Have You Heard the Joke? If You're Poor, You're Gonna Die

American health policy is to allow some people to die—guess who?

Posted Jul 26, 2012

Bobby Jindal announcing cuts in health care for the poor

It's funny that the very people who worry about "death panels"—which means essentially that the government will supervise the kinds of care provided and reimbursed based on the most effective disbursement of health care funding—seem prepared to allow people to die for want of health care.

A new study published in the online NEJM by researchers at the Harvard School of Public Health found that states in which Medicaid was extended to patients without children reduced their death rates by 6 percent relative to neighboring states that did not adopt the policy. To reduce a state's overall death rate by six percent, the target population (expanded Medicaid enrollees) would have reduced its annualized death rate by 30 percent. "This degree of risk reduction is consistent with the Institute of Medicine's estimate that health insurance may reduce adult mortality by 25%," the study noted.

Natural experiments like this one comparing the effects of policy initiatives in one state with nearby states have natural limitations—e.g., perhaps states which instituted the Medicaid expansion grew in wealth and this reduced the death rate for their poorer citizens. But, according to the lead researcher, Benjamin Sommers, “I can’t tell you for sure that this is a cause-and-effect relationship.  I can tell you we did everything we could to rule out alternative explanations.”

The study incidentally offers an explanation for why, compared with other wealthy countries like ours that have universal health care coverage, the United States as a whole suffers from an excessive death rate.* The gains in the NEJM study were found predominantly among nonwhites and in poorer counties—populations least likely to have adequate health care without government assistance. In other words, government spending on health care translates directly into saved lives for poorer Americans.

A principal part of the Obama Administration's Affordable Care Act extends Medicaid, beginning in 2014, in the same ways as the states that were studied in the NEJM. The recent Supreme Court decision on the Act, however, allowed states to opt out of the expansion, which a number of Republican governors have indicated they will do. One such governor is Louisiana's Bobby Jindal.  Jindal, an ardent Christian+, also announced steep cuts in the state's Medicaid program. Before these cuts, Louisiana is already at the bottom among states in terms of health care coverage and ranks 48th in both infant moratlity and premature death^.

All of this reminds me of a horrible sexist joke I once heard:

A woman whose husband was ill went with him to the doctor's office. After the visit, the doctor asked to speak to the woman.  The physician told her, "the only way your husband will survive is if you cook him a warm meal each night, then have sex with him."

On the ride home, her husband—unable to contain himself—finally asked his wife, "What did the doctor tell you?"

The woman turned slowly towards her husband and answered, "You're gonna die."

Needless to say, horrified, I immediately stalked from the dinner table at which this pathetic attempt at humor was perpetrated. I would have slapped the person telling the story, but it was a woman. By the way, to make the story worse, the woman in the "joke" was represented as coming from a specific ethnic group (the woman telling the story was actually a member of this group!)—a canard I won't repeat here—making the joke doubly offensive.

Here's how that "joke" goes in terms of American health care:

A poor man with diabetes visited a medical office alone. The doctor told him, "On a continuing case basis, my colleagues and I can prolong your life substantially.  Otherwise you won't survive."

When he got home, a friend asked him, "What did the doctor tell you?"

"You're gonna die."

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* American Mortality Profile

  • U.S. life expectancy (77.9 years) continues to fall short of that attained by a number of other countries, including Japan (82.7 years), Hong Kong (82.2), Iceland and Switzerland (81.8).
  • The risk of dying is 30% higher for the back population than for the white population.

+ Among his most notable religious activities, Jindal participated in an exorcism in college.

^ Health Care Facts, Louisiana

  • Infant Mortality – 48th
  • Premature Death – 48th
  • 2010's federal health reform, the Affordable Care Act (ACA), included the creation of a prevention fund to provide more than $16 billion over the next 10 years to invest in effective, proven prevention efforts, like childhood obesity prevention and tobacco cessation, and the site has a report on how it impacts Louisiana here. . . .Whooops!