The Trillion Dollar Cost of the Health Care Gap

by: Natasha Chart

Tue Oct 27, 2009 at 08:00


In the middle of heated policy debates, projections of cost to industry and government fly thick and fast. If costs to citizens are mentioned, it's usually in their capacity as taxpayers, as though they weren't otherwise part of the economy. A couple examples from the global warming policy arena put this into sharp relief in a way that emphasizes the urgency of providing affordable health coverage to every American.

First, there's David Roberts' explanation (... with puppies!) of how the Congressional Budget Office undercounts the benefits of lower energy costs from efficiency. Their method counts the promotion of energy efficiency as a cost to the taxpayer, but not a savings to the ratepayer, as though you can make an absolute separation between people who pay taxes and people who pay utility bills.

That may make sense from the CBO's perspective, but not from the perspective of electricity-using members of the public trying to figure out whether new energy legislation benefits them.

Natasha Chart :: The Trillion Dollar Cost of the Health Care Gap
Then there's another cost of our current electricity generation infrastructure, and here we're coming back more directly to the topic of health. According to the National Research Council, electricity production, transportation and heating in the US cost the public $120 billion in illness and early mortality in 2005, as reported by McClatchy's Renee Schoof. Half those costs came from the activities of the coal industry.

A report on the American Coalition for Clean Coal Electricity's (ACCCE) recent lobbying against climate legislation indicates that their 48 coal and utility company members made a combined yearly profit of $57 billion in 2007, or about the same amount incurred as public health losses in 2005. This analyst report republished on a message board (and if you have better data, please send it along) suggested that the entire US coal industry, who are not all represented by ACCCE, had a 2005 profit of $67 billion.

If you subtract health costs to society from profits accumulated by the coal companies, you're ending up with perhaps a slight net gain. Add in the $9 billion in federal subsidies to the coal industry for 2005, never mind the state and local incentives, the cost to the government and healthcare system of treating these illnesses, the loss in workforce productivity to other industries, and you may wonder if we can afford these 'profits', even if $60 billion worth of human suffering doesn't register as a problem.

If the coal industry is entirely financed by making people sick, where's the benefit to society?

Going back to Schoof's article on utility costs to health, here's what was said about the analytic methods: "The dollar amounts were mainly early deaths due to pollution, with the value of each life put at $6 million, consistent with other studies. More than 90 percent of the costs were the statistical cost of early deaths."

Finally, we arrive at a point where we can start fumbling towards some sort of human price tag on doing nothing about our failing healthcare system. This is the Harvard study on health insurance and mortality referred to by Rep. Alan Grayson (D-FL) on the floor of the House, the one finding that, "Lack of health insurance is associated with as many as 44789 deaths per year in the United States."

That $6 million dollar figure used in the coal study multiplied out by 44,789 deaths is in excess of $268 billion dollars.  

While many people who managed to avoid an early death would have considerably more than a year to live, we can also guess at the economic benefits of each extra year of life for some perspective. Last year, Time reported that while many private and government run plans worldwide placed a value of $50,000 on a year of human life Stanford economists placed the value of an extra year at $129,000. So let's use those figures for more perspective.

At a value of $50,000, giving an extra year to everyone who dies in a year from lack of health insurance is worth at least $2.2 billion per year. At a value of $129,000 for that same extra year, it's worth $5.8 billion per year. Though realize, this would be cumulative and doesn't represent the whole yearly cost of early death. If someone loses a decade of life, their absence costs us between $500,000 and $1,290,000, at the very least. Every year until the end of their natural lifespan, the cost of their lost year must be added to the totals of those who die in subsequent years.

For comparison, an HCAN analysis puts the net profits of 10 major private health insurers at $12.9 billion. This Reuters article says the whole US healthcare system is worth $2.5 trillion. People who argue against changing the healthcare system are therefore arguing by their own estimates that the profits of a very few outweigh a toll of loss whose extra minimum yearly increment is somewhere between a tenth and a half of those profits.

If I wasn't already a bit nauseated talking about the value of human life in this way, well, it's worse now.

But let's get back to the lifetime costs, because at the point of death, those costs are locked in and lost one way or another. Summing up, our healthcare system lets another 44,000 people die every year, imposing a lifetime cost of $268 billion on American families and the rest of the economy.

Considering that we spend almost twice as much per capita as other developed countries to get these abysmal results, we've barely begun to total the costs.

Any healthcare reform measure that provides every American with access to affordable care while costing less than $268 billion per year is a net profit to the American public. The current versions of the healthcare bill have a target cost to the federal budget of $900 billion over 10 years - if it saved 44,000 lives per year, preventing the imposition of $2.68 trillion in early death costs, that sounds like an absolute bargain for citizens.

Also at OurFuture.org.


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God forbid Americans (0.00 / 0)
pay the true cost of anything...

We do. (4.00 / 3)
Ordinary Americans always pay the full costs that our aristocratic corporate betters extract from us as profits.

[ Parent ]
Your analysis is confusing. (0.00 / 0)
You are mixing apples and oranges and trying to equate profits to the coal industry with external costs. I think a more useful comparison would be to weigh external costs against external benefits. I'm not sure how you would do that. I guess one benefit of coal is cheap electricity for consumers and other industries. I would not count coal industry profits as an external benefit, other than perhaps the taxes paid on those profits. [Discalimer: I have no education in economics. I'm just trying to use simple logic.]

You do make a great point about CBO scoring on healthcare missing the forest for the trees. Single payer funded 100% by taxes would be cheaper than what we have, but would get a shitty score from the CBO. They would only look at the effect on the federal budget and ignore the fact that people would no longer have premiums to pay to insurance corporations. The amount of people's taxes going to healthcare would go up, but the total amount they spend on healthcare would go down. I wish Obama would stop talking about healthcare in terms of the deficit and start talking about total costs.  

miasmo.com


It's about total benefit to society (4.00 / 1)
When the coal (or any other) industry is discussed, any action taken in regards to it always brings up the jobs it provides, the profits it generates, or perhaps its yearly economic activity.

When those costs are weighed against destruction of mountains and waterways, mercury poisoning, sludge landslides, air pollution, increased cancer, dollar figures are rarely put on those damages. That's the real apples to oranges comparison, because then someone can say, 'Yeah, but fixing that will cost us umpty-billion dollars in economic activity and we can't afford that.' That's usually the point where the discussion ends in favor of coal, or whatever destructive industry is being talked about.

By beginning to put a price tag on the costs externalized to the rest of society, we can start making the point that direct corporate profits, or gross earnings, whatever, aren't the only monetary measure of loss/benefit. Whether you or I think those privatized profits are a benefit, Congress and the coal industry lobbyists they listen to generally think they're the bees' knees. There needs to be some basis for a countervailing insistence that they stop costing the rest of us so dearly.

Capitalism is marketed as the most beneficial and efficient way to allocate resources. How else do you effectively challenge that premise if not on its own terms? I think it's pretty obvious that moral and ethical objections don't weigh much in the scales where policy is measured.


[ Parent ]
Overall, I agree, but... (0.00 / 0)
I just think that if you are going to try to make this argument, it needs to be able to stand up to a rigorous analysis. For instance, if you want to talk about external costs, compare them to external benefits. Profits are an internal benefit (internal to the transaction.) I am on your side on this, but I can see someone on the other side immediately jumping on the fact that industry profits bear no logical relationship to a discussion of external costs. You have devised a way to measure one external cost and then point out that it is roughly equivalent to industry profits. An obvious response is "So what?"

The problem is that you are attempting to imply a mathematical equation that is somewhat like "1.5 tons of potassium + 4 smiles = 2 parking tickets."

If you put externalities on one side of the equation, you need to put externalities on the other side for it to mean anything.

miasmo.com


[ Parent ]
All these costs are external to the public (0.00 / 0)
Money is paid to industry directly for services rendered, and indirectly by government subsidies on the premise that all this economic activity is ultimately for the economy's and, by extension, the public's greatest good. The profits are supposed to recirculate, the operating expenditures are supposed to drive jobs, all of which is usually counted as a positive benefit to the country as a whole.

I didn't make up the warped logic of that. I'm not campaigning as an apologist for coal mining concerns and health insurers by citing how much economic activity they generate as an unqualified good that we can't afford to lose.

Yes, these are different cash flows. But they're cash flows. And I've never heard such an 'apples and oranges' complaint in response to arguments about the immorality of obscenely profitable companies causing x number of deaths, where the deaths are measured in number of fatalities as opposed to imposed costs.

Getting those profits costs something. This post is about what they cost, and the people who are paying it, about the internalized benefit of one group coming from the massive losses of another.

If that still doesn't merit consideration in your opinion, I really can't help you with that.


[ Parent ]
wikipedia definition of externality (0.00 / 0)
http://en.wikipedia.org/wiki/E...
In economics, an externality or spillover of an economic transaction is an impact on a party that is not directly involved in the transaction.

Incidental healthcare costs are an externality. Industry profits are not.

I support your effort to educate people about the external costs of coal (or anything for that matter.) But you are confusing your argument by comparing it to a non-externality. Putting an externality on one side of an equation opposite an internality simply makes no sense. There is no rational way to judge such an equation. It is irrelevant. If the coal industry causes $60 billion in healthcare costs, that sucks. The profits of the coal industry, whether they be $1 or $1 trillion, don't change the amount of suckiness to the rest of us.

miasmo.com


[ Parent ]
Or rather, internal to the public (0.00 / 0)
People in general pay for the profits, they pay for the losses, and in the end they mostly get back less than they contributed.

[ Parent ]
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