Dying for WHAT?!?

Another tease on the Google News page that I knew I should resist following, but failed to exercise sufficient self control:

Nearly 13 Tennesseans die every week due to lack of health insurance, according to a report published this week by Families USA.

Surely the researchers weren’t stupid enough to phrase their conclusion like that!, I thought as I clicked to read the Nashville Business Journal report.

The article predictably didn’t clear things up. Here are its first three paragraphs [hyperlink omitted]:

Nearly 13 Tennesseans die every week due to lack of health insurance, according to a report published this week by Families USA.

That number means about 676 Tennesseans died in 2006 for the same reason, the national organization for health-care consumers says. And between 2000 and 2006, the Washington, D.C.-based organization estimates more than 3,600 Georgians between the ages of 25 and 64 died because they did not have health insurance.

Nationally, about 22,000 Americans without health insurance died between 2000 and 2006.

Now, the idea that not having life insurance can be a direct cause of death is weird enough—but what is that last sentence supposed to mean? (The remainder of the brief article doesn’t expand on or clarify it.) Is the implication that those individuals would not have died had they had health insurance? My mind boggling, I set out to find this “Families USA” group, to see what they’re all about and to see if I could find their report.

I didn’t need to look any further than their home page, which currently sports an ominous-looking graphic that reads, “Dying For Coverage”. The text alongside confirms that the authors of these reports really are that stupid:

For the more than 47 million Americans who are uninsured, lack of health insurance can have dire consequences–medical debt, missed care, and even premature death. We've created the first-ever state reports on the number of deaths due to lack of health insurance.

Visiting their dying for coverage page, one learns that FU isn’t the originator of this stupidity—both the Institute of Medicine (in a background paper and full report [that link goes to a free brief report]—both links go to PDF files) and the Urban Institute (they do a lot of nattering on the subject) addressed it before they stepped in. Needless to say, I don’t have the time to wade through all this material. That said, I do have a couple of observations to make based on scanning a few of these reports.

First, these kinds of studies are necessarily applicable only in an aggregate context. How can it be clearly established that, for a specific individual, the lack of health insurance is directly responsible for death? How can a calculation of “premature death” be made for an individual with a reasonable degree of certainty?

Health insurance and health care are not the same things: one may have health insurance and not pursue health care, just as one can get health care without having health insurance (for, now anyway). Also, having health insurance does not mean that every bit of health care one might want—or need—will be paid for. Valid claims are sometimes denied on technicalities, for example. In looking over the IOM’s preliminary report, I noticed that some time was spent pondering the possible confounding influences of literacy, numeracy, and cultural context, to name just a few, on seeking health care. It makes sense that individuals from cultures that don’t have a history of seeking out a “medical expert” for care will tend not to pursue medical care, irrespective of insurance coverage. All these things set me to wondering ...

And then I started reading The Private Health Insurance Market: Treatable or Terminal?, and my nascent suspicions grew stronger. Comments by the first two people in that transcript were most illuminating. All emphasis in these excerpts is mine. First, Bob Reischauer:

[This] is a timely issue considering concerns over the uninsured and various government policy initiatives to enhance the individual's ability to purchase insurance in the individual market, using tax credits or some other form of subsidy.

And then, economist Marilyn Moon (ellipses in original):

[T]he insurance system in the United States is extremely complicated. That keeps health policy analysts like me busy, but it also causes a lot of problems to the American public....The individual market...is...a sort of market of last resort. And as an economist, I know that the markets work well in some circumstances, but there are many circumstances in which there are problems, and that certainly is the case with the individual market, as we're going to hear today.

Health insurance is an enormous topic of concern in the USSA, and has been for years, judging by news coverage, politicians’ pontifications and legislations, and think tank wonkery devoted to the subject. It is a large and elaborate system that everyone pays for, most obviously in the rising costs of medical care but in many other ways too. Overall, has it improved the quality of health care? I don’t think so—how could it? Has it improved access to health services overall? For some individuals, it undoubtedly has; and perhaps insurance made more of a difference some 30–40 years ago, before state and federal governments started interfering. What insurance has clearly done is created an entire industry that is partly private and partly public (government backed), that has insinuated itself between one of the most intimate relationships relative strangers can enter into: between careseekers and caregivers. It has also helped take those private, very personal encounters and commoditized them—something else many individuals find unsettling. Insurance is what keeps economist Moon, and so many more like her, cranking out their wonkery—for decent wages too, I expect. If insurance went bye-bye, so would those jobs.

Much of the time, when health care becomes the subject of consideration among the chattering classes (viz., wonks and politicians), expanding insurance coverage is often suggested as a way to improve health care—as if mandating universal coverage will somehow take away the pesky problems of individuals who want treatments a company thinks are worthless; as if getting the state involved will solve the problem of underwriting the very sick whose costs are high, or those who are willing to try risky, high-cost, experimental procedures; as if universal coverage equals universal, high-quality treatment for anyone and everyone. For all their so-called expertise, I have yet to encounter a wonk who has presented a real answer to these issues. Nor are they likely to tease out the differences between insurance coverage and actually getting health care.

One of the possible large confounds that went unmentioned (so far as I saw) in that report I skimmed centers precisely on that conflation: it is possible that all the scary headlines dealing with health insurance, and all the proposed solutions to problems constantly offered and analyzed, and all the annoying, nonstop, fucking useless chatter has befuddled a lot of people. Isn’t it reasonable to think that some subset of average-intelligence Americans, who get their “news” and opinions predigested from the mainstream media, believe that one has to have insurance to get a regular doctor’s office visit? Might those with insurance be reasonably concerned that if they actually use it for anything but routine care (or maybe if a routine screening brings bad news), their costs will rise? Why wouldn’t they believe that the only way to improve their situations is to try to force everybody under that leaky umbrella, since that’s the only solution given massive media time? Thus has much of the American populace been bamboozled. It doesn’t even need to be a conspiracy—it’s an open secret that do-gooders tout insurance as being good for everyone while they stand to gain the most from expanding it.

Moon was right about one thing: health insurance is extremely complicated in this country. But she is very gravely wrong when she conflates the health insurance market with the health care market. In a free health care market, there need be only customers and providers. The health insurance market has increasingly burdened that market with its rules and requirements and diktats. So, too, has the state, at multiple levels. It should come as no surprise that the health care market is floundering; it has become overburdened with leeches.

Yet the do-gooders and public policy wonks continue to push the “solutions” that will allow them to get fatter, as the market they feed from gets worse and worse at fulfilling its real customers. It may not seem probable now, but it is possible it could waste away. Americans are increasingly going abroad for all kinds of care—and it isn’t just the wealthy, either. Others are taking matters into their own hands as much as possible; some focus on the role of diet and the healing properties of many foods and spices; some search out free-market practitioners (some obvious, like Simple Care, others less so); some learn how to handle basic medical situations and emergencies themselves, maybe using offshore pharmacies to supply some of their needs.

It isn’t a good thing when a parasite kills its host, but it looks increasingly like that’s going to be the only way to get the insurance-fetishists off of the health care market. And, now that I think about it, it appears that the path health care is taking was trod already by the education do-gooders (if John Taylor Gatto is to be believed); and their splendid results are largely responsible for enabling the repeat performance.

What I think Americans are—only figuratively—dying for are: solid information—the sort that is unlikely to emanate from any government official or policy wonk whose livelihood depends on a juicy host from which to feed; and genuine medical freedom. They’d have much more privacy, and in all likelihood, better care at lower cost.