Notes and calculations on deaths from political neglect

Showing my work: how I did the math.

I have a new essay about the number of deaths that take place every day in this country because of our political decisions – including, but not limited to, our decision not to make health insurance (and full coverage) available to everyone. That piece includes a number of calculations that I didn’t want to spell out in the essay itself, because I felt it would interrupt the flow. (I probably included too many numbers as it is.)

Here are the calculations and relevant citations:

First, I applied the excess mortality rate of 1.25 for uninsured adults under the age of from this analysis to the total number of uninsured people in this country (pre- and post-ACA). It gave me a pre-ACA rate of slightly more than 45,000 deaths per year, which was virtually identical to another study (Woolhandler and Himmelstein, 2009). Since there are mitigating circumstances, and since that paper resulted in (very slightly) lower death rates, I adjusted my findings accordingly.

I then adjusted my rates accordingly to account for the reduced uninsurance rate post-ACA. Many of the uninsured could conceivably be younger and healthier, but others will come from lower-income populations with higher morbidity rates, so I assumed the overall rate would be unchanged. That seemed to be confirmed by other findings, so I went with it. Then I divided by days, hours, etc., assuming that the deaths occur at a fairly regular rate throughout the day.

The UN Special Rapporteurs’ report included many causes of child death, some of which will almost certainly have changed over time. For that reason, I did not emphasize its findings as strongly as I did the deaths caused by uninsurance. (My commentary on the report is here.)

As I say in the piece itself, we lack good data on death rates from under-insurance, but it is a significant issue in OECD comparative health surveys and in other polling.

Other notes and references:

From the Kaiser Family Foundation:

“The number of uninsured nonelderly individuals dropped from more than 46.5 million in 2010 to fewer than 26.7 million in 2016 before climbing to 28.9 million individuals in 2019 ... In 2019, 28.9 million nonelderly individuals were uninsured, an increase of more than one million from 2018 ... The number of uninsured nonelderly individuals dropped from more than 46.5 million in 2010 to fewer than 26.7 million in 2016 before climbing to 28.9 million individuals in 2019.”

https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/

The number of uninsured rose to 30 million in 2020:

https://aspe.hhs.gov/system/files/pdf/265041/trends-in-the-us-uninsured.pdf

One in three Covid-19 deaths linked to coverage problems:

https://familiesusa.org/wp-content/uploads/2021/03/2021-37_Loss-of-Lives_Report_AnalysisStyleB_Final.pdf