Measure Health, not Health Insurance

Most media coverage about health care focuses on insurance: who’s covered, who can’t get coverage, how much people pay for their premiums and their deductibles, the dreaded Obamacare tax penalty, the ongoing debate about whether to repeal Obamacare’s health insurance regulations, and the number of plans offered in each state’s marketplace exchange. All of those links were published in this week’s news. It’s a constant topic of conversation.

It’s worth keeping in mind that insurance is just a means to a means to an end. Insurance helps you pay for medical care, and medical care helps you achieve health. Health is the real goal, not insurance.

We have excellent data available on Americans’ health, both compared to 25 years ago and compared to other industrial countries. You probably won’t be surprised to learn that the US infant mortality rate is double that of Norway, Korea, Spain, and the Czech Republic. (Or, at least, that’s where our infant mortality rate was back in 2014, the last time the Washington Post bothered to report on it.) You might be surprised to learn that US child vaccination use has increased from only 62% in 1993 to 92% in 2013. Yes, it’s annoying to listen to people who deliberately oppose the use of vaccines that science shows to be extremely safe — but we shouldn’t let a handful of rogue idiots obscure the broader success of our country’s vaccination efforts. We have measures of how many people die of a stroke after getting admitted to the hospital, measures of how many people get admitted to the hospital for asthma, measures of how many people are able to get same-day or next-day appointments when in need of care…it’s really a wealth of information.

If you’re more concerned about the financial implications of changes in American medicine, it might be worth taking a look at the medical bankruptcy rate, which Snopes recently confirmed was approximately 600,000 Americans per year, running from 2007 up through 2016. That’s over 4 million medical bankruptcies since the Affordable Care Act passed in the Senate. Total national health care expenditures increased from $670 billion in 1991 to $3,000 billion in 2014. Adjusted for inflation and population growth, that means health care expenditures have more than doubled from $4,600/person to $9,400/person (in constant 2014 dollars)…but life expectancy has inched up at a slow crawl, growing from 75.4 years in 1991 to 78.8 years in 2014.

Debates about health insurance attract attention because it’s easy for people to imagine (or remember) the fear of not being able to afford treatment. There’s nothing wrong with reading the news about health insurance to see how it will affect your family. But if you’re interested in health policy, insurance is the wrong place to try to make a difference — it’s a crowded arena, with thousands of smart, motivated people already tugging and yanking as hard as they can on all of the plausible levers. If you want to improve Americans’ health, consider skipping right over the issue of insurance and attacking the problem directly, by looking at real facts about real people’s medical outcomes and finding an outcome that you think you can improve.