Debunking the 100,000 Medicaid Deaths Myth

Partisan pundits are misreading statistical estimates and misrepresenting the science to suggest that Trump's Medicaid cuts will kill 100,000 people. That claim doesn’t survive scrutiny.

By Aaron Brown. Excerpts:

"Wyse and Meyer only show one side of the ledger—the reduction in mortality among people who gain Medicare eligibility. On the other side are the statistical lives lost from the people the money is taken from, or the programs cut."

"Counting statistical lives saved or lost is a debased currency, because it counts each actual life multiple times. And citing only the good side of the ledger makes it impossible to evaluate.

When New York Times readers are told that "the expansion of Medicaid has saved more than 27,000 lives since 2010," they are misled into imagining 27,000 people who would be dead if it weren't for the Medicaid expansion—27,000 actual lives saved."

"The 95 percent "confidence interval" reported by Myer and Wyse ranged from 4,500 to 50,000 statistical lives saved." 

"the authors lost track of over 400,000 people in their sample, 14 percent of the total, and had to guess whether they lived or died. The uncertainty from that guess is not reflected in the width of the 95 percent interval. They assumed that no one moved to another state or moved out of the income range for expanded Medicaid eligibility. They had to estimate from historical trends what the mortality rate would have been without Medicaid expansion." 

"Turning attention to the negative side of the ledger, after the Medicaid expansion, total expenditures increased by more than $1 trillion. That spending also costs statistical lives, because the same money could have been allocated to other potentially lifesaving programs, such as vaccinations, suicide prevention, mental health services, drug treatment facilities, screening for cardiovascular risk factors, and replacing old cars with newer, less polluting and safer models."

"Medicaid expansion may not have been a cost-effective way to reduce mortality, as a large share of health care spending is not targeted toward saving lives. Think of all your medical bills, including the ones insurance paid, and ask how many were for matters of life or death. Most likely, you purchased health care for symptom relief, a speedier recovery, an improved quality of life, and preventative care.

The lifesaving medical measures with the biggest impact, such as vaccinations and antibiotics, are relatively cheap. The Medicaid expansion may have relieved financial stress and made the program's beneficiaries more physically comfortable, which are better criteria for evaluating its impact."

"If Medicaid expansion had saved 100,000 lives over 10 years, it would have been easily obvious without careful statistical work. That would mean a cost of over $10 million per statistical life saved, when there are far cheaper ways to save statistical lives, and extracting $10 million from taxpayers or other programs could easily cost more than one statistical life."