Read the Literature

Not only do I believe McArdle has badly misread (or not read) the literature on the relationship between health insurance and health outcomes, including mortality, Monday I will publish on this blog a guest post that includes a literature review that illustrates it. Of course, one already exists, it’s just not accessible to everyone. In addition, I’ve already posted a very brief one.

If one knows that literature, McArdle’s statements continue to baffle. In her latest post on the matter she writes,

I think it is possible that the lack of insurance has no effect on aggregate mortality statistics.  I do not think that this is likely, but I think it’s possible.

Mostly what I think is that the statistics are really, really flawed.

And even more stunning,

The mortality question is really important, but it doesn’t touch non-mortality outcomes, which are even harder to measure comprehensively.

Not only are the statistics on mortality and it’s relationship to health insurance not flawed (and certainly not “really, really flawed”), but the connection between insurance and non-mortality health outcomes is extremely well established. I cannot fathom how it could be missed by anyone examining the literature. Measuring the effect of insurance on non-mortality health outcomes is not “even harder,” it is far easier. That’s why health services researchers and health economists do it all the time, and publish the results.

This is incredibly important. People really do suffer and die due to lack of insurance. The empirical evidence bears that out. Meanwhile, policymakers debate (and debate, and debate) what to do. McArdle advises a go slow and/or go small approach based on a misreading of the evidence. If there is one thing I would hope we could agree on it is that that’s a very poor basis for policy prescriptions. My recommendation: read the literature or a credible literature review before claiming to know what it says or what it implies we should do.


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