Will Lack of Insurance Kill You?

You sick of this issue yet? It’ll die soon enough. I’m not trying to keep it going. I’m just posting this for the record. (Posting things helps me keep track of them.)

Over on The Treatment blog, Harold Pollack does a first rate job parsing the issues. He reviews some literature and raises a few points not mentioned recently by others in this debate. His conclusion:

Does health insurance save lives? Almost certainly it does, though the size and the causal pathways of the protective effect remain uncertain. Should we continue epidemiological research to pin down these relationships and improve other, non-insurance strategies to save lives? Absolutely.

On this first money question, then, would universal coverage make people tangibly healthier? You betcha.

Then Pollack turns to the best possible, yet still reasonable, view of McArdle’s article. Unfortunately for her and The Atlantic she didn’t make these points in these ways and blew her own credibility by misrepresenting the evidence. So, I’m happy to let Pollack’s take be the stand in. Here it is:

In addressing the second question, McArdle’s skepticism deserves a more sympathetic hearing. Suppose we accept that universal coverage could save 22,000 lives every year. That’s a large number, but there are other ways to save thousands of lives that are much more cost-effective than expanding health insurance coverage. We systematically neglect these other opportunities.

… More than 400,000 Americans die every year from tobacco use, for example. A stiff increase in cigarette taxes (with the proceeds used to finance other needed tobacco control measures) would probably prevent more deaths than universal health coverage would.

… Ethicist Daniel Callahan muses that every American city includes gleaming hospitals and crumbling schools. That’s not sustainable or wise, even if our only goal were to promote population health. For this reason and others, controlling the long-term growth of health care spending is essential. Health care spending is already crowding out other investments required to address critical national needs.

Nothing I just said provides a good argument against health reform. The economic and health benefits of near-universal coverage are quite large. No wealthy society should allow people to lose their homes because they get sick. Health reform would be a historic achievement. Still, it is only one step we must take to create a healthier and more decent society.

As long a quote as that was it still doesn’t do justice to Pollack’s argument. His post is worth a full read.

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