Nicholas Kristof had a fine proposal in his column yesterday: if Congress fails to pass health care reform by the end of the year, he argued, its members should agree to become true representatives of the American people. Legislators should "surrender health insurance in proportion with the American population that is uninsured."

Under this formula, 15 percent of Senators and Representatives (and their families) would get no coverage. Another 8 percent would get inadequate coverage. For those who argue extending coverage to more people is too expensive, "here’s their chance to save government dollars in keeping with their own priorities."

Big deal, some will say (though I suspect no members of Congress would dare say this): so a few legislators would have to make their way to emergency rooms for treatment. The government’s role should be to protect Americans from lethal threats – terrorism, hostile states – and nothing else. Yet it turns out that America’s health care system is a lethal threat. Kristof’s column linked to this recently published Harvard study, which found that lack of access to medical insurance causes nearly 45,000 excess deaths every year.

The figure represents a sharp rise from the 18,000 excess deaths estimated in a 2002 study by the Institute of Medicine, completed at a time when the quality of treatment for those who could afford it was less advanced and the medical safety net was not as frayed. If you’ve been online for more than ten minutes by now, that means there’s a good chance the death toll just ticked up by one. "The Institute of Medicine, using older studies, estimated that one American dies every 30 minutes from lack of health insurance," said David Himmelstein, co-author of the Harvard study. "Even this grim figure is an underestimate — now one dies every 12 minutes."