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Posted at 3:26 PM ET, 02/28/2011

Yes, health care improves health

By Ezra Klein

I don't think this is too difficult to understand, but perhaps I need to make it clearer: There's no contradiction between saying that "health insurance reduces mortality" and "health insurance doesn't close the disparity in life expectancy between the rich and the poor, or the educated and the uneducated."

Medical care doesn't work nearly as well as we'd like to think it does. But that's not the same thing as saying it doesn't work. There's a reason why we call ambulances at the first sign of chest pain and a reason why those of us with the market power to do so demand health insurance as part of our compensation. I've read quite a few studies on this subject, and even though I'm in my mid-20s and at low risk for pretty much every condition you can think of, I happily send my check to Kaiser Permanente every month, and you can bet I'll pick up the phone pretty fast if I find my chest tight and my breath short.

The same is true, I'll bet, for folks like Tim Carney who like to argue that medical care is ineffective as a way to argue against subsidizing health insurance for poor people. But for the record, the best evidence we have suggests that health-care coverage does much more for the health of poorer people than it does for the health of well-compensated, highly educated people like Carney. That folks like Carney use that evidence to continue a status quo in which they have health insurance and the poor don't is, I think, proof of how seriously they take their arguments on this score, and of what this discussion is really about -- and the answer isn't "improving the health of the population."

By Ezra Klein  | February 28, 2011; 3:26 PM ET
Categories:  Health  
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Comments

"suggests that health-care coverage does much more for the health of poorer people than it does for the health of well-compensated, highly educated people like Carney"

Low income Canadians were about four times more likely to die than highly educated Canadians, despite the low income Canadians using more health care services - and health care coverage does relatively MORE for low income individuals? I wonder what that ratio would look like without health care access of any sort.

Why is it so risky to be a low income Canadian?

Posted by: justin84 | February 28, 2011 3:49 PM | Report abuse

The disparity between the health of the rich and the poor may be based on factors over which health care has almost no control whatsoever: say, environmental conditions. People whose housing exists near a toxic dump in the South or in congested urban areas with poor air quality are going to suffer health consequences that wealthy suburbanites (or even urbanites) are not. You can pass out inhalers and medications to ameliorate the effects of some of the ailments that will ensue due to such environmental factors, and this will improve health and perhaps life expectancy, but it will not ever make the asthmatic or cancer-ridden person who has contracted his illness because of environmental inequities the "equal" of the country squire.

As in education, there are a lot of moving parts that must work together to ensure success. Institutions alone can't cure everything. Poverty, environmental racism (it exists), and other issues must be tackled at the same time we improve our health and educational delivery systems.

Posted by: JJenkins2 | February 28, 2011 3:55 PM | Report abuse

"I've read quite a few studies on this subject, and even though I'm in my mid-20s and at low risk for pretty much every condition you can think of, I happily send my check to Kaiser Permanente every month, and you can bet I'll pick up the phone pretty fast if I find my chest tight and my breath short."

Ezra, what check are you sending in to Kaiser Permanente? Is this payment for services rendered for calling an ambulance to deal with the chest pains? Or is this your monthly premium? If it's the premium, I DO hope you understand that the premium does not come close to covering the cost for checking out your ticker in the ER, etc. And if it's for services rendered, you'll be paying out A VERY LONG TIME...

Posted by: MainStreetMuse | February 28, 2011 5:53 PM | Report abuse

MainStreetMuse, I think you are missing the point of insurance. Otherwise you are uncertain on how it works.

I happily send my check to KP, too, knowing that I won't have to pay through the nose if I do become seriously ill or injured.

Posted by: will12 | February 28, 2011 6:18 PM | Report abuse

Ezra, It is now apparent that you've been bought by a very bad organization that harms a lot of people. Shame on you.

Your article (as well as at least two of the comments made thus far) are prime examples of astroturfing.

I hope you indeed do sign up for Kaiser's purported "coverage" and actually need care. You'll find out precisely why so many people are outraged at that organization's conduct & why they have such a checkered track record. Too bad you're too busy kissing up to this $42B/year business to actually do some journalism.

Posted by: johnincalifornia | February 28, 2011 7:44 PM | Report abuse

"what this discussion is really about -- and the answer isn't "improving the health of the population.""

This is the real heart of the argument. Those against PPACA just don't think that "improving the health care of the population" is something worth paying for, or something the government should be involved in at all.

Trying to convince them that they really do pay for the health care of the poor (with higher premiums, higher hospital costs, other costs to society) doesn't seem to work. And they simply don't believe that they owe any debt to society at all, regardless of everything that society does for them.

Posted by: PattyP1 | March 1, 2011 7:10 AM | Report abuse

To Will12 - and to Ezra,

I have been self-insured for more than a decade, so yes, I fully understand the issues and cost of health insurance. People whose healthcare is heavily subsidized by their employer tend to have no clue what their healthcare truly costs.

What neither of you understand is that your premium is NOT the cost of your healthcare. SOMEONE will have to "pay through the nose" for the astronomical sum required of a cardiac stress test, ER visit, ambulance service, etc. and so on. And that bill is a hefty one.

In my case, as someone with a high-deductible HRA (Bush's fave!), that person who pays through the nose is me.

In Ezra's case, it would be his insurance plan, which then passes on the costs to the insured through higher premiums, or it's the hospital or healthcare providers, who have to write-off certain expenses. That pricing model, based on consumer ignorance of the true cost, is a huge reason why the cost of healthcare rises astronomically every year.

My question for Ezra, if he paid his monthly premium, and was still on the hook for the full expense of the ER visit to the tune of thousands and thousands of dollars, would he be so hasty to call about his chest pains? Or would he wait?

Posted by: MainStreetMuse | March 1, 2011 9:50 AM | Report abuse

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