Health Insurance Works, Trusting Its Detractors Doesn't

Some of you asked me to take a look at The LA Times op-ed by Michael Cannon and Michael Tanner on why universal health care ain't all it's cracked up to be. I should preface this by saying that I like Michael Cannon and have generally found him to be honest, thoughtful, and very, very wrong on health care issues. And so, in trying to give him the benefit of the doubt here, I will say only that this article is violently, even surprisingly, misleading.

By way of diminishing the reader's assumptions that access to health insurance is important, Cannon and Tanner write, "[y]ou may think it is self-evident that the uninsured may forgo preventive care or receive a lower quality of care. And yet, in reviewing all the academic literature on the subject, Helen Levy of the University of Michigan's Economic Research Initiative on the Uninsured, and David Meltzer of the University of Chicago, were unable to establish a "causal relationship" between health insurance and better health. Believe it or not, there is "no evidence," Levy and Meltzer wrote, that expanding insurance coverage is a cost-effective way to promote health."

Believe it or not, Cannon and Tanner are misrepresenting the study's conclusions. Finding a causal link is hard because there are just about no large scale, experimental studies on the subject, and observational studies can't establish causation. Nevertheless, here's what Levy and Meltzer actually conclude, in their own words:

The results of small quasi-experimental studies provide only mixed evidence that health insurance affects health, while larger quasi-experimental studies and the RAND Health Insurance Experiment provide consistent evidence that health insurance improves health. Only one large-scale quasi-experimental study (Perry and Rosen)fails to show a relationship between health insurance and health, and this study may not have adequate power to rule out the possibility that health insurance improves health. Taken as a whole, these high-quality studies of the health effects of health insurance strongly suggest that policies to expand insurance can also promote health...We are left with the conclusion that health insurance can improve health but remain unable to say exactly which interventions related to insurance will do so most effectively.

So yes, causality remains tricky. But the bulk of the data is unambiguous. And we can go section by section in the Levy/Meltzer study for proof. "Lichtenberg’s preliminary findings suggest there is a significant effect of health insurance on health for persons at retirement age," they write. "Currie and Gruber conclude...[that] expanding children’s health insurance coverage improves child health as measured by the reduction in mortality rates." "[Hanratty's] results suggest that there was a significant reduction of 4% in the infant mortality rate as a result of national health insurance and a smaller reduction in low birth weight of about 1.3%." "[Goldman's] study provides strong evidence that health insurance can have a dramatic effect on mortality among patients with HIV." "[W]ith the exception of Haas et al. and Perry and Rosen, these studies find evidence of significant improvements (declines) in health outcomes as result of expansions(contractions) of insurance."

And I could keep going. But I don't think it's necessary. In their zeal to beat back the momentum of universal health care, Cannon and Tanner are simply and blatantly misleading the LA Times' readers. I'm genuinely surprised at them.