13 ms·

An accidental experiment that saved 700 lives

96 points by luu 5y ago

dudeinjapan 5y ago
- deleted 5y ago
  [deleted]
- deleted 5y ago
  [deleted]
tantalor 5y ago
> made possible by an accident of budgeting Would this have been legal/ethical to do intentionally?
- gumby 5y ago
  Probably not, because how would you get consent from the test subjects without messing up the test?
johnorourke 5y ago
It's so very weird reading this as a UK citizen. It feels like reading about some kind of dystopian future. Despite the UK government's best efforts to the contrary, even the poorest in society can still access health care locally at no cost... except the hospital car parking fees, that's a killer.
- deleted 5y ago
  [deleted]
- zeristor 5y ago
  Not everyone has a car.
  - Beltalowda 5y ago
    Most (all?) hospitals are easily reachable by public transport. I've never had a car and never had trouble getting to a hospital when needed.
    - analog31 5y ago
      I got a ride to the hospital. The ambulance ride cost me $2000 out of pocket.
      - Beltalowda 5y ago
        I'm sorry to hear that, but that kind of thing is not an issue in the UK, or indeed, many parts of the world.
      - snovv_crash 5y ago
        I live in Switzerland. I had a skiing accident and got stretchered down to the main station, then an ambulance down the mountain to the hospital. Since at that point I hadn't filed my accident insurance claim yet, they sent the full bill to me. Want to know how much it was, in the land of $25 pizzas? Under $300. And of course, I forwarded it to my accident insurance, so my out-of-pocket was $0. Fix your system.
        vinay427 5y ago
        Also in Switzerland: an ambulance was called for me in the middle of Zurich, they arrived after driving only a few kilometers, performed an EKG, and didn’t transport me anywhere. I was billed over $700 for that, which I had to pay out-of-pocket as the theoretical 50% insurance coverage was below my deductible.
        merightnow 5y ago
        Most likely it didn’t have to pay any money because you either payed your full deductible for the year already, or most likely it was payed by the accident insurance and not the regular health insurance
- Terry_Roll 5y ago
  - justnodude 5y ago
- AussieWog93 5y ago
  Make sure you stay vigilant and keep fighting for the NHS. Our public healthcare in Australia has been slowly eroded over the past decade (if not longer), and I'm starting to wonder if the next generation will even be able to enjoy "full" coverage at all. This isn't propaganda or hyperbole. When my wife had a miscarriage earlier in the year, we were billed $150 for the privilege of being told we'd lost our child. This should not happen in Australia, but it did. Don't follow in our footsteps.
  - deleted 5y ago
    [deleted]
throw10920 5y ago
> Inside was a letter stating that they had recently paid a fine for not carrying health insurance What? The IRS can fine you for not having health insurance?
- dahfizz 5y ago
  Yes, it was called the Individual Mandate. It was a feature of Obamacare which was later repealed. https://www.healthinsurance.org/glossary/individual-mandate/ https://www.healthinsurance.org/glossary/individual-mandate/
- vinyl7 5y ago
  California has a fine for not having health insurance.
robocat 5y ago
From paper: “Of the 4.5 million households who met the criteria for inclusion in this pilot program, 3.9 million were randomly selected to receive the intervention.”, “The final sample consists of 4.5 million returns, corresponding to 8.9 million individuals.” Those in the treatment group were 1.3[1] percentage points more likely to enroll in coverage in the year following the intervention than those in the control group: about 50,000 extra households (~100,000 extra people) were signed up due to the letter. So, about 200 died because they didn’t receive the letter (But that was offset by the 8 billion lives that were saved by something else that didn’t happen that day.). [1] “those in the treatment group were 1.3 percentage points more likely to enroll in coverage in the year following the intervention than those in the control group, a 2.8% relative increase. On average, each letter increased coverage among this group by 0.14 months during 2017, or one additional year of coverage per 87 letters sent. We document larger effects among individuals who lacked any coverage during the prior year and among older non- elderly adults.” Edited: corrected numbers - mistook households for individuals.
- hackernewds 5y ago
  Not to be a nihilist, but 200 seems like a ridiculously and surprisingly low number for impact of such an expensive and broad program. Does it really validate what the author posits?
  - lavishlatern 5y ago
    Bear in mind nearly all of the people receiving letters should be <65. I quickly skimmed the paper and it seems like the authors don't have enough data to come up with a quality adjusted life-year type of statistic like the NHS uses.
  - LorenPechtel 5y ago
    Note that only those influenced to buy insurance would show any possible benefit.
  - robocat 5y ago
    On second thoughts, that should be 100: I stuffed up mixing households versus individuals. “The final sample consists of 4.5 million returns, corresponding to 8.9 million individuals. Individuals in the sample were randomly assigned to receive a letter (86%) or to a control group (14%). One letter, addressed to the taxpayer(s), was sent per return. Hence, randomization was conducted at the household level.” So 86% of 4.5 million households were sent a letter, and that led to a 1.3% percentage point increase in signups compared to the 14% of households that were not sent a letter. They are then saying that those 1.3% of extra signups led to saving ~700 lives. There is the risk of a selection bias because we don’t know why those extra 1.3% signed up versus those that didn’t. The actual paper uses months, since everyone dies, so zero lives can be saved in the long term.
knorker 5y ago
> the first rigorous experiment to find that health coverage leads to fewer deaths, a claim that politicians and economists have fiercely debated in recent years Living in Europe I must have missed this debate. Is it not self-evidently true? What are the arguments against it?
- BurningFrog 5y ago
  Most studies on the topic shows that having health insurance in the US doesn't impact people's health much or at all. Everyone agrees this is counterintuitive, but that's been the data so far. This study adds some weight to the other side.
  - autoexec 5y ago
    > Most studies on the topic shows that having health insurance in the US doesn't impact people's health much or at all. I can't speak to "most" having not seen all of them, but studies have shown it matters. https://www.theguardian.com/us-news/2017/jun/24/us-healthcare-republican-bill-no-coverage-death https://www.theguardian.com/us-news/2017/jun/24/us-healthcar... These came up a year later: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2323087/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2323087/ https://news.gallup.com/poll/268094/millions-lost-someone-couldn-afford-treatment.aspx https://news.gallup.com/poll/268094/millions-lost-someone-co... Seems there has been some prior evidence for supporting the idea that health insurance (the only way to get affordable healthcare in the US) matters. What are examples of studies that show it has little to no impact?
  - lostcolony 5y ago
    No no. They say -mortality- isn't affected. Like, people don't die more often without health insurance. There are all sorts of measured benefits of health insurance, quality of life, lower prevalence of medical debt, etc. It's just that a lack of it doesn't lead to people dying sooner. Which kind of makes sense; the cost even with insurance ensures people don't go to the doctor as often as they should, until something is concerning them. And if it is sufficiently concerning, even someone without insurance goes. And if it's going to prove lethal without treatment, even those without insurance will probably still get the treatment, since better to be alive and in debt the rest of their life than dead. Someone else linked https://en.wikipedia.org/wiki/Oregon_Medicaid_health_experiment https://en.wikipedia.org/wiki/Oregon_Medicaid_health_experim... and it's a good example; it calls out that those with coverage are less likely to have medical debt sent to a collecitons agency, which implies that those without coverage are still seeking treatment...they just are going into debt for it.
DoreenMichele 5y ago
Obamacare was likely the only politically viable solution at the time. I wish we would use it as a stepping stone to more comprehensive coverage for all US residents.
- darkerside 5y ago
  In retrospect, Obama seems to have made a terrible mistake with the Obamacare framework. He made the original sin of acquiescing that there would be no single payer, thereby relinquishing his only true leverage over an obstinate Senate clinging to a skin Democratic majority. The compromise was not a good one. It never made great sense for any of the parties. It was a victory of pragmatism over function, and no Republican voted for it anyway.
  - DoreenMichele 5y ago
    And yet now this accidental experiment exists because of Obamacare which settles a longstanding debate in the US as to whether healthcare coverage actually saves lives -- while Europeans go "Well, duh? Why was this ever a question?"
    - lostcolony 5y ago
      Yeah, but had he not compromised and instead just pushed through a single payer solution ("medicare for all"), it would have passed along the same lines, given us the same data, and have been harder for Republicans to gut since it would have given no individual mandate, or high priced low coverage marketplace plans, to attack.
      - ckw 5y ago
        He didn’t support a single payer system or a public option, he just made mouth noises to that effect. Look at the recent failure in California to bring a single payer bill to a vote, despite the Governor’s ostensible support and Democrats’ 75% super majority in the Senate. Perennial incompetence isn’t a plausible explanation; rank corruption is. Edit: to add a bit of evidence that Obama specifically is corrupt, here is an article titled ‘Barack Obama Got Paid $400,000 for a Speech to Health Care Execs. Here's What He Told Them’: https://money.com/barack-obama-speech-400000-health-care-conference/ https://money.com/barack-obama-speech-400000-health-care-con... How is that anything but a payoff?
windows2020 5y ago
- metacritic12 5y ago
  The pilot was randomized.
- mint2 5y ago
  Don’t wear seatbelts either huh?
  - CryptoPunk 5y ago
    Seeing how seatbelt laws and restaurant safety permits were used to justify COVID lockdowns shows why anti-libertarian ideology should not be given even an inch. Anti-libertarians will use that inch to take more and more of people's human rights, since in principle, there's no difference in mandating you use a seatbelt, and mandating that you stay in your home for three months.
    - mint2 5y ago
      Libertarians have beliefs like > “in principle, there's no difference in mandating you use a seatbelt, and mandating that you stay in your home for three months.” That is why there isn’t much anti-libertarian ideology unless it is redefined to be “anyone not buying all libertarian views” but instead what there actually are is a lack of people taking libertarian principles seriously because those are apparently things like seat belts equals arbitrary home confinement and also seem to be against seat belts and collective pandemic responses.
      - CryptoPunk 5y ago
        You have the same belief that you are now lampooning libertarians over. That is what your initial comment implied: >>Don’t wear seatbelts either huh? The implication here is that someone who on principle, opposes mandated health care, may as well oppose seatbelt laws. In fact I saw many proponents of mandates prohibiting private citizens from providing a wide range of services to unvaccinated people, cite society's acceptance of restaurant sanitary permits, to justify these mandates. So this belief - that there is no principled difference between any restriction on private interaction - appears to be widely held among anti-libertarians. >>That is why there isn’t much anti-libertarian ideology Anti-libertarian ideology is the belief that we as a society have a right to impose our will on peaceful people, and in doing so deny them the right to their person, property and liberty, for the greater good. To give a mundane example, it means restaurants having to meet mandatory minimum health standards, even if there are patrons who are willing to dine at restaurants which don't meet those standards. Once that principle is accepted, then anything can be accepted, even locking 150,000 elderly people in their room for over a year, for their own safety: https://www.cbc.ca/news/canada/toronto/long-term-care-covid-confinement-1.5969825 https://www.cbc.ca/news/canada/toronto/long-term-care-covid-... Or taxing people of 50 percent of their income.
Johnny555 5y ago
At the end of 2017, Congress passed legislation eliminating the health law’s fines for not carrying health insurance, a change that probably guarantees that the I.R.S. letters will remain a one-time experiment. I still get a form from my employer proving that I had health insurance, so even with a financial penalty there's no reason that the letters can't continue to be sent out to the uninsured to remind them of options.
anm89 5y ago
> The experiment, made possible by an accident of budgeting, is the first rigorous experiment to find that health coverage leads to fewer deaths, It, of course, does not prove this. It proves that within this specific set of circumstances, within the specifics of our current health care system, that increasing coverage lead to fewer deaths. You can't just automatically extrapolate that to health coverage in general.
- actually_a_dog 5y ago
  And there exists at least one field in Scotland in which there exists at least one sheep, at least one side of which is black. Look, this was literally a randomized controlled study of the entire US population. You know, the gold standard for generalizability. And what other point of comparison would possibly be relevant besides "the specifics of our current health care system?" What more do you want?
  - anm89 5y ago
    I'm not complaining about the study methodology. I'm just saying this isn't the right takeaway. Just because a study is randomized and has a good sample size doesn't automatically prove every hypothesis of the study. You have to actually look at what the data is saying and isn't saying. And nothing about this data says anything regarding some universal truth regarding the benefits of some universal thing called "health coverage".
    - actually_a_dog 5y ago
      Well, let's see: * More people obtained health insurance after receiving the letters than those who didn't. * Among the people who received a letter, fewer people died than those who didn't. * Since we're agreed that the study was properly randomized, there were no other differences between the treatment and control populations. What conclusion are we to draw, if not that having health insurance prevents deaths? Literally the only differences are that the treatment group got a letter, more of them purchased this thing which then existed called "health insurance" than in the control group, and fewer people in the treatment group died over the course of the study. Are you going to sit there and tell me that people who were already less likely to die went out and bought the thing that at the time of the study was called "health insurance" just because they got a letter? That doesn't pass the smell test. Are you trying to tell me that health insurance is somehow different now than it was before? Also doesn't pass the smell test. I am at a loss for what you are actually trying to say. Could you please just say it, rather than being oblique to the point of opacity about it?
mbac32768 5y ago
As a counterpoint, the Oregon Medicaid health experiment was also an RCT but found the opposite. https://en.wikipedia.org/wiki/Oregon_Medicaid_health_experiment https://en.wikipedia.org/wiki/Oregon_Medicaid_health_experim... > Approximately two years after the lottery, researchers found that Medicaid had no statistically significant impact on physical health measures, but "it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain."
- nautilius 5y ago
  How is that the opposite of "An accidental experiment that saved 700 lives"?
  - mbac32768 5y ago
    An intentional experiment that saved no lives?
- cryoz 5y ago
  I fear for things mostly managed in primary care like diabetes, hypertension, etc. the period of this study is just not long enough to get adequate amount of mortality data.
twoslide 5y ago
If you read the paper, it is not an accident at all. It was an intentional program where 14% of households fined under ACA received a letter to tell them how to enrol. A little sad the US Govt fined the rest but didn't provide this info to them.
lupire 5y ago
For folks in the "experiment", if health insurance had a 1 in 1600 chance of saving your live each year, but costs $10K/yr, is it worth it?
PaulHoule 5y ago
The point of the individual mandate was never that it was good for the individuals, but rather that it avoids ‘adverse selection’ where healthy people see the price and decide they can’t afford it but the mom with MS who has a kid with spinal deformation thinks ‘what a bargain!’
- phnofive 5y ago
  This is the same argument for any tax. Tollbooths, for example, have quantifiable deficiencies, but feel more fair... to some.
- drc500free 5y ago
  In the long run, it's trying to avoid the adverse selection death spiral where the price keeps rising to match the costs, and squeezing more people out of the pool.
- jimmaswell 5y ago
  Has this been happening now that it was eliminated? Costs seem the same as before for me.
  - ceejayoz 5y ago
    My premiums went up 10% this year, to over $2,400/month for the family.
    - labster 5y ago
      That’s normal inflation for health care.
      - deleted 5y ago
        [deleted]
    - robocat 5y ago
      For comparison, in New Zealand, assuming you are earning NZD180k (well into the top 1%[1]): Your taxes are about NZD70k in total. About $12k of that goes towards heath[2]. The most expensive family plan (2adults 3kids) to top up your cover (beyond the normal care everyone gets by the state) is NZD700 per month (the major health insurance provider in NZ[3]). [1] https://www.ird.govt.nz/about-us/tax-statistics/revenue-refunds/wage-salary-distributions https://www.ird.govt.nz/about-us/tax-statistics/revenue-refu... [2] https://www.treasury.govt.nz/information-and-services/financial-management-and-advice/revenue-and-expenditure https://www.treasury.govt.nz/information-and-services/financ... [3] https://join.southerncross.co.nz/quote https://join.southerncross.co.nz/quote

96 points by luu 5y ago

dudeinjapan 5y ago

deleted 5y ago
[deleted]
deleted 5y ago
[deleted]

tantalor 5y ago

> made possible by an accident of budgeting Would this have been legal/ethical to do intentionally?

gumby 5y ago
Probably not, because how would you get consent from the test subjects without messing up the test?

johnorourke 5y ago

It's so very weird reading this as a UK citizen. It feels like reading about some kind of dystopian future. Despite the UK government's best efforts to the contrary, even the poorest in society can still access health care locally at no cost... except the hospital car parking fees, that's a killer.

deleted 5y ago
[deleted]
zeristor 5y ago
Not everyone has a car.
- Beltalowda 5y ago
  Most (all?) hospitals are easily reachable by public transport. I've never had a car and never had trouble getting to a hospital when needed.
  - analog31 5y ago
    I got a ride to the hospital. The ambulance ride cost me $2000 out of pocket.
    - Beltalowda 5y ago
      I'm sorry to hear that, but that kind of thing is not an issue in the UK, or indeed, many parts of the world.
    - snovv_crash 5y ago
      I live in Switzerland. I had a skiing accident and got stretchered down to the main station, then an ambulance down the mountain to the hospital. Since at that point I hadn't filed my accident insurance claim yet, they sent the full bill to me. Want to know how much it was, in the land of $25 pizzas? Under $300. And of course, I forwarded it to my accident insurance, so my out-of-pocket was $0. Fix your system.
      - vinay427 5y ago
        Also in Switzerland: an ambulance was called for me in the middle of Zurich, they arrived after driving only a few kilometers, performed an EKG, and didn’t transport me anywhere. I was billed over $700 for that, which I had to pay out-of-pocket as the theoretical 50% insurance coverage was below my deductible.
      - merightnow 5y ago
        Most likely it didn’t have to pay any money because you either payed your full deductible for the year already, or most likely it was payed by the accident insurance and not the regular health insurance
Terry_Roll 5y ago
- justnodude 5y ago
AussieWog93 5y ago
Make sure you stay vigilant and keep fighting for the NHS. Our public healthcare in Australia has been slowly eroded over the past decade (if not longer), and I'm starting to wonder if the next generation will even be able to enjoy "full" coverage at all. This isn't propaganda or hyperbole. When my wife had a miscarriage earlier in the year, we were billed $150 for the privilege of being told we'd lost our child. This should not happen in Australia, but it did. Don't follow in our footsteps.
- deleted 5y ago
  [deleted]

throw10920 5y ago

> Inside was a letter stating that they had recently paid a fine for not carrying health insurance What? The IRS can fine you for not having health insurance?

dahfizz 5y ago
Yes, it was called the Individual Mandate. It was a feature of Obamacare which was later repealed. https://www.healthinsurance.org/glossary/individual-mandate/ https://www.healthinsurance.org/glossary/individual-mandate/
vinyl7 5y ago
California has a fine for not having health insurance.

robocat 5y ago

From paper: “Of the 4.5 million households who met the criteria for inclusion in this pilot program, 3.9 million were randomly selected to receive the intervention.”, “The final sample consists of 4.5 million returns, corresponding to 8.9 million individuals.” Those in the treatment group were 1.3[1] percentage points more likely to enroll in coverage in the year following the intervention than those in the control group: about 50,000 extra households (~100,000 extra people) were signed up due to the letter. So, about 200 died because they didn’t receive the letter (But that was offset by the 8 billion lives that were saved by something else that didn’t happen that day.). [1] “those in the treatment group were 1.3 percentage points more likely to enroll in coverage in the year following the intervention than those in the control group, a 2.8% relative increase. On average, each letter increased coverage among this group by 0.14 months during 2017, or one additional year of coverage per 87 letters sent. We document larger effects among individuals who lacked any coverage during the prior year and among older non- elderly adults.” Edited: corrected numbers - mistook households for individuals.

hackernewds 5y ago
Not to be a nihilist, but 200 seems like a ridiculously and surprisingly low number for impact of such an expensive and broad program. Does it really validate what the author posits?
- lavishlatern 5y ago
  Bear in mind nearly all of the people receiving letters should be <65. I quickly skimmed the paper and it seems like the authors don't have enough data to come up with a quality adjusted life-year type of statistic like the NHS uses.
- LorenPechtel 5y ago
  Note that only those influenced to buy insurance would show any possible benefit.
- robocat 5y ago
  On second thoughts, that should be 100: I stuffed up mixing households versus individuals. “The final sample consists of 4.5 million returns, corresponding to 8.9 million individuals. Individuals in the sample were randomly assigned to receive a letter (86%) or to a control group (14%). One letter, addressed to the taxpayer(s), was sent per return. Hence, randomization was conducted at the household level.” So 86% of 4.5 million households were sent a letter, and that led to a 1.3% percentage point increase in signups compared to the 14% of households that were not sent a letter. They are then saying that those 1.3% of extra signups led to saving ~700 lives. There is the risk of a selection bias because we don’t know why those extra 1.3% signed up versus those that didn’t. The actual paper uses months, since everyone dies, so zero lives can be saved in the long term.

knorker 5y ago

> the first rigorous experiment to find that health coverage leads to fewer deaths, a claim that politicians and economists have fiercely debated in recent years Living in Europe I must have missed this debate. Is it not self-evidently true? What are the arguments against it?

BurningFrog 5y ago
Most studies on the topic shows that having health insurance in the US doesn't impact people's health much or at all. Everyone agrees this is counterintuitive, but that's been the data so far. This study adds some weight to the other side.
- autoexec 5y ago
  > Most studies on the topic shows that having health insurance in the US doesn't impact people's health much or at all. I can't speak to "most" having not seen all of them, but studies have shown it matters. https://www.theguardian.com/us-news/2017/jun/24/us-healthcare-republican-bill-no-coverage-death https://www.theguardian.com/us-news/2017/jun/24/us-healthcar... These came up a year later: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2323087/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2323087/ https://news.gallup.com/poll/268094/millions-lost-someone-couldn-afford-treatment.aspx https://news.gallup.com/poll/268094/millions-lost-someone-co... Seems there has been some prior evidence for supporting the idea that health insurance (the only way to get affordable healthcare in the US) matters. What are examples of studies that show it has little to no impact?
- lostcolony 5y ago
  No no. They say -mortality- isn't affected. Like, people don't die more often without health insurance. There are all sorts of measured benefits of health insurance, quality of life, lower prevalence of medical debt, etc. It's just that a lack of it doesn't lead to people dying sooner. Which kind of makes sense; the cost even with insurance ensures people don't go to the doctor as often as they should, until something is concerning them. And if it is sufficiently concerning, even someone without insurance goes. And if it's going to prove lethal without treatment, even those without insurance will probably still get the treatment, since better to be alive and in debt the rest of their life than dead. Someone else linked https://en.wikipedia.org/wiki/Oregon_Medicaid_health_experiment https://en.wikipedia.org/wiki/Oregon_Medicaid_health_experim... and it's a good example; it calls out that those with coverage are less likely to have medical debt sent to a collecitons agency, which implies that those without coverage are still seeking treatment...they just are going into debt for it.

DoreenMichele 5y ago

Obamacare was likely the only politically viable solution at the time. I wish we would use it as a stepping stone to more comprehensive coverage for all US residents.

darkerside 5y ago
In retrospect, Obama seems to have made a terrible mistake with the Obamacare framework. He made the original sin of acquiescing that there would be no single payer, thereby relinquishing his only true leverage over an obstinate Senate clinging to a skin Democratic majority. The compromise was not a good one. It never made great sense for any of the parties. It was a victory of pragmatism over function, and no Republican voted for it anyway.
- DoreenMichele 5y ago
  And yet now this accidental experiment exists because of Obamacare which settles a longstanding debate in the US as to whether healthcare coverage actually saves lives -- while Europeans go "Well, duh? Why was this ever a question?"
  - lostcolony 5y ago
    Yeah, but had he not compromised and instead just pushed through a single payer solution ("medicare for all"), it would have passed along the same lines, given us the same data, and have been harder for Republicans to gut since it would have given no individual mandate, or high priced low coverage marketplace plans, to attack.
    - ckw 5y ago
      He didn’t support a single payer system or a public option, he just made mouth noises to that effect. Look at the recent failure in California to bring a single payer bill to a vote, despite the Governor’s ostensible support and Democrats’ 75% super majority in the Senate. Perennial incompetence isn’t a plausible explanation; rank corruption is. Edit: to add a bit of evidence that Obama specifically is corrupt, here is an article titled ‘Barack Obama Got Paid $400,000 for a Speech to Health Care Execs. Here's What He Told Them’: https://money.com/barack-obama-speech-400000-health-care-conference/ https://money.com/barack-obama-speech-400000-health-care-con... How is that anything but a payoff?

windows2020 5y ago

metacritic12 5y ago
The pilot was randomized.
mint2 5y ago
Don’t wear seatbelts either huh?
- CryptoPunk 5y ago
  Seeing how seatbelt laws and restaurant safety permits were used to justify COVID lockdowns shows why anti-libertarian ideology should not be given even an inch. Anti-libertarians will use that inch to take more and more of people's human rights, since in principle, there's no difference in mandating you use a seatbelt, and mandating that you stay in your home for three months.
  - mint2 5y ago
    Libertarians have beliefs like > “in principle, there's no difference in mandating you use a seatbelt, and mandating that you stay in your home for three months.” That is why there isn’t much anti-libertarian ideology unless it is redefined to be “anyone not buying all libertarian views” but instead what there actually are is a lack of people taking libertarian principles seriously because those are apparently things like seat belts equals arbitrary home confinement and also seem to be against seat belts and collective pandemic responses.
    - CryptoPunk 5y ago
      You have the same belief that you are now lampooning libertarians over. That is what your initial comment implied: >>Don’t wear seatbelts either huh? The implication here is that someone who on principle, opposes mandated health care, may as well oppose seatbelt laws. In fact I saw many proponents of mandates prohibiting private citizens from providing a wide range of services to unvaccinated people, cite society's acceptance of restaurant sanitary permits, to justify these mandates. So this belief - that there is no principled difference between any restriction on private interaction - appears to be widely held among anti-libertarians. >>That is why there isn’t much anti-libertarian ideology Anti-libertarian ideology is the belief that we as a society have a right to impose our will on peaceful people, and in doing so deny them the right to their person, property and liberty, for the greater good. To give a mundane example, it means restaurants having to meet mandatory minimum health standards, even if there are patrons who are willing to dine at restaurants which don't meet those standards. Once that principle is accepted, then anything can be accepted, even locking 150,000 elderly people in their room for over a year, for their own safety: https://www.cbc.ca/news/canada/toronto/long-term-care-covid-confinement-1.5969825 https://www.cbc.ca/news/canada/toronto/long-term-care-covid-... Or taxing people of 50 percent of their income.

Johnny555 5y ago

At the end of 2017, Congress passed legislation eliminating the health law’s fines for not carrying health insurance, a change that probably guarantees that the I.R.S. letters will remain a one-time experiment. I still get a form from my employer proving that I had health insurance, so even with a financial penalty there's no reason that the letters can't continue to be sent out to the uninsured to remind them of options.

anm89 5y ago

> The experiment, made possible by an accident of budgeting, is the first rigorous experiment to find that health coverage leads to fewer deaths, It, of course, does not prove this. It proves that within this specific set of circumstances, within the specifics of our current health care system, that increasing coverage lead to fewer deaths. You can't just automatically extrapolate that to health coverage in general.

actually_a_dog 5y ago
And there exists at least one field in Scotland in which there exists at least one sheep, at least one side of which is black. Look, this was literally a randomized controlled study of the entire US population. You know, the gold standard for generalizability. And what other point of comparison would possibly be relevant besides "the specifics of our current health care system?" What more do you want?
- anm89 5y ago
  I'm not complaining about the study methodology. I'm just saying this isn't the right takeaway. Just because a study is randomized and has a good sample size doesn't automatically prove every hypothesis of the study. You have to actually look at what the data is saying and isn't saying. And nothing about this data says anything regarding some universal truth regarding the benefits of some universal thing called "health coverage".
  - actually_a_dog 5y ago
    Well, let's see: * More people obtained health insurance after receiving the letters than those who didn't. * Among the people who received a letter, fewer people died than those who didn't. * Since we're agreed that the study was properly randomized, there were no other differences between the treatment and control populations. What conclusion are we to draw, if not that having health insurance prevents deaths? Literally the only differences are that the treatment group got a letter, more of them purchased this thing which then existed called "health insurance" than in the control group, and fewer people in the treatment group died over the course of the study. Are you going to sit there and tell me that people who were already less likely to die went out and bought the thing that at the time of the study was called "health insurance" just because they got a letter? That doesn't pass the smell test. Are you trying to tell me that health insurance is somehow different now than it was before? Also doesn't pass the smell test. I am at a loss for what you are actually trying to say. Could you please just say it, rather than being oblique to the point of opacity about it?

mbac32768 5y ago

As a counterpoint, the Oregon Medicaid health experiment was also an RCT but found the opposite. https://en.wikipedia.org/wiki/Oregon_Medicaid_health_experiment https://en.wikipedia.org/wiki/Oregon_Medicaid_health_experim... > Approximately two years after the lottery, researchers found that Medicaid had no statistically significant impact on physical health measures, but "it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain."

nautilius 5y ago
How is that the opposite of "An accidental experiment that saved 700 lives"?
- mbac32768 5y ago
  An intentional experiment that saved no lives?
cryoz 5y ago
I fear for things mostly managed in primary care like diabetes, hypertension, etc. the period of this study is just not long enough to get adequate amount of mortality data.

twoslide 5y ago

If you read the paper, it is not an accident at all. It was an intentional program where 14% of households fined under ACA received a letter to tell them how to enrol. A little sad the US Govt fined the rest but didn't provide this info to them.

lupire 5y ago

For folks in the "experiment", if health insurance had a 1 in 1600 chance of saving your live each year, but costs $10K/yr, is it worth it?

PaulHoule 5y ago

The point of the individual mandate was never that it was good for the individuals, but rather that it avoids ‘adverse selection’ where healthy people see the price and decide they can’t afford it but the mom with MS who has a kid with spinal deformation thinks ‘what a bargain!’

phnofive 5y ago
This is the same argument for any tax. Tollbooths, for example, have quantifiable deficiencies, but feel more fair... to some.
drc500free 5y ago
In the long run, it's trying to avoid the adverse selection death spiral where the price keeps rising to match the costs, and squeezing more people out of the pool.
jimmaswell 5y ago
Has this been happening now that it was eliminated? Costs seem the same as before for me.
- ceejayoz 5y ago
  My premiums went up 10% this year, to over $2,400/month for the family.
  - labster 5y ago
    That’s normal inflation for health care.
    - deleted 5y ago
      [deleted]
  - robocat 5y ago
    For comparison, in New Zealand, assuming you are earning NZD180k (well into the top 1%[1]): Your taxes are about NZD70k in total. About $12k of that goes towards heath[2]. The most expensive family plan (2adults 3kids) to top up your cover (beyond the normal care everyone gets by the state) is NZD700 per month (the major health insurance provider in NZ[3]). [1] https://www.ird.govt.nz/about-us/tax-statistics/revenue-refunds/wage-salary-distributions https://www.ird.govt.nz/about-us/tax-statistics/revenue-refu... [2] https://www.treasury.govt.nz/information-and-services/financial-management-and-advice/revenue-and-expenditure https://www.treasury.govt.nz/information-and-services/financ... [3] https://join.southerncross.co.nz/quote https://join.southerncross.co.nz/quote