A couple of PA state legislators have recently cited a recent Harvard study to make the claim that thousands “are dying because of a lack of insurance” and that is why we “need health care reform now”. Unfortunately, the health care “reform” they support would likely do little to improve health care.
For starters, it should be obvious even to casual readers that a lack of insurance is not a cause of death, but heart disease, cancer, and the like are. What studies like the Harvard piece do is note that the uninsured have worse health outcomes than those with coverage, and conclude that the uninsured are worse off. Even then, there is a huge difference between causation – i.e. “lack of health insurance kills,” – and correlation – i.e. “those who don’t buy health insurance are more likely to take poor care with their health.”
But one thing that is important to note is that individuals on government-run programs in the US (not to mention Canada and elsewhere) also have worse outcomes than those privately insured – and, in many cases, worse than the uninsured – and receive lower quality care. Note that the Harvard study excluded everyone on government health insurance from their analysis.
In fact, despite attacks on “greedy health insurance companies”, the insurer most likely to deny claims is Medicare – with a denial rate twice that of private insurers. Thus, given the quality of government coverage, it hardly makes sense to support more government-run health care.
Instead, lawmakers should look to free market solutions to make private coverage more affordable, and give patients more control on health care. This point was very aptly made in a recent Atlantic article by David Goldhill titled How American Health Care Killed My Father, which I recommend reading:
[T]he persistence of bad industry practices—from long lines at the doctor’s office to ever-rising prices to astonishing numbers of preventable deaths—seems beyond all normal logic, and must have an underlying cause. There needs to be a business reason why an industry, year in and year out, would be able to get away with poor customer service, unaffordable prices, and uneven results—a reason my father and so many others are unnecessarily killed.
Like every grieving family member, I looked for someone to blame for my father’s death. But my dad’s doctors weren’t incompetent—on the contrary, his hospital physicians were smart, thoughtful, and hard-working. Nor is he dead because of indifferent nursing—without exception, his nurses were dedicated and compassionate. Nor from financial limitations—he was a Medicare patient, and the issue of expense was never once raised. There were no greedy pharmaceutical companies, evil health insurers, or other popular villains in his particular tragedy.
Indeed, I suspect that our collective search for villains—for someone to blame—has distracted us and our political leaders from addressing the fundamental causes of our nation’s health-care crisis. All of the actors in health care—from doctors to insurers to pharmaceutical companies—work in a heavily regulated, massively subsidized industry full of structural distortions. They all want to serve patients well. But they also all behave rationally in response to the economic incentives those distortions create. Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results. Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity, and discourage transparent competition based on price or quality. That result in a generational pyramid scheme rather than sustainable financing. And that—most important—remove consumers from our irreplaceable role as the ultimate ensurer of value.