Be careful about “obvious” facts about health care

Listen to some of our most radical and outspoken politicians and you would think people die in the street for lack of health insurance or that having health insurance is essential to good health. Hey, everyone should have health insurance, but that doesn’t mean everyone uses it or if they do, they are healthier. It does mean that if they need health care and are insured the rest of society is not burdened by picking up the tab. 

But whatever is driving this trend, it’s a reminder that insurance coverage does not guarantee public health improvement. And so is a new paper, just released through the National Bureau of Economic Research, that tries to look at the Affordable Care Act in full. Its authors find, as you would expect, a substantial increase in insurance coverage across the country. What they don’t find is a clear relationship between that expansion and, again, public health. 

The paper shows no change in unhealthy behaviors (in terms of obesity, drinking and smoking) under Obamacare, and no statistically significant improvement in self-reported health since the law went into effect. (There is some improvement for older Americans in Medicaid expansion states, but not for the population as a whole.).

Add these data points together and you end up with some (highly provisional) vindication for what conservatives and libertarians argued before the A.C.A. was passed: that the bill was likely to provide its beneficiaries with more financial security and greater peace of mind, but that it was not likely to be the sweeping lifesaver that many of its most morally imperious advocates insisted that it would be.

Security and peace of mind are very good things, which is why voters like the Medicaid expansion. The confidence that they don’t have to rely on the emergency room or friends and family when they face an unexpected medical calamity is something that Medicaid recipients would understandably prefer to keep.  

Source: Ross Douthat, writing in the New York Times. Is Obamacare a Lifesaver?


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