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The Affordable Care Act: The Death Argument

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This is a quick one. On the Ed Schultz show on August 9th, Jonathan Alter and Michael Kinsley joined Ed to give their views on the Joe Soptic Ad from Priorities USA Action and the Republican reaction to it. Kinsley thinks the Ad is not dishonest, because to paraphrase him closely, when you lay off hundreds of people and take away their health insurance, it’s a matter of statistics, that a certain number of people will die as a result.

Alter says that Romney will repeal the ACA if the Rs pass the legislation, the first week of his Presidency, and that as Michael indicated “repeal equals death. It’s a simple fact.” If you don’t have insurance you won’t get care and thousands of people will die. Kinsley added, if we don’t go through with Obamacare, then there’ll be deaths without panels. And Alter finished: we’re not calling Romney a murderer, but we are saying that if he’s elected, and goes through with repeal, then thousands will die.

Alter and Kinsley think that’s the issue raised by the Soptic Ad and that the reason why the Ad is honest is because it raises that very real issue about the consequences of the decisions Romney made, and those he may shortly make if he is elected. Kinsley goes on to point out that Romney’s decisions made may have been the right ones; but that Romney doesn’t argue that point; and that this fits his pattern with other issues. That is, he runs away from them, tries to bury them, and won’t discuss his actions, his performance, or his responsibility for the results in the public debate. Kinsley labels this pattern of Romney’s “a tic” of his, to which I might add that it is certainly an undemocratic “tic” in someone who wants to lead a democracy.

I think the two of them are right in what they say; but I couldn’t help thinking back to the great health care debate of 2009-2010 and the decisions made by the President and the Democratic Party to take Medicare for All, the public option, and various Medicare extensions to different age groups off the table in the process of arriving at the final form of the ACA. In 2009, the number of annual fatalities due to lack of insurance was estimated from survey data gathered by Himmelstein and Woolhandler at roughly 1,000 per million uninsured. This projected out to about 45,000 fatalities annually before the passage of any reform since 45,000,000 Americans were without insurance then.

When the bill was being debated, I pointed out that passage of it would, making certain assumptions about population growth, and the number of people who would not comply with the mandate, still leave 267,000 fatalities due to lack of insurance by 2019. At the time I doubted that what became the ACA would really insure 31,000,000 people per year as estimated by its supporters and that the short fall plus population growth in the US would still leave that 267,000 to die due to the inadequacy of the bill, and the decision of the President and other Democrats to give up on Medicare for All and take the steps that would have been necessary to pass it, such as using the constitutional option on the filibuster, or just passing it through reconciliation even if it was not deficit neutral.

We are now 3 years into the period beginning with the time when Medicare for All could have been passed by a militant Democratic Party. We are 2.5 years into the period when the Medicare for All Bill could have been made effective. During this period more and more Americans have lost health insurance and a reasonable estimate today is that there are now roughly 55,000 fatalities per year occurring because Medicare for All was not passed when it might and should have been.

In addition, the possibility looks very good that only about half of the 18 or so million additional people expected to be covered under Medicaid will actually be covered because Republican governors are likely to refuse to implement the ACA in their States. This suggests that the previous estimates anticipating 31,000,000 covered by the ACA will shrink to 22,000,000 by 2014 – 2015 and may remain there even if the bill is not repealed.

Continued population growth is likely to produce 60 – 65 million minus the 22 million covered or 38 – 43,000,000 still uncovered by the ACA as we approach 2019. So, it’s beginning to look as if my previous estimate of 267,000 total fatalities may be a substantial underestimate of the fatalities which are occurring and will occur because the Administration passed on Medicare for All.

Kinsley, and Alter and others may disagree with this analysis, saying it was impossible to pass Medicare for All in early 2009. But the proof of impossibility isn’t there. We know that the Democrats had the authority to end the filibuster in January of 2009 if they wished. We also know that if the President had wanted Medicare for All, a majority vote, or a vote of 50 Democratic Senators plus Joe Biden would very likely have given the President what he wished in the Spring of 2009, before there was ever a tea party to contend with, and when the Democrats in Congress were very much enamored of him. There then would have been no tea party and no bailout of the insurance companies, and likely no Democratic defeat in the elections of 2010 at all.

So, Washington villagers like Kinsley, and Alter can claim impossibility all they want. But they cannot prove impossibility. All we really know is that the President and the Democrats did not want to try to pass Medicare for All in the face of Republican and Blue Dog opposition; and that they did not try to do so.

They made that decision, and just as Alter says “repeal equals death” we must also say that the failure to try to pass Medicare for All, as well as the opposition of Republicans and Blue Dogs also equaled and still equals death as long as that failure goes on. Well, guess what? It’s still going on, and thousands of people who might well have lived are still dying and will die in the future, while people like Alter and Kinsley, and Ed Schultz defend the ACA, against repeal, without mentioning that the very best thing that could be done right now by legislators of both parties is to repeal the damned ACA and replace it with John Conyers’s HR 676, enhanced Medicare for All.

And yes, I know they’ll never do it, so no one has to tell me that this alternative is not politically feasible right now. But that question of political feasibility should not prevent us from keeping HR 676 in the faces of Congress and the President, and pointing out persistently and impolitely, that continued rejection of Medicare for All by them equals death for hundreds of thousands of people in the coming years.

(Cross-posted from

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Joseph M. Firestone, Ph.D. is Managing Director, CEO of the Knowledge Management Consortium International (KMCI), and Director and co-Instructor of KMCI’s CKIM Certificate program, as well as Director of KMCI’s synchronous, real-time Distance Learning Program. He is also CKO of Executive Information Systems, Inc. a Knowledge and Information Management Consultancy.

Joe is author or co-author of more than 150 articles, white papers, and reports, as well as the following book-length publications: Knowledge Management and Risk Management; A Business Fable, UK: Ark Group, 2008, Risk Intelligence Metrics: An Adaptive Metrics Center Industry Report, Wilmington, DE: KMCI Online Press, 2006, “Has Knowledge management been Done,” Special Issue of The Learning Organization: An International Journal, 12, no. 2, April, 2005, Enterprise Information Portals and Knowledge Management, Burlington, MA: KMCI Press/Butterworth-Heinemann, 2003; Key Issues in The New Knowledge Management, Burlington, MA: KMCI Press/Butterworth-Heinemann, 2003, and Excerpt # 1 from The Open Enterprise, Wilmington, DE: KMCI Online Press, 2003.

Joe is also developer of the web sites,,, and the blog “All Life is Problem Solving” at, and He has taught Political Science at the Graduate and Undergraduate Levels, and has a BA from Cornell University in Government, and MA and Ph.D. degrees in Comparative Politics and International Relations from Michigan State University.