of the division of Health Care Services at the Department of Family and Preventative Medicine at the University of California at San Diego, did his own careful review of the IOM's findings and published a paper in 2009.  His conclusion:  after adjusting for demographic and health factors (such as smoking), the uninsured were at no greater risk of dying earlier than people who had employer-sponsored group insurance.  I don't even remember coming across Kronick's study at the time.  As a former Clintonista, he clearly would not have minded coming to the opposite conclusion, and he should be congratulated for his honesty.  But he was drowned out by advocates making up their own numbers.​

Anyway, the world has been waiting for the results of an actual randomized controlled experiment.  (Actually, there was one previous randomized study, done by the Rand Corporation in the 70s.  It found no mortality benefit from health insurance according to Megan McArdle here.)  ​Recently Oregon has handed the world an opportunity for randomized study, in the form of a 2008 Medicaid expansion that was underfunded, so they allowed people into it by lottery.  Two years of data are now in, and the results of analysis of that data were published in the New England Journal of Medicine last week.  Conclusions:

This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.

​Hmmm.  "No significant improvements in measured physical health outcomes."  And as to that business of "reduced financial strain" -- do we get to count financial strain on the government here?  How many trillions are we spending on Obamacare again?

​As I said, medical insurance is about asset protection, not health.