How many people die without insurance?

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Lack of insurance linked to 45,000 deaths
E-mail|Link|Comments (40) Posted by Elizabeth Cooney September 17, 2009 04:00 PM
As medical care has improved for people with health insurance, the consequences of being uninsured have worsened, according to a new study that says the lack of coverage translates into nearly 45,000 deaths each year among working-age Americans.

Researchers from Cambridge Health Alliance report in the American Journal of Public Health on a study that followed 9,005 adults under 65 years old who took part in a national survey conducted by the Centers for Disease Control and Prevention from 1986 through 1994. After 12 years, 351 people had died. Sixty of them were uninsured and 291 were insured.

After accounting for age, education, income, and other factors, the researchers found that people without private insurance had a 40 percent higher risk of dying than people with private insurance. An earlier study by the Institute of Medicine based on 16 years of data through 1993 found that uninsured people had a 25 percent higher risk of dying than insured people, which translated into 18,000 additional deaths.

"Being uninsured is more lethal relative to being insured than it was 20 years ago," co-author Dr. Steffie Woolhandler said in an interview.

According to US Census figures released earlier this month, the number of uninsured people rose from 45.7 million in 2007 to 46.3 million in 2008.

Woolhandler, who advocates a single-payer form of universal health coverage, blamed three factors for the widening gap between those with and without insurance. More people are uninsured and the safety net for those people has eroded, she said. But the gap has also grown because the care that insured people are more likely to get has gotten better.

Treatments for chronic illnesses have improved, including blood pressure medications to control hypertension and statins to lower cholesterol, the authors write.

"We're much more vigilant about care of high cholesterol, diabetes, and hypertension, which has lowered the death rate of people with insurance, which is great, but the uninsured have not shared in those benefits," Woolhandler said. "Uninsured people who have a chronic condition are less likely to know they have it, and even when they know they have it, they are less likely to be able to control it because control of chronic conditions involves regular visits to a primary care doctor."

Uninsured people tend to get their care from hospital emergency rooms when they are urgently ill, the authors say, based on prior research.

Dr. John Z. Ayanian, a professor of medicine and health policy at Harvard Medical School and Brigham and Women's Hospital, served on the committee that issued the 2002 Institute of Medicine report. He said the newer work confirms the results of several prior studies.

It also fits with his own research analyzing what happens when uninsured people turn 65 and qualify for Medicare. In that study, published in 2007, people with diabetes or cardiovascular disease were especially likely to see dramatic improvements in their health after gaining insurance coverage through the national plan for the elderly.

The new study by Woolhandler highlights the importance of regular medical care so that diabetes or high blood pressure can be diagnosed in their early stages when treatment can make a substantial difference, Ayanian said.

"This study underscore the serious health consequences that people face when they are uninsured, as well as the potential benefit of extending coverage to all Americans so that they have access to good primary and specialty care when they need it," Ayanian said.




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Its NOT 'lack of insurance' that kills people. It IS disease, catastrophic accidents and homicide that kills people. This headline is outrageously puerile and insulting to those of us who are educated. Grow up, get a college degree, then write for a news outlet...please get a new day job.

Posted by abby_johnson_3 September 17, 09 04:21 PM"An earlier study by the Institute of Medicine based on 16 years of data through 1993 found that uninsured people had a 25 percent higher risk of dying than insured people, which translated into 18,000 additional deaths."

This is a very huge statistical guess. How many of the 18,000 had accidental deaths? How many of those 18,000 had incurable diseases? How many of those 18,000 chose not to get health insurance? How many of those were illegals and not eligible for health insurance?

45,000 over 16 years is 2800 people per year. 1993 population was nearly 260 million. That .00107% The statistical error of the study is greater than that.

Posted by ray high September 17, 09 04:23 PMThen work hard, get insurance and live longer!!! Why does the Government need to get involved??

Posted by bozo mann September 17, 09 04:29 PMRepublican "death panels"

Posted by eda September 17, 09 04:33 PMGee why this article now... huh

Keep carrying the Dems water it is working out for you so far.

Real reform starts with deregulation and tort reform

Posted by Frank September 17, 09 04:45 PMHow many were non citizens if you know what I mean?

Posted by John D September 17, 09 04:55 PMLet's see...how many neanderthal right wingers here will scream, "absolute lies! Only 30,000 died!"

Awaiting all the Joe Wilsons out there...where are ya?

Side note: Wilson claimed to be an Immigration lawyer. Turns out he WASN'T. EVER.

So...WHO LIED????

Posted by mattal1958 September 17, 09 05:00 PMWow. That's so much less than I thought.

Way less than even the common flu.

So what's the problem?

Posted by Enzo Capacaccio September 17, 09 05:07 PMNew Headline: FULLY INSURED ACCOUNT FOR ALL BUT 45,000 DEATHS

Posted by sarcasm September 17, 09 05:16 PMRegarding accidental deaths and the like, what do you think the study authors adjusted for? Seriously? You think that they just took raw data and published it, without trying to narrow down what the correlations were? Do you understand how research is done?

Also, no one is purporting that not having insurance will kill you. What the study is saying is that if you do not have private insurance, that is correlated with a substantially higher risk of death that someone who does have health insurance would face, most likely because you receive worse health care. Reading is fundamental.

Additionally, working harder is great. If your employer provides insurance, that is, which a great many of them DON'T. And of those that do, many of THOSE don't provide meaningful insurance, so pesky things like yearly check-ups and prescriptions either aren't covered, or are only covered after an absurdly high deductable. So please explain to me how working is going to solve this issue?

And finally, how is someone's citizenship AT ALL relevant to what the study says? They are people, after all. Oh wait, that's not a popular viewpoint in some parts, even though it's 100% true. The study is not at all talking about who should be provided insurance, or what insurance should look like. It simply says that if you do not have health insurance, you are more likely to die than someone who does. Again, reading, fundamental.

Posted by Wench September 17, 09 05:21 PMAbby, by your line of reasoning, AIDS does not kill people either; it just weakens a person significantly so they die of something that could be easily prevented if they didn't have it. Hence, AIDS is not a problem and should be ignored too, right? That's what lack of health insurance does as well.
You right-wingers are a complete embarrassment to this country. You selfishly stick to the same wacko dogma that the Republican Party tells you to say even when confronted with something that IS life or death for people. Shame on you. We'll pass health care reform without you, and we'll look back at you 20 years from now amazed that such people could make such ridiculous arguments, sort of like the Dixiecrats or Know-Nothings.

Posted by Al September 17, 09 05:44 PMWhy does this discussion keep happening? Health care is not the same as health insurance. People purchase insurance of all types (auto, health, property, business, etc.) to protect against catastrophic losses. Routine medical care like an annual physical should be a personal responsibility like food and rent. Nobody should be impoverished by a catastrophic illness and insurance should be required and regulated to assure of access to health insurance by eliminating the pre-existing condition rules, etc. If someone desires from first dollar health coverage then you can pay more than a healthy person that chooses a high deductible plan with a health savings account but you both have health insurance. However, if a person chooses to high deducible plan and prioritizes entertainment, alcohol, and other non-essential items above paying for health care, why should we as a society question those choices even if it means an early death for that person.

Posted by DisinterestedObserver September 17, 09 05:46 PM45000 people *may have died* and that *may be attributable* to lack of insurance. This is the math - they followed 9002 people aged 65,"After 12 years, 351 people had died. Sixty of them were uninsured and 291 were insured." They then corrected the stats to null out "age, education, income, and other factors" - then they multiply the rate by the number of people uninsured (~40+ million) to get the attention grabbing 45000 deaths.

If you just take the nominal facts - 351 out of 9002 people died over 12 years (as stated above) - and 60 of them were uninsured - I am actually surprised only 351 died. These must have been generally healthy to begin with.

You could look at this another way, all that money spent on insurance only gets you a 40% reduction in risk of dying so you may want to take your chances. Healthy lifestyle keeps you alive longer, medical insurance attempts to prevent you from going bankrupt when you have a catastrophic illness. Everything else is just deciding what you want to die from.

For mattal1958, it's not 30,000 - it's 351 out of 9002 sixty-five year olds. Plainly stated. Anything beyond that is a statistical projection.


Posted by Chris September 17, 09 05:50 PMMany of you are misreading this; The fact that anyone with Health Insurance is denied life saving care is tantamount to the Health Insurer(s) truly acting as a "Death Panel". And this report does go so far as to state that there were thousands of people in this study who died after being denied treatment based on the decision of their Health Insurer.There was a beautiful young girl from Connecticut, who died recently from liver failure because her Health Insurer denied her treatment, (a Transplant). Any death because of a lack of treatment, whether or not they had health insurance or the inability to pay for the necessary treatment, is just needlessly despicable. Those of you who continue to insist that Health Care is a privilege as opposed to a basic Human Right, are obviously about as humane as were those responsible for the Holocaust. This nation could easily afford to cover the cost for every legal resident to have the best health care in the world. Those that are fighting it, do so only in the interest of the profit mongers that are now running the Health Care System and seek to gain even more control so they can make billions more. We should be far more worried about the power and control they still seek, than any attempts the federal government is making to try to control costs & seek to give more people the ability to afford decent Health Care and insurance.

Posted by Dave Z September 17, 09 05:54 PMThis article is bizzare, and that's being polite. Any third-rate socio-economic analysis could poke a 1000 holes in this statement.

So, because the rate of mortality is higher in those without insurance, then the lack of insurance directly contributed to that level of mortality. Obviously that quid-pro-quo has minimal credibility, at best............If the Federal Gov't. comes in and mandates health insurance, what is supposed to follow?........Nirvana?

Health insurance does not and never will affect personal habits, lifestyle, and levels of education. If anything, it's the other way around.........and hasn't the War on Poverty and the myriad of other Federal Programs done such a great job in the last 45 years????..........But if we just had Health Insurance, things would be so much better..........NOT!!!

Integration and the effects of technology have affected the lot of the poor and less-gifted more than any Govt-mandated/funded transfer payment.

Posted by Stephen Stephens September 17, 09 05:57 PMLack of access to health care is what caused those 45,000 deaths. Having health 'insurance' is not the same thing as having health care. I have no insurance and I have no money, so I don't get any health care at all. In what used to be the richest country in the world, that used to be concerned about its have-nots, what is wrong with this picture? Greed, selfishness, lack of compassion for anyone who is not white and rich. And we should be thoroughly ashamed of ourselves.

Posted by DottyAnn September 17, 09 06:00 PMHey Bozo Mann,

What about all those hard working housekeepers at Hyatt? Some of them worked for over 20. Now they are without health insurance.

Add that to the people taking over for them who make $8/hr and don't get health insurance.

So we go from 100 people with insurance to 200 without.

Posted by Yoshi September 17, 09 06:46 PMWhy is this so hard to understand, or greeted with such incredulity...if you don't have helath insurance, you can't go to a doctor to treat any illnesses you might have, and you certainly won't get any preventive care or check-ups to identify early stages of chronic and deadly illnesses such as heart disease, diabetes, and cancer (the diseases that kill the vast majority of people). Therefore, it is completely reasonable to assume that someone who does not have health insurance would have a higher risk of death than someone with health insurance. I would be shocked if the research showed something else. As far as the individual who questioned how research on a small sample of people could be generalized to a larger population...that is called statistics. You may want to take a course in it. It is used every day in every field of scientific endeavor. UNless you can argue that the sample population was not representative (which I don't think you could argue without a lot more detail on the specifics of the study), or you argue that the sample size is too small (again...would take in depth knowledge of the study and a trained statistician to know this), then you can't argue that the conclusions lack validity. This study was from a peer reviewed journal, so professionals have had a crack at saying it was invalid, and it would not have been published if it was.
Bottom line: anti-reform people get upset when they read this study because they don't want to face the truth...which is that when people are uninsured, it causes them serious harm. To suggest that insurance is a privilege, not a right, and that it doesn't matter that some people don't have insurance, you therefore have to be OK with saying that some people deserve to suffer and even die because they don't have insurance...whether that is because they don't have a job, or have a job that doesn't give them insurance, or because they have a pre-existing condition and can't get it...all of those people must deserve to suffer and die if you really believe that people shouldn't have a right to health care. So I guess my question for you is, wouldn't it be more humane to just shoot them? Think about that, all you anti-insurance reform folks...especially the next time you lose your job and have to decide whether to pay for COBRA on your non-existent paycheck or just wing it without insurance. There's lots of folks out there who think you deserve to suffer and die for your sin of losing your job.

Posted by StarboardLean September 17, 09 06:49 PMI performed a scientific study in my backyard this summer and learned a shocking statistic: 100% of conceptions linked to 100% death rate. Washington must intervene and stop this atrocity!

Posted by A-VeryOfficialScientist September 17, 09 06:58 PMIsn't that less that than what global warming...sorry climate change kills every year?

Posted by Tom September 17, 09 07:02 PMcan we send this along to all the fat cat insurance executives and various governmental officials who have created this abomination. Not that give a rat's _ _ _. and no I do not think we are misreading these figures.

Posted by BarbaraSamburu September 17, 09 07:09 PMDottyAnn: You have no health insurance and no money?

Hospitals will always treat you in emergency rooms, so dont say you have no health care at all.

Are you unable to work? If not are you on welfare, disability or otehr of the many social services? Do you smoke or drink? Do you exercise?

I'm ashamed of the many physically able people who do not work. Many of those people somehow can afford to smoke, drink, have children they cant afford, eat fast foods, pay for cable tv, computer and internet, etc..

We already subsidize welfare, medicare, social security, food stamps, rent control.

Time to wake up and take responsibility.




Posted by Wake Up September 17, 09 07:56 PMThe hateful ignorance and downright meanspiritedness of some of the posters is appalling. I have simply stopped believing in the fundamental goodness of people.

Posted by baileyislandgirl September 17, 09 08:07 PMstatistics are almost always misleading. the uninsured also include a higher percentage of homeless, drug and alcohol abusers, as well as people with all sorts of other life shortening factors. insure these people and they will still die sooner.

Posted by the wizzard September 17, 09 08:20 PMOf the 351 people who died, 200 of them declared their favorite color to be blue, while the remaining 151 chose red as their favorite color.

It's obvious that the color blue is much more deadly than the color red. For this reason alone, the government must intervene.

Blah, blah, blah. You're not going to steal my healthcare, lefties, go chase down some empty water bottles before they kill the planet.

Posted by SSUR4 September 17, 09 08:33 PMI got news for these researchers: there is a 100% chance of 100% of the population dying. "those without insurance are 40% more likely to die" nope. sorry. we are all going to die.

Posted by LukeWilliams September 17, 09 08:48 PMWhen I was in High School a half-century ago, I knew a lot of students whose only talent was for endless sarcasm. They all seemed convinced that they could use this infantile ability to trump the intelligence and evidence that their betters brought to arguments about serious topics. It didn't work then and it doesn't work now.

Posted by JerseyCurmudgeon September 17, 09 10:06 PMIts sad that there are so many uneducated people posting here that do not understand how scientific studies work. Nor do they understand statistics.

The next time you are sick and get prescribed a drug, just remember that the same methods and statistical analysis used in this study are also used to determine the viability and safety of that new drug you just got. If you believe in the safety and effectiveness of that drug, you should should believe in these type of studies as well.

You are being hypocritical if you think you can pick and choose what to accept and what not to, based on your own person beliefs. Its all the same methodology.

Posted by Yoshi September 17, 09 10:38 PMBottom line the 2 studies found that those uninsured had anywhere from a 25-40% greater rate of death

Posted by keith September 17, 09 10:39 PMThis is actually great news! We now have a way to reduce the number of people without health insurance. Have them die because they don't have health insurance.

Posted by lnmonster September 17, 09 11:42 PMThe problem is there are people out there who are highly educated, working very hard and diligently at one or more full time jobs and still do not have health coverage. We call ourselves an industrialized nation and preach equality, yet there is absolutely nothing equal about our health care system. That is what kills people. We have the money and the resources to prevent and treat disease and yet the system is broken because people are still dying. We may as well be signing the death certificates if we, as a nation, insist on sitting wallowing in our complacency by choosing to not reform health care.

How can you call yourself American and not support health care coverage for all? Hang onto your health care coverage all you righties? No one is taking it from you. This battle of the haves and the have-nots is so Machiavellian.

I have a college education. I am an employed Professional worker. I don't smoke or drink. I run marathons and am of average weight. I have been paying taxes for over 20 years and I cannot get health coverage due to a pre-existing condition (congenital heart defect). Every time I have to go to the cardiologist it costs as much as my mortgage, which is why I don't go - it's too expensive. There are many people out there like me being screwed by this so-called democratic health care system. Open your eyes, America.

Posted by dying from heart failure by age 40 September 18, 09 12:07 AMThe United States of America is the richest, freest, most liberal nation in the history of world. That there is any mortality rate whatsoever associated with a lack of health insurance for our fellow citizens is profoundly unacceptable. The good men & women of this country have the means and the will to rectify the problem. This may indeed require directing elected officials to curb the vast power of health insurance & pharmaceutical corporations. The selfish and the ignorant may balk at any attempt to change the shameful status quo for the better, but with such positive change we shall be one step closer to building that "shining city upon a hill" our forefathers envisioned.

Posted by YankeeFlyah September 18, 09 12:35 AMNOT IN POSSESSION OF A HEALTH INSURANCE POLICY, NOT THE SOLUTUIN TO THE PROBLEM

Not having health insurance is sure an indication that you will most likely not be a beneficiary of the superbly advanced United States health care system.

This problem will be addressed, and fully so, only when politicians cease to design misguided social policies, subsequently giving most citizens the impression that those who do not have health coverage are at fault when in fact their disposable incomes may be far from being sufficient to permit them to pay for the economic cost of basic food needed to stay alive, to keep themselves going.

The writer, Yves A. Isidor, is executive editor of wehaitians.com, a democracy and human rights journal.


keep themselves going.

Posted by Prof. Yves A. Isidor September 18, 09 12:49 AMOh my god! people die!! how has humankind maintained itself for hundreds of years without subsidized health insurance? It is a miracle.

Posted by cantstandya September 18, 09 12:53 AMI help to support the prisons, the Union workhouses, the Treadmill and the Poor Law! Those who are badly off must go there, and if they would rather die, they had better do it, and decrease the surplus population! It's enough for a man to understand his own business, and not to interfere with other people's. Mine occupies me constantly!


Posted by ebenezer September 18, 09 09:26 AMWAKE UP, SHEEPLE! THE GOVERNMENT IS KILLING US!

Posted by jk September 18, 09 09:28 AMI have taken and done some research for my masters dgree and just be cause they say it was a scientific study does not make it true. From what little info they give the reader it does not look like a scientificly sound study. And one thing you always learn with statistics is that they can be scewed to go what ever way the reporter wants them to go. And it makes me sad when people who don't want a govt. paying or controlling health care are presented as not wanting to help those without coverage. We (over half the USA pop.)want true health care reform...not another expensive ineffective government run program. Can't you see that they want us fighting amonst ourselves as they slowly take control of our lives.

Posted by M. Mielke September 20, 09 12:02 PMThese naysayers might like to ask their doctors what they think of health insurance reform.

Posted by LS September 22, 09 10:59 AMI'm really tired of the "you always have the emergency room" argument. Do people think going to the emergency room is free? The BILL will arrive in the mail. If one doesn't have the money for a doctor's visit they sure don't have the money to pay for an emergency room visit.

Posted by Sage September 23, 09 04:19 PMTo Abby- If you do not have health insurance, you can not afford to visit your doctor at the rates they charge or pay for some prescription medicines. If you are not getting routine follow ups when you have a major medical condition, like heart failure, it could get worse and you can die. So yes, lack of insurance can kill you if you aren't getting the care you need or medicines you need to treat a severe medical condition. And for some of you, is it better to have routine medical care/preventative care than for your condition to be so bad that you end up in an emergency room so the government can pay for it. Some of us are in states like Texas who do not have any medical or financial assistance to anyone except families with children or illegal immigrants.

Does that mean uninsured individuals believe that a government program will solve our problems. Not exactly. Putting an end to the corrupt insurance companies and outrageously unfair practices, high premiums and high deductibles might decrease the number of uninsured.

Posted by irishjdf September 26, 09 01:42 PM
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Elizabeth Cooney is a former health reporter for the Worcester Telegram & Gazette, where she also was a business reporter and an editor. Earlier in her career, she edited medical books and journals at Little, Brown, and worked for Boston magazine.
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