“The day that this country ceases to be free for irreligion, it will cease to be free for religion — except for the sect that can win political power.”
—  Justice Robert H. Jackson, Zorach v. Clauson, 343 U.S. 306, 232 (1952)

“Life is like playing a violin in public and learning the instrument as one goes on.”
— Samuel Butler

“When I put on the robe, I am also reminded that under our Constitution, it is for this body, the people’s representatives, to make new laws.  For the executive to ensure those laws are faithfully enforced.  And for neutral and independent judges to apply the law in the people’s disputes.  If judges were just secret legislators, declaring not what the law is but what they would like it to be, the very idea of a government by the people and for the people would be at risk.”
— Neil Gorsuch, opening statement to Senate Judiciary Committee, March 20, 2017

Scott Pelley: “How do you fix it?”
Donald Trump: “There’s many different ways, by the way. Everybody’s got to be covered. This is an un-Republican thing for me to say because a lot of times they say, ‘No, no, the lower 25 percent that can’t afford private.’ But–”
Scott Pelley: “Universal health care?”
Donald Trump: “I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.”
— Donald J. Trump, interview on 60 Minutes, Sept. 27, 2016

Last week, Republicans in the U.S. House of Representatives pushed their “American Health Care Act” — their promised replacement for the Affordable Care Act (“ACA”), a/k/a “Obamacare” — through two House committees in marathon meetings.  They did so even though the text of the bill was keep secret until two days before those committee hearings, and even though the Congressional Budget Office (“CBO”) had not issued its estimate, or “score,” of the probable impact on that bill on the federal budget and on the number of persons in the U.S. who have health insurance.

Now we know the CBO’s scoring.  It issued an estimate today that the Republican bill will cause 24 million people to lose their health insurance coverage.  Specifically, the CBO estimated that by next year, 14 million people will lose their coverage, compared with levels under “Obamacare,” and that number will grow to 24 billion by 2026 as a result of cuts to Medicaid that are supposed to take effect beginning in 2020.

What will be the impact of that 24 million person increase in the ranks of the uninsured on death rates in the U.S.?  The CBO report is silent on that subject.  However, we can calculate the probable change in the death rate by extrapolating from a 2009 study, conducted by Harvard Medical School and the Cambridge Health Alliance, that was published in the American Journal of Public Health.

That study estimated that, at a time when there were about 50 million people in the United States without health insurance:

• The mortality rate for the uninsured was 40% higher than the mortality rate for people who had health insurance; and
• About 45,000 people per year died as a result of their lack of health insurance.

With 24 million people losing health insurance as a result of this new law, should it be passed, that translates to about 21,600 additional deaths per year.  That means that, on average, one person would die every 24 minutes as a result of this bill.  That does not include the people who would have to file for bankruptcy because they had incurred medical bills that, now, are covered by the ACA.

This could be an optimistic estimate.  Conservative Republicans in the House are reportedly insisting on introducing cuts to Medicaid in 2018, as opposed to the plans in the current bill to make them effective in 2020.  Any changes to this bill that would make health care even less affordable would increase the uninsurance rates even higher and would increase the death rates above these estimates.

There is a simple word to describe what the Republicans are proposing to do.  That word is “murder.”  The Republican Party is proposing to murder some 21,600 people each year, year in and year out, by making health insurance unaffordable for tens of millions of people.

My use of that word is not hyperbole.  The Colorado statute setting forth the elements of murder in the first degree provides that a person is guilty of that crime if he or she:

Under circumstances evidencing an attitude of universal malice manifesting extreme indifference to the value of human life generally, he knowingly engages in conduct which creates a grave risk of death to a person, or persons, other than himself, and thereby causes the death of another.

C.R.S. § 18-3-102(1)(d) (2016).

Any person, and in particular any politician elected to public office, who knowingly passes a law that a bipartisan office of the United States Congress reports will lead to 24 million people losing their health insurance, at a predictable cost of hundreds of thousands of lives within just the first ten years, has displayed “an attitude of universal malice manifesting extreme indifference to the value of human life generally.”  That legislative act would create “a grave risk of death to a person, or persons,” other than to the legislator, and would “cause[ ] the death of another.”  Any Republican legislator who objects to this analysis should be required to explain why he or she is moving forward with a bill that will cause this level of death, disease, bankruptcy and personal despair.

And if any Republican believes that this term is still too harsh, that person should admit that the “American Health Care Act” will cause hundreds of thousands of people to die prematurely.  Sarah Palin and some Republicans in Congress made the memorable and wildly inaccurate claim that the ACA would lead to, if not require, the establishment of “death panels” for Americans.  Those who falsely proclaimed “death panels” should not be heard to complain when they are, themselves, part of the real death panels that will lead, inevitably, to massive and unnecessary levels of death.

It is not settled that this bill will become law.  As a result of public outrage and totally justified fears about the result of this effort to repeal the ACA with an extremely flawed and grossly inadequate substitute, Congressional Republicans may yet abandon to repeal and replace Obamacare.  They may yet decide to improve the law, rather than to try to replace it.  But given the Republicans’ refusal to even delay consideration of this bill until after they had received the CBO scores, that appears highly unlikely.

“I firmly believe that nobody will be worse off financially in the process that we’re going through, understanding that they’ll have choices that they can select the kind of coverage that they want for themselves and for their family, not the government forces them to buy.”
— Tom Price, Secretary of Health and Human Services, March 12, 2017

     “That’s what America is about. A land of dreams and opportunity. There were other immigrants who came here in the bottom of slave ships, worked even longer, even harder for less. But they too had a dream that one day their sons, daughters, grandsons, granddaughters, great grandsons, great granddaughters might pursue prosperity and happiness in this land.”
— Benjamin Solomon “Ben” Carson Sr., M.D., Secretary of Housing and Urban Development, March 6, 2017

“When a man wants to murder a tiger, he calls it sport: when the tiger wants to murder him, he calls it ferocity.  The distinction between crime and justice is no greater.”
— George Bernard Shaw

“Ignorance is degrading when found in company with riches.”
— Arthur Schopenhauer