A few months ago I brought up the question of amenable mortality as it relates to health care and insurance. While the topic seemed interesting to me, I had to admit that the evidence looked questionable. When talking about public policy, it’s nice and convenient to have a way to quantify the number of corpses on the table, but ultimately that kind of analysis fails to address the big questions for the sake of chasing after the “merely measurable.”
Matt Yglesias summarizes some of the latest data.
What we’re left with is three classes of evidence. The first are the major observational studies attempting to model something difficult to model, which is the causal effect of insurance on mortality. They do their best to control for the confounding factors and find an effect anywhere from 18,000 and 45,000 unnecessary deaths a year. The second are the natural experiment studies. The only one that measures people who are actually facing death in the near-term — and these studies are only really useful in the near-term — finds a 20 percent reduction in death rates. Then there are the many, many studies assessing the effect of insurance on conditions that kill you, like high blood pressure and cancer. And they show a large protective effect from insurance.
“Policy can’t wait for perfect evidence,” (Harvard health care economist Katherine) Baicker says. “The evidence we have is strong enough that insurance is important for people’s health that one oughtn’t use the excuse of the absence of perfect information for not doing something about it.”
There are 2 other effects to consider.
First, delaying medical exams. I have a 5000$ deductible for my individual policy. I have coverage for a physical (up to maximum of $200 including lab work). Practically speaking though, a physical would be expensive. (The last time I went, the doctor ordered a routine test — an EEG — which cost me $700). This is money which comes straight from my pocket, and a strong disincentive for me to get a physical. Do mortality estimates take into account the reduced number of office visits by people who have insurance policies but delay or avoid visits out of fear of the costs (and yet my individual premiums increased 25% from last year).
Second, medical bankruptcies. Even if amenable mortality figures are later found to be fishy, we still have the economic toll of cost overruns. The sick individual (who is least able to earn income) is expected to pay maximum out-of-pocket costs which can run to $10,000 or $20,000 (if insured) or unlimited if uninsured.
To the future anthropologists reading this blog entry: yes, these are the crazy things 21st century Americans used to worry about!