Tinkerbell Meets Health Policy

Tinkerbell is rescued from near death by the audience clapping their hands showing their faithful belief in her.  The “Tinkerbell effect” describes things that tinkerbellexist only because we agree to believe in them –like the value of dollar bills or the rule of law or, perhaps these health policy nuggets: 

  • Prevention is cheaper than cure.
  • Cancer screening tests save lives.
  • If we give more people health insurance, they will be healthier.
  • More people getting more medical care will cost us less in the long run.

We save these ideas by clapping and drowning out hard facts.  And woe to you who question these – it’s like farting in church.  Everyone is enthusiastically nodding or even actually clapping and you are ruining the party.

I can see how agreeing that the law is the law keeps us all between the lines, but how does it serve us to keep the myth alive that people are healthier when they have health insurance?  This myth, in particular, will likely be in the news as revisions or repeal of the Affordable Care Act now seems inevitable.

One of the Affordable Care Act’s great achievements was to get more people insured for medical costs.  This has many noble things to recommend it – an insured person’s assets are protected for his family if he becomes seriously ill; there will be less bad debt from unpaid medical bills; chronic conditions can be treated and stabilized, especially for lower-income people who might not otherwise get regular, ongoing care.  Clap, clap, clap . . . .

Yet (and here comes the fart part) people who have health insurance are healthier than uninsured people not because of health insurance, but because of who they are.  As recently as 2015, workers offered health insurance by their employer had average earnings of $53,960; those whose employer did not offer health insurance had average earnings of less than half that, $23,245. Already, those with insurance have a huge health advantage since having higher earnings is linked to better health.  On top of that, they have eased access to medical care through their health insurance plan.

If you take a person who has no health insurance and give him health insurance (I’m picturing little Tink tapping his sorry uninsured head and health insurance sparkles raining down), does he get healthier?  The short answer is no.  Take a peek at the health insurance “lottery” experiment in Oregon for details, but the bottom line was that people who got health insurance had small, but insignificant improvements on certain health measures compared to those who stayed uninsured.  Which only points to the butt-ugly truth that health insurance by itself does not create better health.

Peter Pan never gets older, but surely these fairy tales do.  So, I’ll be covering my ears as the next wave of health policy debate washes over – the clapping will be a horrible din.

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