Cato’s Michael Cannon has a post up which, unlike Charles Lane’s writings on the matter, actually attempts to engage on the merits with the argument that lack of health insurance leads to people dying. But even though he cites a number of studies on the subject, only one, the Richard Kronick study, actually address the point the Institute of Medicine study was referring to. Kronick concludes that the approximately 20,000 deaths per year is an overestimate due to a failure to control for relevant demographic variables. Conversely, Andrew P. Wilper, Steffie Woolhandler, Karen E. Lasser, Danny McCormick, David H. Bor, and David U. Himmelstein found in their “Health Insurance and Mortality in US Adults” that the IOM study is a serious underestimation:

The study, which analyzed data from national surveys carried out by the Centers for Disease Control and Prevention (CDC), assessed death rates after taking education, income and many other factors including smoking, drinking and obesity into account. It estimated that lack of health insurance causes 44,789 excess deaths annually.

Previous estimates from the IOM and others had put that figure near 18,000. The methods used in the current study were similar to those employed by the IOM in 2002, which in turn were based on a pioneering 1993 study of health insurance and mortality.

A separate study indicated that individuals lacking health insurance were more likely to die even in the context of emergency room visits:

The researchers took into account the severity of the injuries and the patients’ race, gender and age. After those adjustments, they still found the uninsured were 80 percent more likely to die than those with insurance — even low-income patients insured by the government’s Medicaid program.

“I’m really surprised,” said Dr. Eric Lavonas of the American College of Emergency Physicians and a doctor at Denver Health Medical Center. “It’s well known that people without health insurance don’t get the same quality of health care in this country, but I would have thought that this group of patients would be the least vulnerable.”

If “no health insurance means bad health care” or “bad health care can lead to death” were some kind of wildly counterintuitive propositions at odds with sound theory, then I think we might have good reason to doubt these results. But in fact they’re perfectly intuitive results that accord perfectly with, among other things, the elementary economic theory that says people wouldn’t pay for health insurance unless it provided something of value. The bulk of empirical studies also seem to confirm this. Lack of insurance is associated with low-quality health care which is associated with enhanced risk of death.

Today Michael Ettlinger, Michael Linden, and Lauren D. Bazel are releasing CAP’s long-term deficit vision. They call for the government to stabilize the debt-to-GDP ratio by 2014 and achieve a balanced budget by 2020. The goal would look something like this:

The Committee for a Responsible Federal Budget also has a new report out on this subject calling for a more aggressive (unrealistically aggressive, I would say) debt-stabilization target of 60 percent of GDP by 2018. But probably the most interesting part of their report is this table showing foreign countries’ ability to recover from major debt situations:

That said, I think the point this underscores is simply that the problem of debt reduction isn’t primarily a policy problem, it’s a political problem. As long as members of the Republican Party remain 100 percent opposed to tax increases, you can’t possibly have a bipartisan agreement on debt-reduction. And I think the big moral of 2001 is that you have to have bipartisan agreement on debt-reduction. The Clinton administration succeeded in achieving massive deficit reduction and was putting the country in a position to deal with the long-term fiscal challenge. But the Republican Party didn’t buy in to the theory that the long-term fiscal challenge should be dealt with. So instead of embracing budget surpluses as a way to massively reduce the debt-to-GDP ratio ahead of the baby boomers’ retirement, they characterized surpluses as a sign of overtaxation that required large, deficit-inducing tax cuts. And of course they got Alan Greenspan to embrace that theory.

So if I were a Democratic legislator, I would just shrug at all these reports and tell the authors to come talk to me when they’ve found some Republicans who are willing to say that the looking bankruptcy of the country is a bigger problem than high taxes. I don’t see any in the House, I don’t see any in the Senate, so until then I don’t know what there is to talk about. Right now, Democrats have a health care bill before the congress that would somewhat improve the long-term fiscal situation so the best thing they can do is pass it.

Greg Sargent has the video of Joe Lieberman from three months ago explaining to a local newspaper that while he doesn’t like the idea of creating a new public option, he does favor expanding Medicare and Medicaid, complete with a buy-in to Medicare option for people over 50 or 55.

Meanwhile, John McCain tweeted earlier today “Joe Lieberman – standing up for his principles on health care is being viciously attacked by the liberal left…what a disgrace!” I guess to McCain being bitter and ignorant counts as standing up for your principles.

Actually, I think that’s a perfectly fair characterization of McCain’s ideological drifting over the years.

But the term “viciously” again, reminds us of Charles Lane’s substance-free outrage that anyone would dare call health care reform opponents on the fact that lack of insurance leads to preventable death. Apparently only a “vicious” person would point this out, though total fabrications about death panels don’t count as smears I guess.