Health Insurance for All Is About a Lot More Than Just Health

Fight disinformation: Sign up for the free Mother Jones Daily newsletter and follow the news that matters.


Megan McArdle writes today that there’s little consistent evidence showing that giving people health insurance actually does much to save lives. This is based largely on a couple of recent papers (plus a few other older ones), and she’s basically right. She’s also right when she says that health insurance does save people lots of money. I don’t want to address this literature in detail right now, but if you want to know more about it you should read Ezra Klein’s post about this and then McArdle’s response.

However, I do have some quick comments I want to add to this conversation. Some of it echoes what the other posts say, while some of it is new. Here it is:

  • The single biggest piece of evidence about the effect of health insurance is a study of Medicaid in Oregon a few years ago. It showed that people who randomly got Medicaid coverage didn’t show much improvement in their health, nor did they live any longer than those without Medicaid.
  • However, as important as it was, the Oregon study was small; the time frame was short; the population was drawn entirely from the poor; and the results were ambiguous. Nobody should ignore this study, which was unique in being a true controlled trial, but no one should think it’s the final word either.
  • The results of the Oregon study would probably not scale up. One way or another, Oregon’s health care system can absorb a few thousand uninsured people. Some of the cost gets absorbed by hospitals that don’t get paid. Some gets absorbed by local programs. Some gets absorbed by free clinics. It’s a strain, but the system can handle it without breaking completely.
  • But this isn’t an argument against health insurance generally. If half the state were uninsured, the system would almost certainly break down. There would simply be too many people who either couldn’t or wouldn’t pay for their care, and not enough people left over to absorb that cost.
  • Also, as I like to point out ad nauseam, there’s more to health care than mortality. A dental filling won’t extend your life, but it will sure make you feel better. Ditto for a hip replacement or an antidepressant.
  • Health insurance is a financial lifeline, and in many cases prevents bankruptcy. But there’s more. It’s also a huge reliever of stress. Trying to cobble together care from a complicated, ad hoc network of clinics, ERs, doctors who don’t want to see you, and friends who can loan you a few bucks is soul destroying—especially for people whose lives probably kind of suck to begin with.

In the end, I think this is what health insurance is mostly about: financial security and common decency. Yes, the uninsured can usually patch together health care in an emergency, and sometimes even when it’s not. This is why access to health insurance probably has only a modest effect on health. (Though I don’t believe it’s zero. If we could do a bigger, better, longer-term study we’d almost certainly see a difference.) Still, is a constant, desperate search for health care really a decent thing to tolerate in the richest country in the world? Is relentless, gnawing worry about whether to buy food this week or take your child in for a checkup a decent thing for us to tolerate? Is an endless, threatening barrage of harassment from hospital bill collectors a decent thing for us to tolerate?

It kills me that some people think it’s just fine to tolerate this—among the poor, anyway. It’s true that there are lots of things that are inevitably going to afflict the lives of the poor. Compared to the better off, they’ll have worse food, worse housing, worse cars, and worse clothes. But should they have worse health care? That’s a moral question, not a scientific one. And my moral compass says that health care is one of the things all of us should have decent, regular access to. In fact, it makes me a little sick to my stomach every time I have to face up to the fact that a lot of moral compasses here in America apparently don’t agree.

AN IMPORTANT UPDATE

We’re falling behind our online fundraising goals and we can’t sustain coming up short on donations month after month. Perhaps you’ve heard? It is impossibly hard in the news business right now, with layoffs intensifying and fancy new startups and funding going kaput.

The crisis facing journalism and democracy isn’t going away anytime soon. And neither is Mother Jones, our readers, or our unique way of doing in-depth reporting that exists to bring about change.

Which is exactly why, despite the challenges we face, we just took a big gulp and joined forces with the Center for Investigative Reporting, a team of ace journalists who create the amazing podcast and public radio show Reveal.

If you can part with even just a few bucks, please help us pick up the pace of donations. We simply can’t afford to keep falling behind on our fundraising targets month after month.

Editor-in-Chief Clara Jeffery said it well to our team recently, and that team 100 percent includes readers like you who make it all possible: “This is a year to prove that we can pull off this merger, grow our audiences and impact, attract more funding and keep growing. More broadly, it’s a year when the very future of both journalism and democracy is on the line. We have to go for every important story, every reader/listener/viewer, and leave it all on the field. I’m very proud of all the hard work that’s gotten us to this moment, and confident that we can meet it.”

Let’s do this. If you can right now, please support Mother Jones and investigative journalism with an urgently needed donation today.

payment methods

AN IMPORTANT UPDATE

We’re falling behind our online fundraising goals and we can’t sustain coming up short on donations month after month. Perhaps you’ve heard? It is impossibly hard in the news business right now, with layoffs intensifying and fancy new startups and funding going kaput.

The crisis facing journalism and democracy isn’t going away anytime soon. And neither is Mother Jones, our readers, or our unique way of doing in-depth reporting that exists to bring about change.

Which is exactly why, despite the challenges we face, we just took a big gulp and joined forces with the Center for Investigative Reporting, a team of ace journalists who create the amazing podcast and public radio show Reveal.

If you can part with even just a few bucks, please help us pick up the pace of donations. We simply can’t afford to keep falling behind on our fundraising targets month after month.

Editor-in-Chief Clara Jeffery said it well to our team recently, and that team 100 percent includes readers like you who make it all possible: “This is a year to prove that we can pull off this merger, grow our audiences and impact, attract more funding and keep growing. More broadly, it’s a year when the very future of both journalism and democracy is on the line. We have to go for every important story, every reader/listener/viewer, and leave it all on the field. I’m very proud of all the hard work that’s gotten us to this moment, and confident that we can meet it.”

Let’s do this. If you can right now, please support Mother Jones and investigative journalism with an urgently needed donation today.

payment methods

We Recommend

Latest

Sign up for our free newsletter

Subscribe to the Mother Jones Daily to have our top stories delivered directly to your inbox.

Get our award-winning magazine

Save big on a full year of investigations, ideas, and insights.

Subscribe

Support our journalism

Help Mother Jones' reporters dig deep with a tax-deductible donation.

Donate