Joe Lieberman, Mass Murderer?

So insinuates the Washington Post’s Ezra Klein, who writes that, because Sen. Joe Lieberman (I-CT) does not support the health care legislation forwarded by Senate Democrats, Lieberman “seems willing to cause the deaths of hundreds of thousands of people in order to settle an old electoral score.”

In a subsequent post, Klein relies on the Institute of Medicine’s methodology – which has been used to estimate that 22,000 Americans die each year from lack of insurance – to conclude that the Senate bill would save 150,000 lives over 10 years.  He further claims that “Medicare saved lives.”  (In fairness, Klein writes that he’s not accusing opponents of murder.  When he writes of Lieberman’s willingness to cause hundreds of thousands of deaths, maybe he’s thinking of mass negligent homicide. Or something.)

On Twitter, Klein writes, “People are oddly resistant to talking about the impact of [health care reform] on lives. Do they think insurance has no connection to mortality?”

Indeed, health insurance does have a connection to mortality.  But I’m pretty sure Klein doesn’t know what it is, mostly because people with more expertise and fewer axes to grind don’t know what it is.

For example, a careful study by health economists Amy Finkelstein and Robin McKnight found that in its first 10 years, Medicare had no discernible impact on elderly mortality rates.  The authors hypothesize that prior to Medicare, seniors who lacked coverage largely got the care that they needed either by paying out of pocket or relying on public or private charity.  Whether Medicare had any impact on elderly mortality after its first 10 years remains an open question.

Or consider a study by Richard Kronick, a professor of family and preventive medicine at U.C.-San Diego and a former health policy adviser to the Clinton administration.  Kronick performed the largest-ever study on the health effects of being uninsured and concludes that the IOM estimate “is almost certainly incorrect.”  Kronick concludes that “the best available evidence” suggests “there would not be much change in the number of deaths in the United States as a result of universal coverage.”

How can that be, when Ezra Klein finds his own argument so “intuitive”?  Kronick admits “it is not clear” why the data produce such a counterintuitive result, but posits that existing channels “may provide ‘good enough’ access to care for the uninsured to keep their mortality rate similar to that of the insured.”

Economists Helen Levy of the University of Michigan and David Meltzer of the University of Chicago surveyed the entire economics literature on the connection between health insurance and health.  They conclude, “The central question of how health insurance affects health, for whom it matters, and how much, remains largely unanswered at the level of detail needed to inform policy decisions.”

Sarah Palin’s “death panels” claim had far more credibility than Klein’s slander of Joe Lieberman, which, incidentally, also slanders anyone else who opposes the Senate bill.  If there be justice in the world, that slander will backfire.

(Cross-posted at Politico’s Health Care Arena.)