You know the person who commits murder and the dead person really are both victims in Robert Samuelson land. His latest column on health care shows his great expertise in obscuring everything he touches to say it's all just so complicated.

He tells readers:

"Still, there’s no moral high ground. Some Democrats have wrongly accused Obamacare opponents of murder. This is over-the-top rhetoric that discourages honest debate. It’s also inconsistent with research. Kaiser reviewed 108 studies of the ACA’s impact and found that, though beneficiaries used more health care, the 'effects on health outcomes' are unclear."

Yes, Kaiser was being very careful in its comments. The Affordable Care Act has been in effect for three and a half years. There is a lag between research and publication, that means that at this point in time we still have limited solid measurements of outcome measures. We do have data on diagnoses and treatment.

The study reports:

So we have evidence now that people with conditions like heart disease and cancer are being diagnosed earlier and getting treatment. We are not going to have good data on mortality rates at this point since the vast majority of people with heart disease and cancer do not die immediately from these conditions. But, if we make the huge leap that treatment might affect survival, then we can infer that the ACA is keeping people from dying.

But hey, we want to be cautious, unlike those irresponsible Democrats who are accusing the Republicans of murder. After all, it is possible that all the money we spend on treating heart disease and cancer is totally worthless.

This is hardly the only part of Samuelson "it's all so complicated" piece that should infuriate normal people. Samuelson never says the obvious, health care is expensive in the U.S. not because we get so much care, but we because we pay so much to our doctors, drug companies, medical supply companies.

We pay about twice as much to these folks as people in other wealthy countries. But rather than risk pissing off folks with money, Samuelson goes after the elderly. 

"We are left with a system in which medical costs are highly concentrated with the sickest patients. (The top 5 percent account for half of all medical spending.) This creates a massive resource transfer, through insurance and taxes, from the young and middle-aged to the elderly. (Half of all health spending goes to those 55 and over, who represent just over one-quarter of the population)..."

Yes, the problem is those damn elderly. Actually, even blaming the elderly as a group is misleading. Most people over 55, 65, and even 75 are healthy with relatively low health care expenses. We are not making transfers to them.

Even Samuelson's measure of the cost of health care is wrong.

"If you go back to 1962, the earliest year with such data, federal health spending totaled $2.3 billion, which was 2.1 percent of the $107 billion budget. In 2016, the comparable figures were $1.2 trillion in health spending, which was 31 percent of the $3.85 trillion budget."

This figure doesn't include the higher payments that everyone will make to drug companies and medical manufacturers because of government-granted patent monopolies. Patent monopolies are an alternate mechanism of government financing. The government can either directly pay for research and development, as it does to some extent with National Institutes of Health, Center for Disease Control, and other government agencies, or it can grant patent monopolies, effectively allowing the holders to tax the public. A serious analyst would count both as burdens imposed by the government to pay for health care.



Robert Salzberg called my attention to research showing that being covered by health insurance reduces mortality (here and here).