Off the Cuff: Health Insurance and Health

(Photo by Jeffrey MacMillan)

This summer, as politicians were debating whether to repeal the Affordable Care Act (ACA), a paper in the New England Journal of Medicine showed that while expanding health insurance does not reduce spending, it improves health in many ways. Lead author Benjamin Sommers, a health economist and primary care physician, synthesized evidence from more than 40 papers published over the past decade. His Harvard Chan School co-authors were Atul Gawande, director of Ariadne Labs, a professor of health policy and management, and a surgeon at Brigham and Women’s Hospital; and Katherine Baicker, then the C. Boyden Gray Professor of Health Economics and now Dean of the University of Chicago Harris School of Public Policy.

“Health insurance brings significant benefits to people’s lives. It protects against the risk of catastrophic spending and improves financial security. People who are insured are more likely to have a primary care provider and to take their prescription medications. People get more regular care for chronic conditions and more preventive screenings for cancer, high cholesterol, and diabetes. Depression, one of the leading causes of disability in the country, improves. One of our most prominent findings is that people simply feel better—they tell you that their health has improved. And several studies show that large coverage expansions save lives.

But while the evidence shows clear benefits of health insurance, that’s separate from the question of whether the government should expand coverage. That’s not primarily an economic or evidence-based question—it’s a values question. I wish the recent debate over the Affordable Care Act had been honest about that. The honest debate would have been between people who support expanded coverage and those who say health insurance is not the government’s responsibility, that it’s not worth the cost, or that taxpayers shouldn’t be subsidizing coverage for lower-income people. Instead, a lot of the discussion was misleading political rhetoric, with supporters of repeal claiming that their proposals would actually expand health care access.

For those who think that expanding insurance is a good thing, there was a silver lining in the recent debate: It forced several moderate and even conservative politicians to come out and say, ‘You know what, some of this law is good. Sometimes the government does have a role in expanding coverage.’ Conservative skeptics of the ACA say, ‘Once you give a benefit, it’s impossible to take it away.’ Liberal supporters of the law say, ‘Once you give a benefit, it’s impossible to take it away.’ Both recognize the same fact, but they disagree on whether it’s a good or a bad thing. Either way, there’s likely no going back to a fully pre-ACA world.”