Where did I put that post I wrote on how Massachusetts has the highest health care costs? I need it now, because apparently all that money is working. Today I learned that since the mandatory health insurance law was passed in 2006 mortality has decreased by 3%. Which is 3% more than any other state.
So this is good. Changes in mortality can really only be measured over years with millions of patients, both of which this study, which came out today in the Annals of Internal Medicine, has. And these results make a certain amount of sense. What do people die of these days? Heart disease, diabetes, infections, cancer. All of these things, except maybe some forms of cancer, are things that can be treated if treatment is careful and consistent. Which means a decent doctor, regular appointments, and faithful adherence to medications. The chances of all three of those things happening definitely increases if patients have insurance. It actually corresponds to the finding a few months ago that people are using more health care now than they were, even in emergency rooms. If you take the money component away, they will come, to paraphrase Kevin Costner.
Remember the Oregon study? It found that giving people insurance improved mental health and financial security, but not physical health. This is not contradictory to the Massachusetts finding. Remember that healthcare does not equal health, and lower mortality does not mean more health. It just means that people with chronic conditions are being treated. That’s a really good thing.
But. If you treat more people, it costs more. The ACA doesn’t do anything substantive to change that. Health care costs will go up, even if less people die, because chronic, lifestyle- and genetically -based conditions will not go away by insuring people. For that to happen we need much broader efforts at encouraging health, not encouraging health care.