By skyforbes 
By Hrayr Attarian, M.D.
A couple of months ago Idaho congressman Raul Labrador drew intense criticism because of his statement “Nobody dies because they don’t have access to healthcare”. This was uttered in defense of the American Health Care Act (AHCA) the legislation passed by the House to replace the Affordable Care Act (ACA or Obamacare) and in particular the AHCA’s deep cuts to the Medicaid program.
In late June, the senate Republicans recommended their version of health care reform called Better Care Reconciliation Act (BCRA). BCRA will also cut $772 billion from Medicaid programs nationwide. Most economically disadvantaged people depend on Medicaid for basic health care and the ACA had expanded Medicaid in a number of states. BCRA also will make it legal in some states for insurance companies to discriminate against people with preexisting conditions. In addition, according to the non-partisan Congressional Budget Office (CBO) the BCRA will leave 22 million more people without health insurance.
Although it does not look like the BCRA will become law, the threat to Medicaid is still active. The idea of allowing insurance companies to offer plans that do not cover preexisting conditions also remains alive and well.
Does Medicaid save lives? First let me illustrate the importance of Medicaid with the case of a bright 25-year-old advertisement executive who, for the sake of confidentiality, I shall call Rose. Rose had insurance through her employer during the pre-ACA days. Unfortunately, she started suffering from a disabling and painful condition called Scleroderma or hardening of the skin and, occasionally, some of the organs. She had to leave work and lost her coverage. When she tried to buy insurance on her own she was denied because of preexisting condition. Being unemployed and struggling with illness Rose relied on Medicaid for coverage. That was a good thing as she came down with tuberculosis and was only able to afford lifesaving medicine because of Medicaid.
Let us go beyond individual cases. A detailed review published in the prestigious Annals of Internal Medicine analyzed data from nine randomized clinical trials focusing on nonelderly adults. The authors report that in this population there was a definite link between being uninsured and dying with a hazard ratio of 1.40 (95% CI, 1.06 to 1.84). This means that those who were uninsured were 1.4 times more likely to die from their chronic illnesses than those who had health insurance.
There is also evidence from states who expanded their Medicaid programs. Researchers at Harvard School of Public Health compared three states (Arizona, New York and Maine) who increased Medicaid coverage to neighboring ones who did not. The result was a relative mortality reduction of 6.1% over 10 years in the states with more robust Medicaid coverage.
So the answer is clear. Increased coverage helps save lives ergo people do die because they don’t have access to healthcare. BCRA, or any version of it, will leave the most economically vulnerable Americans without coverage by gutting the Medicaid programs nationwide.
Is ACA perfect? Certainly not. There are still 28 million uninsured under ACA but the answer is not to increase this number to 40 million. In fact the answer is and has always been right in front of us. Single payer. Among the nations of the developed world the US has the lowest life expectancy and the highest per capita health care expenditure as well the highest percentage of uninsured residents.
Image is from the commonwealth fund.
For instance, with publically funded universal healthcare Australians are overall healthier than us and live longer, mean life expectancy of 83 years vs 78. Australia also spends less on healthcare than we do; $4115 per capita per year vs $9086.
Image from the Commonwealth Fund
There are many other countries, particularly in the developed world, that have demonstrated the effectiveness and viability of the single payer system. The reason I give the example of Australia is because our own president praised the Australian healthcare.
In conclusion providing affordable health care for everyone does not mean significantly underfunding Medicaid and increasing the number of the uninsured. It is creating a single payer program to provide health care, a fundamental human right, to all. And now is the time to do it.