Does Health Insurance Actually Make People Healthier?

Good health is still determined more by personal choices than insurance, hospitals and procedures

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Saul Loeb / AFP / Getty Images

Supporters of the Affordable Care Act outside the Supreme Court in Washington, DC, June 28, 2012.

Last Thursday, the Supreme Court voted 5–4 to uphold the Affordable Care Act (ACA), our country’s most expansive healthcare legislation since Medicare. As intended from the outset, the ACA was designed with one prevailing purpose in mind: provide health insurance to nearly 32 million uninsured Americans, thus moving us to a nearly universal health coverage paradigm.

There are very sound moral, ethical, humanitarian, and even financial arguments in favor of universality. But the main driver for the ACA has been the notion that health insurance makes people healthier. Almost immediately following the ruling, the American Medical Association released a statement where president Dr. Jeremy Lazarus said “…we are pleased that this decision means millions of Americans can look forward to the coverage they need to get healthy and stay healthy.” But in the end, it’s hardly certain that health care for all will give us a healthier nation.

(PHOTOS: Supreme Court Health Care Protests)

It seems logical that when we have insurance, we are more likely to access and utilize healthcare resources, and so we will be healthier. But there’s increasing evidence showing that much of the care we receive probably provides marginal clinical benefit, and that more care isn’t always better.

Two robust studies have attempted to answer this conundrum in more depth. The first was the RAND (Research and Development) Corporation’s Health Insurance Experiment that ran from 1971 to 1982. People were randomized to varying levels of cost-sharing insurance plans ranging from free care up to 95% shared cost. The only positive correlation between health coverage and health was that free care to the poorest and sickest 6% of the sample population improved a few select problems. The nuance here is it actually improved only 4 of 30 measures that were studied (hypertension, vision, dental health, and a fourth condition called “serious symptoms” defined as chest pain when exercising, bleeding not caused by accident or injury, loss of consciousness, shortness of breath with light exercise of work, and weight loss of more than 10 pounds). So in 87% of the outcomes that were studied — such as overall physical and mental health, cholesterol levels, weight or smoking — free care made no difference.

The most recent study to tackle the question was the Oregon Health Study. In 2008, researchers compared poor people who had been randomly assigned to Medicaid or no insurance and found no mortality difference between the two groups. There was a difference between the two groups in “self-reported” health status — those on Medicaid said that they felt healthier — but it’s difficult to know, however, whether these patients were truly healthier. Even the study recognized this limitation in its results: “Given the subjective nature of the responses, it is more difficult to judge with the available data whether the results reflect improvements in actual, physical health.”

The mere act of providing health insurance probably doesn’t correlate with better health because we are actually more in control of our health, and longevity for that matter, than we realize. Good health is mostly determined by our personal choices and environments — rather than our insurances, hospitals, procedures, doctors and drugs. Even our genetics probably play only a minor to moderate role at best when it comes to developing chronic illness or cancer (with exception for strongly penetrated genetic diseases). We know this is true because of decades of research on twins that use heritability factors to quantify the genetic influence on the development of disease. With the exception of death from coronary artery disease in men, it’s non-genetic factors that hold the majority of the power when it comes to our chances of developing breast cancer, prostate cancer, colon cancer and Type II diabetes.

(MORE: Is the Fight Against Childhood Obesity Creating Eating Disorders?)

Writer and speaker Dan Buettner has researched communities around the world where people live the longest and has identified nine things that he thinks make the most difference to health and longevity: 1) Move naturally. 2) Have a purpose. 3) Have a stress shedding strategy. 4) Stop eating when your stomach is 80% full. 5) Eat a plant-based diet. 6) Drink 1-2 drinks per day (preferably Sardinian Cannonau wine). 7) Belong to a faith-community. 8) Put loved ones first and 9) Hang with a tribe that has healthy attributes.

If the Affordable Care Act makes a big difference, it will be because of the preventative services provisions, which have gotten the least attention. These provisions will help all of us, patients and providers alike, prioritize higher on our agendas things like counseling on smoking cessation, losing weight, eating healthfully, treating depression, managing our relationships, and reducing excessive alcohol use. Perhaps herein lies the greatest gift of the ACA — a reminder that we still rule supreme over our bodies and our health. And that the basics — exercise, vegetables, a healthy weight, a community to belong to, a loving partner, friends that care — can take us a very long way.

MORE: Roberts Rules: What The Health Care Decision Means For The Country

19 comments
Hollywooddeed
Hollywooddeed

When my clean-living husband came down with non-Hodgkins lymphoma, the chemo was $3,000 a day, followed by $1700 a day for 37 seconds of radiation x 30 days.  Do the math.

So, yes, having health insurance made him healthier.

Amanda Wade
Amanda Wade

This is silly. There are people who legitimately cannot make their health better by just making better choices. I exercise 8 hours a week, eat well, drink lots of water, have a good support system, etc. Yet I have 3 chronic health problems that I can do NOTHING about. Luckily, I grew up in Canada and could go to the doctor anytime I needed, and get any test or treatment that I needed. And I did. I am eternally grateful to my country for caring enough about its residents to have a universal healthcare system that I could use to sort out my problems. Without it, I probably wouldn't want to have lived past the age of 23 when my health problems really peaked. If Americans don't want socialized healthcare, legislating people to have coverage for their healthcare is the only way the government can cover their butts and try to help people. Ironically, you've moved farther from socialized healthcare than you were before. Isn't that what Americans want? You got it!

Talendria
Talendria

You can't judge the efficacy of health insurance by mortality.  The point of medicine is not necessarily to prolong life but to enhance it.  When you have an angry-looking mole or a burning, itching sensation somewhere on your body, you want a doctor to check it out.  Most of the time these conditions aren't life-threatening, but they nevertheless cause anxiety and discomfort.  The better question is why does it cost $100 for a doctor to glance at a mole or a rash?  We need to find a way to reduce administrative overhead in medicine and discourage avaricious personalities from entering the field.

Jennifer Shutwell
Jennifer Shutwell

Thank you for having the guts to write the article amidst so much cheering and booing.  Hooray for you - I'm with you in believing personal choices lead to good health. 

Keeping in mind that the healthcare system was created during the Great Depression and it goes against the root of the Hippocratic Oath of a physician in the first place.  "It requires a new physician to swear upon a number of healing gods that

he will uphold a number of professional ethical standards."  The oath did not encompass an exchange of money and "I will not provide care if you cannot pay me."

The origins of the healthcare system seems hypocritic vs hippocratic.  It's still steeping with the vibe of The Great Depression (1929) of "I don't have enough money to keep lights on" and "I don't have money to pay my doctor bill". 

And the beat of the Great Depression drum beats louder.  Fortunately for a "tweener" like me I see both sides.  I own my health and care for myself and those around me.

Shams Aci
Shams Aci

Comment / Opinion / Concern:

Notwithstanding, there are rumors  that insurance corporations are less reputed about caring to pay benefits to the deserving policy holders as and when they are in need of getting the declared remuneration / benefit. How far its a fact in reality?

  - A.R.Shams's Reflection  -  Press amp; Online Publications.

       http://arshamssreflection.blog...

 

vaughnsimon
vaughnsimon

The opposition to the Affordable Care Act seems to speak from both sides of its mouth:   On one hand, we are told that there are sinister "Death Panels" hidden somewhere in the Act so that government bureaucrats can somehow deny us needed care. 

On the other hand, this article seems to claim that we are better off without having health care choices because some of those choices might be of "marginal clinical benefit ".  

Which is the real truth?  You can't have it both ways.

RicoSoavarooski
RicoSoavarooski

Relatively uncontroversial thesis; some suggested article topics: 'Will the ACA stop 

 patients from being rendered bankrupt by a medical crisis?"  "Is requiring insurance

 companies not to deny coverage for preexisting conditions fair and humane policy?"

 "Is there a better health care model in Canada?"  "Should Medicare fraud merit a minimum prison sentence of thirty years at hard labor"? etc.

Samantha Simmons
Samantha Simmons

Cannot believe the healthcare article! The Latin phrase Incredibile dictu et miserabile victu sums it up. The issue is not "more" healthcare, but turning "no healthcare" to "yes healthcare" for millions of Americans. Even childhood obesity was thrown in there to make things more "convincing." Give it up, guys. We needed universal healthcare and we got it thanks to a President with guts and a Chief Justice with vision!

Susan Keller
Susan Keller

I LOVE how people use personal anecdotes to make an argument.  Undergrad research teaches the fallacy of personal anecdotes. You are the exception, not the rule.  We as a nation are unhealthy because we are fat and inactive. If you do everything right and get sick you are an exception. Do a bit of research. Only one of these top tens is not preventable in some way (genetic DO): 

http://www.livestrong.com/arti...

RicoSoavarooski
RicoSoavarooski

That's the relatively uncontroversial thesis --- barring envirotoxins in the workplace or elsewhere, or the hazards posed by dangerous substances wielded  negligently or with intent,  or the rare genetically linked conditions cited in the article, "good personal choices lead to good health," ceteris paribus --- "all other things  being equal" the causal chain could hardly be clearer --- DO NOT SMOKE and stop if you do;  DRINK MODERATELY or not at all;  Sound diet; Meditation and Exercise;  yet meanwhile glaxosmithkline disgorges their ill-gotten gains to the tune of THREE BILLION DOLLARS so there's more to it than only this relatively uncontroversial thesis.

SheenaYurczakBADC
SheenaYurczakBADC

@Shams Aci  I have seen such things as a practitioner.  Remember that these companies profit from NOT paying out.  It's not a savings account.

Killroy71
Killroy71

Actually, this does work both ways, Vaughn. Haven't you read any of the recent articles about "medicalization" of every hiccup, pre-disease states (and treatment), and how much harm is caused by overscreening? (false positives = unneeded procedures that cause damage). I've seen this in my own family.  Yes, actual harm from the do-no-harm crowd, probably little of which would occur if your health insurer weren't standing by to pay for the plethora of procedures available.

Going to the doctor now is like going to Jiffy Lube - you go in for an oil change and wind up with a list of possible things they can do for you, all "preventive" measures. When it's your own pocket - at Jiffy Lube - you say no. When its paid by insurance (and all the other people like you paying premiums who NEVER get sick, they say), you figure, sure, why not. Hopefully you don't get a false positive, followed by a needless procedure that lands you inthe hospital, where you get a life-changing infection.

Read Shannon Brownlee's "Overtreated."  Read also today's news about Glaxo SmithKline's $3B fine. Not all medicine is good medicine. But as long as your insurance will pay, somebody will recommend it for you -- and get paid for doing so.

Still don't get it? Read this again, slowly.

Fla4Me
Fla4Me

I would add, "Who are the big power players, political and corporate, running our health care and how they profit from your illness".

Killroy71
Killroy71

It can also kill -- how many people die of hospital-related infections and other causes? And do you think they are in the hospital without insurance? This is a bogus argument. In theory anyway, it's possible to get care without insurance. It's doctors and hospitals that link care to payment.

Juarez
Juarez

just as Kelly implied I'm startled that a mother can get paid $6247 in one month on the computer. did you read this website (Click on menu Home more information)    http://goo.gl/B9QvZ  

RicoSoavarooski
RicoSoavarooski

glaxosmithkline  disgorging their ill-gotten gains to the tune of THREE

BILLION DOLLARS according to today's headlines; they have "learned

 their lesson"...maybe so.

RicoSoavarooski
RicoSoavarooski

To Fla4Me --- Likely MANDATORY PRISON TIME is the ONLY

solution to deter these ongoing egregious thefts on the part of

Big Pharma, the banksters etc.

Fla4Me
Fla4Me

I doubt it...profits seem to bring out the worst in people when they think they can get away with something.  Another example it the fraud case against Pfizer where the apparently made false claims about Celebrex.  I worked in the medical industry for awhile and set in meetings where the whole point was how profitable a product was going to be......oh and it might work too.  On and on it goes...