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Worse Than War: Deaths from Uninsurance

'We're not done with health care reform yet'

Johnathon Ross

A recently released Census Bureau report reveals that 48.6 million Americans lack health insurance.

We know that being uninsured is dangerous to your physical and fiscal health. Research has shown that for every million uninsured, 1,000 preventable deaths occur due to untreated or undiagnosed illness.

This means 48,000 Americans will die needless deaths this year. To put this in perspective, that’s about the same number of U.S. combat deaths in Vietnam War over a decade.

President Obama and the Democrats fought to get the Affordable Care Act (ACA) passed. This was a remarkable political achievement. For 100 years, American presidents have tried to achieve health system reform. The last significant achievement was the passage of Medicare in 1965. Since then political deadlock has allowed only minor tinkering.

Sadly, the ACA is not remarkable as a policy success. Reform should have been modeled on our successful Medicare program. Instead, the ACA was modeled on the reforms passed by Mitt Romney in Massachusetts.

Massachusetts did expand coverage, as will the ACA, but the Bay State’s reforms, which rely on subsidies for the mandatory purchase of private insurance, have left 200,000 people uninsured to this day, six years later. Costs in Massachusetts have soared and continue to be the highest per capita in the world.

Fully implemented, the ACA will still leave 30 million uninsured in 2022, according to the Congressional Budget Office. That figure may climb even higher if more states decide to turn down federal Medicaid dollars, which several governors have said they may do.

But assuming all goes ahead as planned, 10 years from now we will still see about 30,000 of our friends, neighbors and family members die avoidable deaths from lack of coverage.

Keep in mind these sobering statistics do not account for the terrible suffering and disability that results when treatable illness is allowed to progress untreated, even if it does not result in death. This suffering is unmeasured.

During the debate over the ACA, a different type of reform – an improved and expanded Medicare for all – was shut out of the discussion despite popular support for this approach and despite multiple federal and state-based studies showing that the administrative cost savings from such a program would save about $400 billion yearly. Those savings would be enough to cover all the uninsured, improve benefits for all, and eliminate most out-of-pocket health spending for everyone.

As with the ACA, an improved Medicare for all would have no pre-existing condition exclusions and no lifetime limits for those with chronic conditions. Unlike the ACA, you could go to the doctor or hospital of your choice.

Under our current arrangements, dominated as they are by private health insurance companies and giant, for-profit pharmaceutical companies, we know that medical bills are responsible for over half of personal bankruptcies.

This financial suffering is passed along to all of us as bad debt and these costs are a drag on the economy. The ACA may reduce these bankruptcies somewhat, although in Massachusetts, the model for the ACA, the rate of medical bankruptcies hasn’t changed much at all.

By contrast, under an improved Medicare for all, medical bankruptcies would be a thing of the past. Patients would benefit by having ready access to comprehensive, high-quality care with no more co-pays and deductibles.

Businesses would benefit by being relieved of all the administrative burdens of our dysfunctional insurance system, a source of high costs and endless headaches. Physicians would benefit by being free of insurance company meddling and would be able to return to what they know best – caring for patients.

An improved and expanded Medicare for all will save money that can relieve the deficit. It will be good for business and the economy. It will save lives and relieve suffering.

As far as health reform goes, we are not done yet.

Our work is licensed under Creative Commons (CC BY-NC-ND 3.0). Feel free to republish and share widely.

Johnathon Ross

Johnathon Ross, M.D., M.P.H., is past president of Physicians for a National Health Program and an executive committee member of the Single Payer Action Network in Ohio (

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