Insurance and Mortality

Last week, Megan McArdle wrote in The Atlantic that after you control for this and that, it's not clear that having insurance makes one less likely to die. Leftists were shocked and outraged. Matt Yglesias was all a-twitter:

Do rightwingers really believe that US health insurance has no mortality-curbing impact?

Megan McArdle replied that, okay, maybe there is a relationship between having insurance and being less likely to die that we don't see in the research, but if there is, it's gotta be small.

I'm surprised at the shock and awe from leftwingers, though maybe I shouldn't be. It's part of their gospel that people are dropping dead left and right because of lack of insurance.

As someone in the medical field, though not an epidemiologist or familiar with the research, my personal reaction was a lack of surprise at McArdle's conclusion. Why?

  • Any emergency will be treated at US hospitals. If you don't have insurance but are in a car wreck and bleeding, you will get treated-- you'll receive fluids, blood, angiograms, and if needed, surgery.
  • Aside from that, medical science is still at a primitive level on an absolute scale, even if it has made significant progress on a relative scale. Most things that are going to kill you will still kill you even with the best medicine has to offer. Insurance won't save your life if you get a metastatic cancer (with rare exceptions).
  • The place where insurance would make a difference is with things that would kill you if not treated but would save your life if treated. These types of illnesses, in my anecdotal experience, are rare in the larger scheme of things.
  • On the other side of the ledger is when medical care kills people who would otherwise live to an old age.
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The main counterpoint I have

The main counterpoint I have heard is that insurance helps to prevent you from being financially ruined if something expensive happens.

Not a counterpoint

How is that a counterpoint to private insurance. The whole purpose of insurance is to prevent you from being financially ruined by pooling your resources and risks with other people.

On the other hand socialized medicine does not serve this purpose. Instead it serves as a welfare system where risks and costs are shifted to others. Socialism works till you run out of other peoples money, and that is exactly the problem Britain faces today with it's hospital scandals. They've run out of money and now you run the risk of not getting care at all, as in the Stafford Hospital Scadal.

It certainly isn't a good argument for socialized medicine over private insurance. If you want to prevent your financial ruin then cough up the money for an insurance premium.

How is that a counterpoint

How is that a counterpoint to private insurance.

Not what I meant.

The whole purpose of insurance is to prevent you from being financially ruined by pooling your resources and risks with other people.

And so you agree with me 100%.

Your list of bulleted points

Your list of bulleted points should include advances that significantly improve mortality, but have occurred far enough in the past that they are part of the generic body of knowledge, and can be paid out of pocket. Examples: antibiotics and insulin.

The major risk to insure against, then, are those conditions that are not covered by your bullets: non-emergency, preventable-with-early-diagnosis conditions with recent significant breakthroughs in treatment.

Effective = Cheap

Many treatments are expensive because they don't work. If you can actually cure a disease, then you don't need to keep coming back for more treatments.

For example, kidney dialysis doesn't actually cure the underlying condition. It's still useful, but it is not a cure. Ditto for diabetes maintenance, a great many heart therapies, etc.

Note I said many, not all. Neonatal intensive care for premies is very expensive and it can work completely. Many premies graduate to be just as healthy as non-premies.

The surprise should be use of the word, "insurance."

What have pre-paid medical services have to do with the purpose or principles of Insurance?

Most everyone knows how to be healthier. Doesn't cost anything. Lost weight. Exercise. Quit smoking. This is the only country where poor people die of being fat and lazy.

Cheaper way to insure against car wrecks

If you don't have insurance but are in a car wreck and bleeding, you will get treated

We canceled our $10,000 deductible, $100/person/month premium Blue Cross Blue Shield medical insurance after they announced a 38% premium hike. It had a maximum limit of $3000/year for ambulance services, though no doubt a higher limit for ER work or follow up surgery or therapy, if you were willing to work through the 532 pages of fine print and 46 hours of phone calls to claim departments.

As an alternative to insure against auto accidents, we are adding a $10/month rider to our (Progressive) auto insurance policy that increases the included $25,000/person/accident medical coverage to $50,000.

I prefer to buy pure insurance. By getting a medical rider on an auto policy I can avoid a lot of regulations tied to health insurance.

Now I just need to make monthly bets with a London bookmaker that I will contract a catastrophic but treatable condition in the following 30 days. Anyone know what odds are being offered?