Wednesday, October 24, 2012

How Many Thousands will Die if the Republicans Win?

Republicans have promised major changes in government policies should they assume power in the upcoming national election.  One proposed change is a broad-based reduction in government regulations.  Reductions in government regulation of air, water, food, drugs and medical devices could have adverse effects on human health. For example, just recently inadequate regulation of a small pharmacy compounder in Massachusetts has resulted in over 300 cases of fungal meningitis with 23 deaths to date.  Nevertheless, until we know which specific regulatory changes would be enacted, we can’t quantify what the impact on human health might be.

However, there are two specific policies that the Republican Party has clearly articulated whose likely impact can be quantified: (1) repeal of the Patient Protection and Affordable Care Act (Obamacare) and (2) banning of abortion.

Mitt Romney and the Republican Party have identified repeal of Obamacare as their number one priority. What effect would such a repeal have?  A 2010 study published in the American Journal of Public Health (Wilper et al) examined the impact of not having health insurance on mortality.  Based on their analysis, the authors estimated that in 2005 there were between 35,000 and 45,000 excess deaths attributable to lack of health insurance among individuals age 18 to 64 in the US. There were 43 million uninsured that year.  The non-partisan Congressional Budget Office estimates that Obamacare by 2022 would reduce by 30 million the number of uninsured otherwise expected in that year.  Thus, repeal of Obamacare would be expected by 2022 to increase the number of deaths annually by approximately 28,000 (~40,000 X 30/43).

As Paul Ryan and Mitt Romney have both clearly stated, a Romney administration would oppose abortion except in a small minority of cases (rape, incest and life of the mother).  Since 2011, the Republican controlled House of Representatives has repeatedly passed bills restricting access to abortion and Republican dominated legislatures in 26 states have also passed anti-abortion laws. Mitt Romney has also said that he would appoint Supreme Court judges who he hopes would overturn the Roe vs. Wade decision which established abortion as a protected choice for women under the US Constitution.

Furthermore, Republicans have attempted to limit access to contraception.  In the so-called Blunt amendment they supported the right of employers or insurers to remove contraception coverage from medical insurance policies and to entitle health care providers to refuse to provide contraceptives. The proposed Personhood Amendment to the US Constitution, endorsed by Mitt Romney, would define life as beginning at fertilization. This amendment would greatly reduce access to contraception by outlawing some of the most commonly used contraceptives because they interfere with implantation of a fertilized ovum.  IUDs are in this category.  Oral contraceptives also fall into this category. Oral contraceptives, while primarily intended to prevent ovulation and fertilization, also impede implantation of ova that do nevertheless manage to get fertilized. 

What would be the expected impact of a US ban on abortion and reduced access to contraception?  Multiple studies have shown that countries with restrictive abortion laws and reduced access to contraception have substantially higher rates of abortion than countries where abortion is legal and contraceptives freely available.  Thus, the likely outcome of the enactment of Republican policies on abortion and contraception would be to substantially increase the number of abortions occurring each year in the United States – the difference would be that all, or nearly all, abortions would be illegal.

The mortality rate for legal abortion in the US is very small (less than the mortality risk of continuing the pregnancy). A ban on abortion would increase maternal mortality because illegal abortions are not likely to be performed in a medically safe manner.  Furthermore, women suffering complications from illegal abortions may be reluctant to seek life-saving medical help if they would face criminal penalties or if they lack health insurance.  Depending on the specifics of the laws banning abortion and limiting access to contraception, I estimate that between 500 and 2,000 additional maternal deaths per year would result. This mortality estimate does not include other complications of illegal abortion such as sterility.

As a consequence of implementing health policies already articulated by the Romney-Ryan ticket and the Republican Party, one can estimate there would be 28,500 or more additional deaths each year in the United States – not to mention the additional non-lethal medical morbidity which would affect a much greater number of individuals.

28,500 deaths per year is equivalent to a 9/11 attack occurring every 5.5 weeks. 

The outcome of the US election on November 6 will not just be a national judgment about candidates’ temperament and political philosophy. For many it will be a matter of life and death.


  1. It is amazing that those that scream as conservatives do not want a woman to have equal pay and the decision as to pregnancy. The junky conservative from Florida talks of morality each day and he has had several marriages that like his drug addiction and false prescriptions for pain medications have had no negatives. He walked away from a prison sentence with 5 years probation.

  2. Rush Lembaugh is his name, racism is his game, and drugs use he proclaimed.

  3. How many would die if Iran completed their plan?