The Killers Among Us (And Other Weak Arguments for the Senate Health Bill)

03/18/2010 05:12 am ET | Updated May 25, 2011

Have you heard?  Progressives who oppose the Senate health bill are the moral equivalent of mass murderers.  That argument is actually being made - along with the charge, ironically enough, that they're being too emotional.  Other pro-Senate-bill arguments are pretty thin, too, but let's start with this one:

We have met the "death panels" and they are us. 

Ezra Klein seems to have started the "killers" trope in a response to Markos Moulitsas's opposition to the bill.  Klein cited recent figures showing that 45,000 Americans die each year from lack of health insurance.  The Senate bill, he argued, would save "more than a hundred thousand lives, to say nothing of the people who
will be spared bankruptcy, chronic pain, unnecessary impairment,
unnecessary caretaking, bereavement, loss of wages, painful surgeries,
and so on."

Pretty persuasive ... and as it turns out, pretty easily countered, too. First, while the Senate bill will reduce the ranks of the uninsured, it won't eliminate them.  The CBO says 9 million will still lack insurance if it passes, which is very close to my estimate last year of 8 million. And given the weakness of the subsidies in the Senate bill, I'd revise that figure upward.  So we already know the 45,000 number is overstated.  I would argue that the Senate bill might save no lives at all (and, in any case, most opponents are arguing for a better bill, not inaction.)

Regarding bankruptcy, 75% of people facing health-related bankruptcies have health insurance.   The Senate bill doesn't do enough to help them.  Nor does it go far enough in addressing  underinsurance, which affects roughly 25 million Americans. 

And make no mistake:  Underinsurance kills, too.   The United States ranks 19th among developed countries in preventable deaths.  While lack of insurance is a factor in those deaths, so is underinsurance.  As the Kaiser Family Foundation reported, 53% of all Americans - most of them insured - reported cutting back on health care in the last year, with 23% of respondents saying they skipped a recommended medical test or procedure.  Last year, Gallup found that 3 households in 10 put off getting care they needed, with 17% (nearly one in five) saying it was for a "very serious" or somewhat serious condition."

Tellingly, of those putting off needed care, the Gallup poll found that 77% of them have health insurance.

An HSC study had similar findings, and also found that "insured people also faced large increases in unmet need between 2003
and 2007."  Other studies like this one support Gallup's finding that the chronically ill - the people most in need of help - face the greatest challenges, whether or not they have insurance.

If the Senate bill passes in its current form, there is a very real danger that it will reinforce a system that's designed to create underinsurance.  What's more, its excise tax will actually make the uninsurance problem worse.  The bill could lead to angoing death toll that offsets any lives saved, while permitting continued suffering from disease and financial hardship. 

Despite the dubiousness of the "45,000 dead" figure, the bill's defenders keep spreading it around the Internet.  This comment in Nate Silver's hyperbolic defense of the bill is fairly typical:  "(I)f it's okay with you for 45,000 + people to die every year because of bad (or no) insurance -- then yeah, Kill Bill."  Or this one, from Bob Cesca's blog:  "They should spray paint 'Kill the Bill' on every tombstone and ashes
urn that belongs to a person who has died ... since Bill Clinton's ... (t)hen they spray paint 'Kill the Bill v.2' for every one who dies
until the next President is foolish enough to take on the right AND

Oh, but, commenters will be commenters, right?  Surely the bill's responsible defenders have repudiated these attacks, haven't they?  Not that I've seen (with the exception of Jonathan Cohn, who expressed some misgivings.)  Instead, as Glenn Greenwald demonstrates, bill critics have chosen to personally demonize opponents like Matt Taibbi and Jane Hamsher in much the same way Howard Dean was attacked by members of the White House staff.  Klein even went so far as to call Hamsher's critique of the bill "purposefully misleading."

That's a particularly unfortunate choice of words, since Klein overlooks a rash of recent studies in the same piece to can keep defending the flawed "Cadillac tax." (UPDATE: Ezra has responded thoughtfully to my earlier criticisms, and my thoughts about his response are here.)   His other defenses of the bill are open to debate, but Ezra's continued defense of the tax is particularly shaky. He continues to insist that average readers "probably don't have these plans," despite evidence showing that one in five employee plans will be affected.  And he continues to insist that the tax is "tilted towards the
rich, not the middle class,"  despite multiple studies proving otherwise. (For evidence, see here, here - pdf, and here - pdf, and that's just for starters.) There are a total of 18 recent papers or studies (pdf) that contradict Klein's assertions.

(David Leonhardt of the New York Times also repeated these discredited claims about the excise tax in touting the Senate bill yesterday.)

The fact is, Jane Hamsher is right about the excise tax.  Her statements square with the latest analyses from impartial experts (including one from a respected actuary that I summarized here), while Klein's and Leonhardt's do not.

Meanwhile, while the bill's defenders were slamming the character of those with whom they disagree, those fighting against the bill in its current form were getting things done.  Among them is Bernie Sanders, who won billions of dollars to provide primary care to as many as 25 million people.  Other significant improvements, noted here, seem designed to mollify progressives unhappy with the overall bill.  Score a few points for the "killers."

That said, I've noticed that some of the bill's defenders are quietly shifting their stance from 'pass it' to 'improve it and then pass it.'   That's progress.  In fact, it essentially brings them in line with Howard Dean's position. And how can it be improved if not through resistance?  Progressives will have no leverage left if they embrace it in its current, highly flawed form.   

As I've said, I'm still agnostic about the 'pass it/kill it' debate.  But, while I can't go as far as Hamsher and Taibbi - yet - I find the bill's defenders less and less convincing as time passes.  And the personal aspersions being cast on the bill's opponents are completely unacceptable.

We need to make this debate less personal and more about the substance.  Otherwise, the only thing that's certain to be 'killed' is a lot of good will among people who should be allies.


(Note: I am currently working eith the Campaign for America's Future to overturn the Senate bill's excise tax provision. See for more information.)

RJ Eskow blogs when he can at: