Do you support the
compromises made to put together this year’s state budget? Would you
support them if you knew they will cause people to die? Statistically
speaking, one cut is likely to cause as many as 30 deaths over the next few
years.
The problem with
discussions of the state budget is that they’re usually conducted in the
abstract. We talk about budget numbers and cutting a little here and moving
this number into that column and it’s all rather academic and somewhat
bloodless. To make it a little less bloodless, I’d like to look at just
one number and see what it really means. And since we’re talking about
blood, let’s look at the Medicaid cut.
As was reported here, the Finance Committee’s budget drops Medicaid
coverage for about 6,500 parents to save a bit more than $4 million. The
deal is that these are people whose incomes are between 133% and 175% of the
Federal poverty line, or $25,975 to $34,177.
Their children will
continue to receive health care through Medicaid and RIte
Care, but these parents will have to buy insurance on the new Health
Benefits Exchange, part of Obamacare.
There is a federal
subsidy available, that will keep the monthly costs down to $100-150/month, but
each person will be liable for out-of-pocket medical costs expected to average
around $2,000 per year. There’s a good summary here.
So, now to the math:
someone who earns $26,000 each year will see an increase in monthly payments
equal to a little more than half a month’s gross pay per year, plus
out-of-pocket costs. If he or she is healthy, maybe that’s all. But
if there’s an illness or injury, we’re looking at an additional month’s pay in
medical costs.
So how would you feel
to know that your salary next year is going to be short 1.5 months gross over
this year? In fairness, the House budget includes $500,000 to provide
some subsidy. More math: $500,000 divided by 6,500 is about eight cents
short of $77. That will surely help.
Still more math:
According to a 2008 study by the Urban Institute, using numbers from
the Census Bureau and the Institute of Medicine, about 137,000 people died
between 2000 and 2006 from a lack of insurance. These are estimated
excess deaths due to late or skipped treatments for disease and injury, or
missed diagnoses. This is a mortality rate of a bit less than half a
percent for the uninsured.
Unfortunately, 6,500
is a fairly big number. A bit less than half a percent of that still
comes up a bit more than 30 people. If none of those 6,500 get insurance,
or if they forego treatment because of its expense, we can expect about 30
people to die in the next few years as a result of this change in policy.
Presumably lots of
them will get coverage, but I doubt that all will. If as many as 29
people out of 30 — 6,283 out of 6,500 — manage to scrape up enough to pay for
health insurance and also pay for all the doctor
visits they might have used under Medicaid, there will still be one death.
In other words, we can
reasonably expect that people will die because of the House Finance vote last
Tuesday. Thank you, Helio Melo and Gordon Fox.
Ok, so this is not a
large number of deaths in the grand scheme of state business (unless it happens
to be you, of course), but the point of doing a study like the Urban
Institute’s is that mortality is just the readily countable tip of the iceberg,
and that for each preventable death, we can expect a great deal of pointless
suffering from untreated chronic conditions, illness, and injuries.
This is what’s so
infuriating about what passes for debate on the state budget around here.
Because the legislative leadership has so thoroughly assimilated the idea
that the only way to conduct state business is simply to do what business wants
— tax policy, education policy, health care, whatever — it seems impossible to
construct an argument in favor of something as simple as preventing death and
suffering.
Sometimes it seems the
only effective way forward is to argue in terms of cost-benefit analyses and
advancing the state’s economy. But in fact, sometimes things must be done
simply because they are the right thing to do, and other things must be
condemned because they are not. What kind of state do you want to live
in?
So next time you hear
someone saying how important it is that we pay back all our bonds, even the
ones borrowed to fund stupid insider deals, don’t ask “is this important?”
Ask, “Is this more important than the death and suffering of some poor
people?”
Is cutting the sales
tax on liquor to improve sales in liquor stores near Massachusetts more
important than the death and suffering of poor people? How about letting
businesses accelerate depreciation? Is preserving all the tax cuts rich
people got between 1997 and 2010 more important than that death and suffering? See
how much clearer it gets?
Needless to say,
people will object to having their budget choices portrayed in this manner, but
do you sympathize with them, or with the poor people who will not get decent
health care here, in what is still among the richest countries on earth?
Tom Sgouros is a freelance
engineer, policy analyst, and writer. Reach him at ripr@whatcheer.net.
Buy his book, "Ten Things You Don't Know About Rhode Island" at whatcheer.net. - See more at: http://www.rifuture.org/rite-care-cuts-could-prove-to-be-killer.html#sthash.dwbMLNbH.dpuf