In principal health care doesn’t require insurance. In practice lack of insurance poses significant barriers to access and affordability of care. Please do try to keep the issues straight. There are empirical findings (see lit tomorrow’s post) and there is what you want the world to be like. Those are different things.

Is it INSURANCE that causes better health and lower mortality or HEALTH CARE. Because I don’t need the one [insurance] to have the other [health care] – and having the one [insurance] may not lead to the other [health care].

For those with annual incomes over around $150,000 there is a pretty good argument for self insuring up to say $10,000 a year [my doctor discounted my bill 50% when I paid cash]

Catastrophic coverage for the big C and other extraordinary events would seem to make sense for 90% or so of that group…

I really do wish the answer to “the first part” was as clear as you feel it is…

As to how reforms will affect individuals and the market, I think the burden of proof is on proponents of reform. But recognize that’s not an empirical question. It can be informed by evidence but it requires projection into the future. However, an honest view also examines the projection of the status quo.

I look forward to reading tomorrows post – and I have TRIED to stay open minded on this issue – but I get a bit nervous when people suggest that the burden in on us skeptics [and use loaded terms like deniers to describe me].

What is being proposed is a system that would FORCE people to initially get insurance and taken to a logical conclusion FORCE people to get health care.

I would argue that there is at least some minimal obligation on the part of “true believers” to show that I will not be harmed by being forced into this sort of system.

Another question that I cannot get answered is where will the supply come from to meet the increased demand for health care services – and how are we going to know that the added supply of health care is of the same [or better] quality as the existing supply.

If some of my doctor friends are to be believed we face the possibility that supply might of quality health care might actually decline.

I see the two questions related – if we want more health care and believe that it is a good thing then we have to find ways to expand the supply of quality health care – or am I missing something…

And great post Glen R.!

The post tomorrow that reviews the literature (or the subset of it that fits in a blog-length piece) is not by me, but is a guest post by someone who knows that literature far better. The post will also reference a lengthier review so one can find more on this if one wishes (I’ve already cited it in my posts actually). I am not at liberty to make sure the review satisfies any particular request for content. It will be what it will be, but it should be quite a sufficient review and far more thorough than McArdle’s.

When you collect your studies for tomorrow, what we really want is a demonstration that if you ran the Rand Experiment again today you wouldn’t get the same result – that people who paid for their own care used half as much but were roughly as healthy as those who got “free” care. We want to see svidence that more heath care results in better health *outcomes* – not just input measurements like blood pressure but mortality or quality-of-life – and that it does so in a general population – not just a population suffering from a specific problem – and does so to a degree that isn’t explainable as the result of selection bias or placebo effect.

The conventional wisdom is based on medical studies. There are vast numbers of medical studies showing that in a population with exactly one specific carefully-diagnosed condition and no confounding other conditions, an expert spefcialist who is competently following a specific protocol will produce better results than one following some other protocol. Sometimes there’s even a “control” group. There is a huge selection bias effect in that studies that didn’t find the treatment to work usually don’t get published, but even when the study finding is reliable, it’s not clear how well it extends to less-competent doctors treating patients who have multiple problems and might have been misdiagnosed. The long-term results of following a “do nothing” option often isn’t considered ethical so Christian Scientists might be one of the few populations where you could find cases where that option is seriously practiced.

I look forward to reading what you have to share tomorrow. My problem with many of the studies that some find convincing is that they rely on samples that are flawed. For example – I will agree that folks who are unemployed are less healthy than the employed – but that does not convince me the CAUSE of their relatively poor health is lack of insurance when it might very well be that they are less healthy due to a lack of a job.

My only point in asking if someone had done a scientific study of those who choose not to engage in traditional health care – the Christian Scientists are only one possibility – was that this might be a way of controlling for things like employment, social status, income, etc…

If that were true we would have seen numerous studies providing comparisons of the relative health of those using health care and those who for religious reasons do not – Christian Scientists are certainly a large enough sample to provide the proof to the health care makes people healthier argument.

If such a study exists I have yet to see it referenced.

http://www.cato-unbound.org/2007/09/10/robin-hanson/cut-medicine-in-half/