The ACA and the white working class

When Bill Gardner this morning pointed out, as many have, that Americans approve of the core components of the ACA but disapprove of the law, I expected the corollary to be "slander works," or"it's really hard to communicate how these moving parts fit together," or some combination of the two.

Instead, I was confronted with this chart from a paper by Henry Aaron and Gary Burtless:

Is health insurance worth the money? Would you do without it?

A rigorous study* of the effects of health reform in Massachusetts since its 2006 launch yielded powerful evidence that the state's expansion of access to health insurance improved health and reduced mortality, particularly among poorer citizens. Adrianna McIntyre summarizes the core finding:

Benjamin Sommers, Sharon Long, and Katherine Baicker estimate that overall mortality in Massachusetts declined 2.9 percent relative to control counties between 2007 and 2010; mortality amenable to health care declined 4.5 percent. This translates to one death prevented for every 830 people who gain insurance, and the effects were larger in counties with low income and low pre-reform insurance rates—the counties we would expect to be most favorably impacted by reform.

Health economists, as is their wont, have put  (tentative) price tags on lives saved.  The ever-humane Harold Pollack pegged the cost-per-life at $3.3 million, adding the essential caveat:

The "I want the best" quality measure in healthcare

On The Incidental Economist, Bill Gardner rather wearily brushes off claims, based on personal experience, that the U.S. has "the best healthcare in the world." He outsources to Aaron Carroll the marshaling of evidence that "on most important measures, the US has poorer quality of care than comparable countries" and concentrates on a prior question: what do we mean by quality of care? He then offers a breakdown of quality measures which, for policy purposes, may be comprehensive, but which I think misses a dimension that may be in the minds of many who claim "best" status for the U.S. Here are Gardner's "dimensions of health quality*":

• The hotel experience. Some hospitals are nicer places to stay than others. This may seem trivial in the context of life and death, but any hospital manager will tell you that ‘hotel quality’ matters to patients.
• The relationship experience. Did the health care providers treat you with respect? Were they considerate of your religious beliefs? The well-educated readers of this blog may have difficulty imagining that they would not be well-treated by health care providers. But disrespect may be a primary consideration if you are poor, speak a language other than English, live outside the mainstream culture, or are mentally ill.
• The rightness of treatments. By the ‘right’ treatment, I mean the one that was most likely to benefit you.
• Safety. Were you harmed through error or neglect while you were in care?

In response, I posted this comment: