Some of You Will Have to Die

I’m very sorry to have to tell you this, but we’re going to have to let some of you go. Actually, by that, I mean die. All of us have to die someday, but unfortunately some of you are going to have to die sooner than you might otherwise prefer. We’re being obliged by circumstance to “downsize” some of you … to nothingness. We aren’t sure how many of you we will have to “let go” just yet. We’ll know more after the election.

You see, if the Republicans win the White House, the House, and the Senate in November, Mitt Romney and the GOP have sworn on a stack of Bibles that they will repeal the Affordable Care Act. But, even if they don’t win the big enchilada, they’re still going to require some sacrifice on your part.

Sitting Republican Governors in at least six states have announced that, thanks to the recent Supreme Court decision, they will choose not to expand their state Medicaid programs. So that means that some of you will have to die. We don’t know how many just yet. The numbers have been crunched, and they tell us quite clearly that the failure to expand Medicaid nationwide will cost lives. And, well, honestly, they’ll have to be some of yours. So … sorry.

It’s all right there in black and white. In a study published in the New England Journal of Medicine, researchers looked at the effects of expanding Medicaid in three states and came to the inescapable, fact-based conclusion that the expanding Medicaid is associated with a decline in deaths. Simply having Medicaid in place meant that 2,840 fewer people died each year for every 500,000 adults who were added to the roles.

And that’s on top of an earlier study by Harvard Medical School, which found that 45,000 Americans die each year just because they lack health insurance. They do risky things like not going to the doctor simply because they can’t afford it. And their kidneys fail or their wounds go septic or their appendixes burst. I’m afraid we can all agree that impoverished, ill-educated sick people are sometimes crappy at making complex medical judgments.

So, let’s just do some back-of-the-envelope calculations here: the Affordable Care Act was set to expand Medicaid to cover an additional 17 million people.

If the Republicans win the whole ball of wax and repeal Obamacare and don’t replace it immediately with something else that covers 17 million people, that means about 100,000 Americans will die prematurely. Every year. I know it’s ugly, but it’s all right there in the spreadsheet.

Now, I know that may seem harsh to some of you. But at least it means that the “job creators” like Mitt Romney, who of course doesn’t technically create any jobs, will have their low tax rates kept alive. It’s what they like to call a “trade off.” I’m sure you understand.

On the bright side of things, if Obama wins, and the GOP can’t repeal “Obamacare,” you’ll only have those GOP governors to worry about. Taken together, their decision to opt-out of Medicaid expansion would only shrink the Medicaid roles by about 4 million people. That means just 22,720 people would have to die earlier than they might prefer.

Now let me single out those of you who live Massachusetts. You can relax. Romneycare means that about 98 percent of the state’s residents are insured. But as Romney himself has proclaimed that “the genius of federalism … encourages experimentation.” So in Massachusetts, we’re experimenting with universal access, and in Texas, those geniuses will be experimenting with cutting access and letting more poor people die. I guess the bright side is that all of those deaths will certainly create some job openings. Yeah, they’re crappy, low-paying jobs without benefits, but hey, at least you’re not dead.

We realize that this is not the outcome some of you might prefer. We understand your concerns. But it’s either letting you die or doing something truly ghastly, like raising taxes. We have had to make some hard choices. And it’s just an unfortunate coincidence that all of the choices we make are just hard on you: the poor.