Tuesday, February 16, 2010

Assured access to health care helps make people healthier (continued)

Following up the mini-controversy touched on here last week, J. Michael McWilliams ("MD, PhD, assistant professor of health care policy and of medicine at Harvard Medical School and an associate physician in the Division of General Medicine at Brigham and Women’s Hospital") reviews the range of evidence currently available from both experimental and observational studies and concludes:
To date, numerous studies have found consistently beneficial and often significant effects of insurance coverage on health across a comprehensive set of outcomes and a broad range of treatable chronic and acute conditions that affect many adults in the U.S., including hypertension, coronary artery disease, congestive heart failure, stroke, diabetes, HIV infection, depressive symptoms, acute myocardial infarction, acute respiratory illnesses, and traumatic injuries (McWilliams 2009). In particular, several studies have robustly demonstrated positive effects of near-universal Medicare coverage after age 65 on self-reported health outcomes and clinical measures of disease control, particular for adults with cardiovascular disease or diabetes who make up two-thirds of the near-elderly (Decker and Remler 2004; McWilliams et al. 2007, 2009). Thus, when rigorous study designs have been coupled with appropriate outcomes and applied to clinical populations for whom medical care is effective, the evidence that insurance coverage improves health and survival is consistent and convincing.

How many lives would universal coverage save each year? A rigorous body of research tells us the answer is many, probably thousands if not tens of thousands. Short of the perfect study, however, we will never know the exact number. In the meantime, we can let perfect be the enemy of good. Or we can recognize the evidence to date is sufficiently robust for policymakers to proceed confidently with health care reforms that promise substantial health and financial benefits for millions of uninsured Americans.
Whether or not we can manage to do this is a moral test for us as a society. As a friend pointed out in December, important as the technical details of policy options and the dynamics of the political maneuvering may be, we should not let them distract us from the moral heart of the matter:
a decent affluent society ensures that all its people can get adequate health care and doesn't make this a matter of individual resources or accidents.
The first step in this direction, clearly, is to Pass The Damn Bill.

--Jeff Weintraub