“Yes, the Senate GOP tax plan would cause ‘thousands’ to die.”
So read the headline of a short essay by Lawrence Summers published in the Washington Post on Sunday night. Summers, an eminent economist and former Treasury secretary, argues that the thousands of deaths will be a consequence of the Senate tax bill’s provision eliminating the Affordable Care Act’s requirement that individuals purchase health insurance or face a penalty.
This argument is overblown. It implies that the goal of public policy should be to reduce the number of preventable deaths to something as close to zero as possible. But of course this isn’t the case. More than 30,000 people die every year in car accidents. Each of these deaths is a tragedy, and in the truest sense, every life has inestimable value. But our fallen world has finite resources, and as a society we have decided that some deaths are an acceptable trade-off for the benefits of allowing vehicles to travel faster than 20 miles per hour. A similar argument could be made for policies surrounding homicides, foreign conflicts and a host of other issues.
Even in health policy, the goal has never been to eliminate preventable deaths. To take the extreme case, no one is arguing for a paramedic in every building and home. We have implicitly decided that some number of preventable deaths is acceptable in order to achieve other social goals.
Economists typically think of policies like the individual mandate as affecting the probability of death, rather than causing death directly. Repealing the individual mandate as part of tax reform is unwise. But will it increase the probability of death, and hence mortality rates? It’s hard to say.
On the one hand, the elimination of the mandate will increase the number of individuals without insurance, which could increase mortality rates. But the link between mortality rates and insurance coverage among the population that buys insurance because of the mandate is largely unknown. (For one thing, this population is intended to be young and healthy, not old and sick, which suggests that the link between insurance and mortality among this specific group is weaker than you might think.)
More fundamentally, the effectiveness of the individual mandate in compelling individuals to purchase insurance is highly uncertain.
The nonpartisan Congressional Budget Office estimates that repealing the individual mandate will increase the number of uninsured people by 13 million in 2027. This sounds like a precise estimate, and I’ve strongly defended the integrity and quality of CBO analysis.