Should we tolerate an increase in preventable deaths? No! | Behavioral Healthcare Executive Skip to content Skip to navigation

Should we tolerate an increase in preventable deaths? No!

January 26, 2015
by Ron Manderscheid
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Yesterday’s Washington Post carried an opinion piece with a totally unacceptable conclusion: The author reasoned that if the preventable death rate increases somewhat as a result of doing away with or removing key components of the Affordable Care Act (ACA), that really is okay, because we need to tolerate a certain level of preventable death in all federal programs to contain costs.

Such dramatically distorted logic in my opinion is exactly the type of thinking that led Adolf Hitler and the leadership of the German Third Reich to ever greater excesses in the killing of millions of persons: routine acceptance of death for a percentage of slave laborers each year, planned euthanasia of specific groups of disabled persons, and ultimately, the Final Solution designed to eliminate all Jews. The steps between tolerating preventable death, promoting it, and ordering it really are quite short indeed.

Let’s dig a little deeper into the author’s conclusion. The ACA is intended to provide insurance coverage and better healthcare principally to those who are poor and near poor, many of whom also are minority persons or disabled persons. Thus, we could rephrase the author’s conclusion in a more direct way: An increase in preventable deaths is tolerable for persons who are poor, who are disabled, or who are minorities, compared with preventable deaths in the remainder of the population.

And to take this logic one further step, we also know that mental illness and substance use conditions occur disproportionately among those who are poor and near poor. In fact, the rates are 6 to 8 times as great in these groups, compared to those who are most wealthy. Here, the author’s conclusion would read: an increase in preventable deaths is tolerable for persons with mental illness and substance use conditions, compared with others who do not suffer from these conditions.

Do you agree with the author’s logic? Doesn’t his position sound dangerously similar to the positions held by leaders of the Third Reich?

For each of these groups, the hidden premise that underlies the tolerability of increases in preventable deaths is crystal clear. Stated most boldly, it is: We do not value these people as much as we value other more wealthy citizens.

Our own Declaration of Independence proudly speaks of our “inalienable rights to life, liberty, and the pursuit of happiness.” The Preamble to our Constitution states a clear mandate to “promote the general welfare." An inalienable right to life is fundamentally incompatible with condoning a tolerable increase in preventable deaths. Likewise, promoting the general welfare is fundamentally incompatible with condoning poor health outcomes and excess mortality.

Building from our Declaration of Independence and our Constitution, we need to achieve recognition of a fundamental human right, accepted since 1946 by the Nations that came together to create the World Health Organization:

All Americans have a fundamental human right to good health.

Our Declaration of Independence also makes clear that “all men are created equal” and our Constitution provides for “equal protection under the law” From these, we can deduce a second fundamental human right:

All Americans have a fundamental human right to be valued equally.



Ron Manderscheid

Exec. Dir., NACBHDD and NARMH

Ron Manderscheid


Ron Manderscheid, Ph.D., serves as the Executive Director of the National Association of County...

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