May 6, 2010
Is there strong empirical evidence that expanding health insurance significantly improves health outcomes? The answer, according to a scrupulous review of the literature by health economists Helen Levy and David Meltzer, is no.
Despite years of research, the question of whether health insurance has a substantial impact on health "remains largely unanswered at the level of detail needed to inform policy decisions," they wrote in a 2008 journal article. While it seems clear that insurance boosts the health of certain groups -- infants, children, AIDS patients -- and helps address various conditions in adults, such as high blood pressure, "for most of the population at risk of being uninsured (adults ages 19 to 50), we have limited reliable evidence on how health insurance affects health."
According to Levy and Meltzer:
- The biggest reason is that insurance coverage and health status are usually dependent, at least in part, on common variables, such as income, education and lifestyle.
- Also, health status itself can have a direct influence on coverage, since sick people sometimes lose their jobs or get dropped by their insurance companies.
- Therefore, the fact that someone with insurance is healthier than someone without it may not be caused by the latter's lack of coverage.
The ObamaCare debate primarily concerns the effects of insurance on the adult population, rather than on the subgroups just mentioned, and stressed that the relevant studies fail to compare alternative policies for improving general health results. There is no evidence, says Michael Cannon, a scholar with the Cato Institute, that broadening insurance coverage saves more lives for every dollar spent than do other health interventions.
We should thus be skeptical of claims that ObamaCare will dramatically reduce U.S. mortality rates, says Levy. Throughout the debate, Americans have repeatedly heard mind-boggling statistics about the number of people who die for want of health insurance.
Source: Duncan Currie, "Hardly Healthier," National Review, April 19, 2010.
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