With all this misinformation propagated by health insurance reform opponents, especially the evocative “death panels”, I decided to review how life and death decisions are made now for people who are excluded from the system today. Rather than try to gather information on every manner of illness and disease, and the impact of being uninsured, it seemed more practical to choose a single common, but deadly, disease, and understand the data in this more narrow view. Cancer seems the most logical disease to review. First, it’s important to understand actual life threatening emergencies, the COBRA of 1985 made it illegal for any medical provider who accepts Medicare or Medicaid dollars to deny emergency treatment to anyone on the basis of their ability to pay. This covers about 99% of doctors and hospitals. That’s the good news.

The bad news, especially with regards to cancer, is that by the time an individual is in such dire condition that they need emergency care, their chances of survival are far less than those whose cancer was discovered earlier.

Before considering a comparison between the insured and uninsured, it’s important to understand why people are uninsured. Clearly, some individuals are uninsured by economic choice (they could afford it, but choose not to for economic reasons), and others by empirical economic realities (they simply cannot afford health insurance), and others are uninsured because they simply cannot qualify for health insurance coverage. There are also a small percentage of people who are uninsured for non-economic reasons, religious, moral, ideological, and the like. In all of the current health insurance reform proposals, a level of mandatory insurance is proposed for all American, and denial of coverage or price discrimination of individuals with pre-existing conditions is prohibited. So let’s look at the difference this might make in the mortality rates of cancer victims who are currently uninsured.

An American Cancer Society study shows that about 20,000 uninsured individuals die of cancer each year. The study further finds that uninsured individuals are 50% more likely to die in the first five years than insured individuals. This means that of approximately 57,000 uninsured diagnosed with cancer, 35% die within five years, while of their insured counterparts, 23% percent die within the first five years. In raw numbers, that equates to about 7000 people each year, whose death is clearly correlated, and arguably caused, by a lack of insurance.

I submit that the current health insurance system, which is being aggressively protected by the GOP, effectively lines these 7000 people up in front of metaphorical death panels and deems them too insignificant to live. And remember, this is ONE disease, one potential cause of death.

Looking at the broader picture, a study by Brigham and Women’s Hospital found that the uninsured between the ages of 50 and 64 are 43% more likely to die than their insured counterparts. This adds up to 105,000 people each year whose death is directly correlated to their lack of insurance. The authors noted that if being uninsured were a disease, it would qualify as the third leading cause of death in America for that group.

Opponents of reform might argue that the US has lower wait times than countries with universal healthcare, suggesting that lower wait times insure early treatment and save more lives. While it is true that the US has lower wait times, the conclusion that it equates to more lives saved is false. The actual results, as compared to universal health plans are better in countries with universal coverage, with higher life expectancies, overall performance, and lower cost. Lower US wait times are a statistical anomaly caused by the fact that people without coverage are statistically under-represented because they are far less likely to try and schedule treatment or care at all. Essentially, the wait times for some of the uninsured are infinite, but since no appointments are made, the wait times are skewed to show a misleading lower wait time average. Reform opponents actually acknowledge this fact in their arguments, but do not understand the implications. They say that if you add 50 million insured, there will be more people to make appointments, so wait times will have to go up, essentially arguing that they want their wait times lower at the cost of sacrificing care for other Americans. All this, ignoring that fact that broader coverage, not lower wait times are more significant elements to improved healthcare performance.

Additionally, while Republicans talk about the government sentencing people to death because they will cost to much, the private vs. public rality tells a far different story. The big public insurance plans available today, Medicare, Tricare, and the VA have NO maximum limit on lifetime benefits. Two Thirds of private health insurance plans DO have lifetime limits, creating an automatic "death panel" for those who cost the insurance company too much.

The “death panel” boogeyman propagated by the GOP is pure fiction, an invented scare tactic designed to provoke fear among older Americans who are already covered by Medicare, so have no vested interest in seeing health insurance reform, but are a very powerful and active constituency if they can be swayed to oppose health insurance reform. But our current system, in contrast with proposed mandatory insurance coverage, kills 105,000 individuals each year, essentially lining them up in front of an economic policy “death panel” and telling them the current system must be protected and their lives are a worthwhile sacrifice to this goal.

The “death panels” we have heard about are fictional, but the Republican policy “death panels”, though metaphorical, are real in their impact on the lives and deaths of real Americans today.