Insurance and Mortality

Insurance and Mortality

by Jonathan Wilde

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.