About one-sixth of all residents of the US Northwest lack health insurance, according to the most recent data from the US Census Bureau. And you’d think that this would be a major reason that residents of BC—where health care is universal—live about two and a half years longer than do residents of Oregon, Idaho, and Washington.
Or, maybe not. I recently ran across this article from 2002, which reports on an Institute of Medicine study that estimates that 18,000 people between the ages of 18 and 64 die each year in the United States because they lack health insurance.
Now, 18,000 deaths is certainly a tragedy of significant proportions. However, according to mortality data from the US Centers for Disease Control and Prevention, those 18,000 deaths represent only about 3 percent of all deaths among working age Americans in 2002.
Let’s say that, by extending health insurance to everyone in the US, those 18,000 deaths could be prevented. In terms of outcomes, that would be a good thing: US life expectancy (one of the best proxies for overall health) would rise by about 2 months. But, still, the life expectancy gap between Canada and the US would narrow only a bit, falling from 29 months to 27. That’s obviously a good thing, but in the big picture, it’s still a drop in the bucket.
Now, a couple of caveats. First, the IOM study didn’t look at deaths among children under 18; extending insurance to them would probably improve life expectancy by a bit more. Second, it may be hard to tease apart the effects of underinsurance as opposed to outright lack of insurance. Some folks have catastrophic coverage that takes care of them in case of an emergency, but avoid going to the doctor for preventative treatment because they pay for such care out of pocket. And, of course, there may be some methodological errors in the IOM study that make the 18,000 figure a significant understimate (or overestimate) of actual deaths that result from uninsurance.
Still I can’t escape this conclusion: there’s a lot more to health than health insurance. The health gap between the US and most other industrialized is pretty wide; and it’s not *just* our (broken and wildly expensive) health care system that’s at fault. Other factors are at play. So as important as it may be to improve access to health care, it’s probably just as important to look at—and fix—the underlying factors that cause us to get ill in the first place.