HEALTH CARE ISN'T ALL ABOUT HEALTH. Garance asks me to comment on this fascinating New York Times article laying out the strong correlations between health and education. She wonders if our health care debate isn't "too focused on questions of coverage and disease treatment, rather than on actually improving the long-term health of the population through public health initiatives whose are results are not immediately apparent." That's simultaneously true and untrue, but let's bracket it for the moment. The question of whether we could vastly improve health outcomes in this country by forcing everyone into college is an interesting one, but I'm skeptical. Given that no one thinks the dedicated study of Proust unlocks secret immortality enzymes, the question is what education is correlating with to create these outcomes. Most likely, it's a host of factors. On the individual level, less physically taxing jobs, more occupational control, more social capital, less economic stress, more personal power (feelings of control are heavily correlated with good health), etc. More globally, higher levels of society-wide education will correlate with higher economic growth, a less menial economy, higher incomes, etc. And the article strongly implies that a primary effect of more education is that it makes people smart enough to not smoke, in which case we should pump research into smoking bans (thank you, DC!). And it should be noted that we could make everyone much healthier if we could make them Hispanic. Those concerns aired, Garance is absolutely right: Our health care debate focuses too much on insurance. Most everyone in this country can access some sort of care, even if only at the point of crisis. That's not an optimal situation, but the available strides in outcomes are fairly limited. The way we pay for coverage simply isn't the primary determinant of health. That said, I wouldn't pull the throttle back on the reform fight by even an inch. The health care question is more economic than medical -- indeed, it's likely the most important economic problem facing the country. Everyone gets care, but the ambulance ride or cancer diagnosis bankrupts no small number of Americans. That they also lack access to preventive medicine and early diagnostics is deeply troubling. Meanwhile, health care is going to chew up our national economy if we don't get medical inflation under control, and the vagaries of the employer-based health system substantially reduce the freedom of individuals to pursue their own dreams, business ideas, and general bliss while simultaneously bankrupting employers and incentivizing a race to the bottom in benefits. Indeed, though there are better ways to improve health outcomes than reforming the way our system delivers coverage (like massively funding the NIH), there's nothing that would do more to ensure the economic security and personal freedom of average Americans, or the financial health of the country, than reforming the system. And in the end, it's not an either/or question. A better system would save money, freeing up funds for other public health and social policy priorities. --Ezra Klein
