Insurance Status and Mortality

A few points on the insurance status and mortality debate:

— Normally we require overwhelming empirical data to overturn a principle that has strong theoretical support.

— The empirical data to support the “insurance status doesn’t impact mortality” conclusion is not overwhelming.

— The Institute of Medicine estimates about 18,000 excess deaths annually due to lack of health insurance.

— A Harvard Medical School study finds 45,000 excess deaths.

— Numerous small-scope studies also support this conclusion:

— Insurance coverage status effects mortality rate in pediatric trauma patients.

— Uninsured adults are almost twice as likely as insured adults to die after blunt or penetrating trauma.

— Studies of broader metrics of health show a robust link between insurance status and health.

— The outcomes of these studies appear to rely significantly on exactly how you specify the model in terms of control variables, which I think is again a reason to be skeptical of overturning the theoretically sound conclusion that insurance saves lives.

— Publicly subsidized health insurance should improve the financial well-being of its recipients, and the linkages between financial well-being and health also appear robust.

— I don’t believe that the people touting these studies really believe them; if widespread beliefs about the desirability of health insurance are totally wrong, this should have dramatic policy implications that should be explored.

— It’s true that there are major inefficiencies in the health care system, and one of the main goals of the health reform plan before congress is to reduce them.

Bottom-line: I’m happy to say that if I were dictator and were about to increase expenditures on public services by $80 billion per year, increasing the number of Americans with comprehensive health insurance would not be my first choice for use of the money but this isn’t the choice-set available. The real issue in the health reform debate, I think, is that many people think that keeping the tax share of GDP low is very important for economic growth. I think that, rather than anything about health care, is the issue that America usually debates in an evidence-free manner.