[vwinsyee]

> Hospitals don't let uninsured people die and insuring people doesn't magically save their lives.

Not sure where you're getting this. A quick Google Scholar or PubMed search shows a consensus that mortality rate is significantly higher for uninsured than for insured. [1, 2, 3]

[1] e.g. http://jpubhealth.oxfordjournals.org/content/32/2/236.short -- On multivariate analysis, uninsured compared with insured patients had an increased mortality risk (odds ratio: 1.60, 95% CI: 1.45–1.76). The excess mortality in uninsured children in the US was 37.8%, or 16 787, of the 38 649 deaths over the 18 period of the study. Children who were hospitalized without insurance have significantly increased all-cause in-hospital mortality as compared with children who present with insurance.

[2] e.g. http://journals.lww.com/jtrauma/Abstract/2012/11000/Undiagno... -- Undiagnosed preexisting comorbidities play a crucial role in determining outcomes following trauma. Diagnosis of medical comorbidities may be a marker of access to health care and may be associated with treatment, which may explain the gap in mortality rates between insured and uninsured trauma patients.

[3] e.g. https://www.sciencedirect.com/science/article/pii/S000296101... -- A total of 1,203,243 patients were analyzed, with a mortality rate of 3.7%. The death rate was significantly higher in penetrating trauma patients versus blunt trauma patients (7.9% vs 3.0%; P < .001), and higher in the uninsured (5.3% vs 3.2%; P < .001). On multivariate analysis, uninsured patients had an increased odds of death than insured patients, in both penetrating and blunt trauma patients.

[trhway]

>mortality rate is significantly higher for uninsured than for insured.

correlation doesn't mean causation.

>to help make our government work better

i somehow doubt that throwing a team of "rockstars" to clean up the mess is making the government to work better. If anything, it enables the typical government behavior we saw in the case of healthcare.gov.

[vwinsyee]

> correlation doesn't mean causation.

As a statistician, I guess I should be happy that more people are aware of this. But I also think too many people are taking "correlation != causation" superficially. I mean, almost all of science is based on significant correlational findings, especially when the traditional way to prove causation (i.e. via randomized trial) is unethical (i.e. we can't randomly assign people to be insured vs. uninsured).

Along these lines, I often find people who say "correlation != causation" don't stop and wonder "so how _can_ we prove causation (in a non-randomized study)?" I guess many of them can be partially excused since the answer is non-trivial. But generally, here's a few rules of thumb for making a stronger case for causality from correlation:

* the effect size is relatively large (e.g. uninsured children die at 60% higher odds than insured children)

* the cause comes before the effect (e.g. people are uninsured before they go to the hospital and/or die)

* reversible association (e.g. risk of dying at a hospital changes when people get insurance)

* consistency / consensus across multiple studies (e.g. many studies showing that a difference in insurance status is associated with a significant difference in hospital mortality )

* dose-response relationship (e.g. I didn't link examples previously -- but there were a few studies showing that different levels of insurance, from none to Medicaid to private, is associated with different rates of hospital mortality)

* plausibility (e.g. even from a qualitative point of view, it's quite believable that people who unable to pay a hospital bill might get worse service)

[DanielRibeiro]

Please turn this into a blog post and submit it to HN. I'd love to see this comment about correlations see more attention ;)

[Fomite]

I just submitted this: https://news.ycombinator.com/item?id=7317254 which is the CrossValidated (StackOverflow for stats) discussion of whether or not causation implies correlation.

[gizmo686]

All good points, but you also should consider the plausibility of it being a correlation. By this I mean that there seem to be clear candidates for a common cause between no insurance and high mortality, for example: income.

Once you control for this, and other potential common causes, your case for causality becomes much stronger (or non-existent).

[Fomite]

If you had read the paper linked above, you'd note they controlled for income.

[aero142]

Many people believe that the Oregon Health Study is the best chance we have of teasing causation out of the data. It is still in progress but it is being watched closely. http://oregonhealthstudy.org/

[tunesmith]

To clarify, this is because they actually did what would normally be unethical: they randomly assigned citizens to be eligible for the insurance plan. It was a lottery.

[anon808]

so are you saying not having health insurance is better for people? I'll take the common sense angle that having health insurance increases the chances of medical care being applied to a health problem, versus not having any health care insurance.

there's no such thing as a monolithic 'government' being that can either work better or be enabled to act a certain way. there are people, and groups of people that do certain things. some of those things are worthless, some of those things are worthwhile. i'd argue the mess the 'rock stars' cleaned up is a generally positive activity.

[trhway]

>so are you saying not having health insurance is better for people?

i'm just saying that being from a poor or damaged family, uneducated, having mental illness or substance abuse problem, etc... usually leads to higher mortality and also to not having health insurance. Giving them a health insurance [i'm all for it, i think modern civilized society should provide basic level of free health insurance to everybody] would be inconsequential in many cases as not having the insurance isn't the cause, just a manifestation.

>there's no such thing as a monolithic 'government' being that can either work better or be enabled to act a certain way.

http://en.wikipedia.org/wiki/Systems_theory

and if we specifically consider a closed loop system of "government + society" then this may be of interest too:

http://en.wikipedia.org/wiki/Cybernetics

[saraid216]

I completely support the conclusion that we should be fixing our third variables.