Staying alive

Massachusetts slowed down its death rate after its state-level health reform (which is remarkably similar to Obamacare), especially in low-income/ high-uninsured counties.  It’s an excellent and careful study published in the Annals of Internal Medicine.

Does this mean that more health insurance would keep more of us alive longer?  Sort of.heart_beat

It depends who you are, how much difference health insurance makes.  For the uninsured, undiagnosed diabetic whose kidneys are on their way out, health insurance could make a big difference.  The person has to take the time and effort to get diagnosed, and treated, which is not a simple task.  Even with treatment, the person’s health insurance plan is not saving the day – medical care is only a small part of the picture.  For anyone – wealthy, poor, insured, uninsured, movie star, butcher, baker, or candle stick maker – medical care only “counts” for 10 to 25 percent of our health status.  Health insurance helps, obviously, but it’s not everything.

The Center for Health Policy and Inequities Research estimates that the Massachusetts health reform saved 320 lives at a cost of $272,000 per quality-adjusted life year (“qualies” for you hipsters).  This means for each single year of additional life gained, the entire state health reform program spent $272,000.  The money came from employers, taxes, workers, and insurers, not to mention patients who pay their deductibles and co-pays.  And it didn’t necessarily get spent on one person who got to live a year longer.  It got spent on thousands of people who got kidney dialysis, cancer treatments, medications, or whatever else; all of this made their lives a little bit longer.

Those hundreds of thousands of dollars went to the noblest of enterprises – extending a human life.   This also means that they did not go for any of the other factors that determine 75 to 90 percent of our health status.  So, for example, newborn babies would be healthier if their mothers had less emotional stress and lived in better neighborhoods.  They would be healthier as toddlers too, and their brains will develop better through their adolescence and into young adulthood.  Better neighborhoods do more for health than neonatal care ever will.

We can keep spending more and more on medical care, and ignore the many other simple yet strong contributors to our health.  Is it admirable that we can keep a one-pound newborn alive, if we then send the child to sub-standard housing, poor schools, and a bleak future?  Experts debate whether it is possible to spend too much on medical care, at the expense of other things.  I think there is, and we have surely passed the point long ago if other countries spend half as much and live as long or longer.

This is not to say that expanding health insurance is a waste – for the good that medical care can do, expanding health insurance brings that to more people.  It’s that we need to broaden our focus on how we create and promote health.

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