Mythbusting From Megan McArdle
By Paul Hsieh, MD @ 12:05 AM   
Megan McArdle asks the provocative question, "Everyone knows that people without health insurance are more likely to die. But are they?"
Here's an excerpt from the article in the March 2010 Atlantic, "Myth Diagnosis":...If we lost our insurance, would this gargantuan new entitlement [of government-guaranteed health insurance] really be the only thing standing between us and an early grave?
Perhaps few people were asking, because the question sounds so stupid. Health insurance buys you health care. Health care is supposed to save your life. So if you don’t have someone buying you health care well, you can complete the syllogism.
Last year's national debate on health-care legislation tended to dwell on either heart-wrenching anecdotes about costly, unattainable medical treatments, or arcane battles over how many people in the United States lacked insurance. Republicans rarely plumbed the connection between insurance and mortality, presumably because they would look foolish and heartless if they expressed any doubt about health insurance’s benefits. It was politically safer to harp on the potential problems of government interventions -- or, in extremis, to point out that more than half the uninsured were either affluent, lacking citizenship, or already eligible for government programs in which they hadn't bothered to enroll.
Even Democratic politicians made curiously little of the plight of the uninsured. Instead, they focused on cost control, so much so that you might have thought that covering the uninsured was a happy side effect of really throttling back the rate of growth in Medicare spending. When progressive politicians or journalists did address the disadvantages of being uninsured, they often fell back on the same data Klein had used: a 2008 report from the Urban Institute that estimated that about 20,000 people were dying every year for lack of health insurance.
But when you probe that claim, its accuracy is open to question... McArdle raises a similar point in her February 10, 2010 essay, "How Many People Die From Lack of Health Insurance?":...Probably the best one looked at patients who had been taken to the ER, which still showed higher mortality for the uninsured. But it's not clear that this indicates that lacking insurance is dangerous; it may be telling us that people who lack insurance have a lot of factors that lead to poorer health outcomes.
To my mind probably the single most solid piece of evidence is this: turning 65 -- i.e., going on Medicare -- doesn't reduce your risk of dying. If lack of insurance leads to death, then that should show up as a discontinuity in the mortality rate around the age of 65. It doesn't. There are some caveats -- if the effects are sufficiently long term, then it's hard to measure, because of course as elderly people age, their mortality rate starts rising dramatically. But still, there should be some kink in the curve, and in the best data we have, it just isn't there. McArdle highlights the greatly under-appreciated concept that "coverage" is not care.
Insurance is a particular method of financing medical care, but is distinct from actual medical care, just like automobile insurance is distinct from the actual services rendered by a mechanic in an auto repair shop.
Too many politicians conflate insurance "coverage" with care. And by imposing government policies that attempt to guarantee theoretical "coverage" (as in Massachusetts), they hinder people's ability to receive actual medical care.Labels: Analysis, Insurance
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