Who Will Save You

I have a Medicare card. It kicks in next month. I can say goodbye to extortionate insurance company premiums and micromanagement of my medical care. Good riddance.

Yet a study published 30 years ago by the RAND Corporation says that my health won’t improve. So if better health insurance won’t save me, who or what will?

Conservative columnist Ross Douthat wrote in the New York Times last week under the title What Health Insurance Doesn’t Do that recent increases in Medicaid implemented under Obamacare won’t accomplish anything other than waste a lot of money. What launched this and the reference to the 30-year old RAND study is research published in the New England Journal of Medicine that reports that people in Oregon who went on Medicaid experienced no improvement in standard health measures.

Where commentators take this is captured by the title of an article in Slate that covered the Oregon research: Bad News for Obamacare: A new study suggests universal health care makes people happier but not healthier.

How odd. I thought being happy was healthy. Evidently not. What counts for health, it turns out, is things such as serum cholesterol and glycated hemoglobin.

What this illustrates is a structural blindness in both the science and the media. The obvious conclusion to the 30-year old RAND study and the more recent Oregon study is that the medical system doesn’t know how to measure actual health and that the medical system fails to effectively treat people’s medical conditions.

Another outcome that both studies identified is that the more people have to pay for health care, the less they use it—a real shock there. Conservatives think this is really great because for them it means that we could save a pile of money by only providing catastrophic insurance because doing so would have no effect on people’s medical conditions.

This is nonsense, of course. Not because spending more and using the medical system more will make things better but because health is about having a good life, which includes things such happiness and social justice. How can you say it doesn’t? Yet the conventional understanding is that health care is the same as medical care.

Let me say it again: health is not the absence of disease as measured by a blood test and health care is not a course of medical procedures. To be simple but direct, health is happiness, it is having a good life.

Looking back to the early RAND study, almost all medical measures failed to improve as medical care became more financially accessible—almost, but not all. What improved were a collection conditions that are unmistakably associated with stress, especially chronic stress. In other words, as access to medical care got easier, life got better as measured by indicators of chronic stress.

As I’m sure you know, obesity among children is a big worry. The President’s wife has taken on the issue, cheerleading for lifestyle changes and so forth. Yet a study presented at the Pediatric Academic Societies meeting this last weekend as part of its forum on the social determinants of childhood obesity says that neighborhood characteristics have a powerful effect on childhood obesity rates. The neighborhood characteristics that had the greatest effect were the distance to parks and stores and the safety of the neighborhood.

And as I’m sure you also know, obesity among children is associated with poverty, both because of the poverty itself and the characteristics of the neighborhoods where the children live. As a matter of fact, the Pediatric Academic Societies meeting includes a forum on the health effects of childhood poverty. As a class, children suffer greater rates of poverty than any other class. Because of that poverty they are more likely to have a wide variety of both medical conditions and health impairments.

Why aren’t income and neighborhood safety health measures like blood pressure and glycated hemoglobin?

According to the studies I mentioned, single payer insurance would be no better than private insurance restricted to catastrophic coverage: the medical outcomes (mistakenly called health outcomes) are the same. I say that’s a demonstration of the ineffectiveness of current medical care, in which more is not better. I also say it’s a demonstration of our failure to accurately understand and attend to what makes us sick and what makes us healthy.

If insurance won’t save us, who or what will? Isn’t it obvious? We will.