Back around 2007 the private health insurance industry worked to get state insurance regulation boards to allow the insurance industry to pre-approve treatment they would pay for. California was the main state, and the only one I can find published evidence that they did, to deny the health insurance the right to deny health care that they did not want to pay for. Since then, California has moved to have the best change in middle age death rates from 2007 to 2019, the last year before COIVID. The states’s numbers on the above map shows the percent of their age 25 through 64 deaths that would not have happened if that state had experienced California’s annual percent change in their death rate. During this time the non-California age 25 through 64 population experienced 7,513,336 deaths. If they had followed California’s changing death rates during this time would have been 6,987,738. In other words, 525,598 or seven percent of those middle aged deaths in the other states would not have happened if their death rates had changed like California’s. The states’s numbers on the graph shows the percent of the states’s middle age deaths from 2007 to 2019 that the health insurance industry’s denial of care has caused. Or, we can see that California’s age 25-64 death rate changed from 306.6 deaths per 100,000 to 297.2 while the rest of the United States increased from 381.2 to 410.3 on the same measure. For example, West Virginia’s. 113,511 middle aged deaths would have only been 76,140, or from 670.9 to 570.8 deaths per 100,000 in 2019, if their death rate had changed in the same direction and percent California’s did.
Why is California different? It is because Natalie Sarkisyan died in December of 2007 when the health insurance industry was trying to get approval for the system of requiring patients to get prior approval for them to pay for health care. She died a few hours after the insurance company, after denying care three times, finally agreed to pay for a transplant because their denying her care was getting too much publicity. With help from the California nurse’s organization, her parents got substantial publicity. An internet search for her unique name fourteen years after she died comes up with more than 2,500 hits. The publicity about how the health insurance industry caused her death seems to have caused California to most thoroughly deny the health insurance industry the right to deny care through a pre-care approval process. This denial sets up an accidental control experiment that lets us see how the introduction of this way for the health insurance to deny care caused additional deaths. California gets to play the role of control group and the other 49 states get to be, or repeat being 48 times, the experimental groups to measure the effect of letting health insurance companies deny care on death rates.
There is another aspect of this unique event and the relationship to California mortality described in chapter VII of the book Deadly Spin by Wendell Potter. Potter was a high executive in health insurance public relations when she died and his experience using public relations tools to take the blame for her death away from a private health insurance company, caused him to leave the health insurance industry and write the best description we have of how the private health insurance industry makes more money by denying care. (If anyone knows how to reach him without paying him, let me know. I just want to let him see some empirical results that supports his argument).
How did I come to look at this? A couple of years ago when I was playing with mortality data, I found this unusual set of changes in our death rates by age, our middle aged deaths rates were going up and our elderly death rates were going down. On my next doctor’s visit, I asked him if he knew what was causing it. He said: “Health insurance is denying care.” He also asked that if I wrote about this to not use his name.
The source of the mortality data for this is the “Underlying Cause of Death” link at wonder.cdc.gov. If you go play with this data source for an hour or so you will be amazed at how much you can find out about how we are dying. It is free and available almost all the time, I can even access it when my access to the internet is only through my cell phone.