Ezra Klein: Health care doesn't keep people healthy -- even in Canada

[dkf]

File this one under "health care doesn't work nearly as well as we'd like to believe." A group of researchers followed almost 15,000 initially healthy Canadians for more than 10 years to see whether universal access to health care meant that the rich and the poor were equally likely to stay healthy. The answer? Not even close.

The researchers ran the data two ways: High-income patients vs. low-income patients, and highly educated patients vs. less educated patients. Over the course of the study, the high-income patients were only 35 percent as likely to die as the low-income patients, and the highly educated patients only 26 percent as likely to die as the low-income patients. And the problem wasn't that the low-income and low-education patients were hanging back from the health-care system. Because they were getting sick while their richer and better educated counterparts weren't, they actually used considerable more in health-care services.

The problem, the researchers say, is that the medical system just isn't that good at keeping people from dying. "Health care services use by itself had little explanatory effect on the income-mortality association (4.3 percent) and no explanatory effect on the education-mortality association," they conclude.

You don't want to over-interpret this data. It's possible that in the absence of insurance, the gap would be much wider. Indeed, there's good evidence suggesting that's true. Nevertheless, this should make us very skeptical about a world in which we're spending almost one out of every five dollars on health-care services. Universal insurance is crucial both for certain forms of health care and for economic security. But as I've argued before, it's probably not the best way to make people healthier. Rather, the best way to make people healthier would be to get health-care costs under control so there's more money in the budget for things like early-childhood education and efforts to strip lead out of walls, both of which seem to have very large impacts on health even though we don't think of them as health-care expenditures.

http://voices.washingtonpost.com/ezra-klein/2011/02/health_care_doesnt_keep_people.html

[Mimosa]

1. Ezra Klein should get a Pulitzer for his health care articles.

DKF, you deserve a few big hugs and drinks of your choice for posting Klein's articles. :)

[dkf]

2. He is good isn't he?

I'm shocked how I find these older articles that I've never seen posted that are pretty Interesting and eye opening.

[inna]

4. no he's not, he's a fucking apologist for the system. not even always good at that.

[leftstreet]

6. +1

[Raine]

11. +2 nt

[girl gone mad]

12. +3

[handmade34]

3. good article

title is misleading... it is that health and health care are complex with unlimited factors determining our health and longevity

first comment posted after article: "...if health care reform was really about health, it would have mandated a healthy diet and exercise, not insurance" :o

[Monk06]

5. The question isn't whether equal numbers of Canadians die from the same health care.

The question is how many Canadians die in their beds with
adequate health care and how many Canadians die in the ally
without any care at all. Let me tell you hundreds die in the
alleys of Vancouver. The even made a TV series about it.

Today a bus ride through Vancouver's east end is like a Zombie
Walk. It makes Pioneer Square in Seattle look like a tourist
attraction.

[OHdem10]

7. Our system is set up in such a way it is impossible to cut costs.

NO ONE WILL ADMIT THIS.

Ours is a for profit system. Therefore, every health care
entity is on the Stock Exchange. Drug Companies, Medical
Supply Companies, Medical Equipment Companies, Some hospitals.

Every company in the Stock Market has to turn in quarterly
Reports. They MUST SHOW earnings and Profits. If they
have not increased their profits the Ratings Agencies rate
DOWNGRADE THEIR STOCK. This is such a dreaded action that
companies have gotten into serious trouble for cooking their
books rather than be downgraded.

In order to make profits, they cut services or increase the
cost to the consumer. We have HEALTH CARE COMPANIES who must
increase their earnings every 3 months year after year. Wall
Street is there to earn money.

It is unrealistic to expect them to bring their cost down.
It goes against their very mission. TO MAKE MONEY FOR
SHARE HOLDERS.

This is why the Europeans have some versions of single payer.
Health Care is not for profit in Europe or Canada.

The Single Payer Medicare Program is much more economical
than the new system we developed.

It is true that if we did not spend so much on Health
Insuranceetc, there would be much more money for prevention.

[senseandsensibility]

8. The voice of sanity.

Thank you.

[Fumesucker]

9. Excellent, you really should post this as an OP, I'd K&R it ..

[dkf]

10. The truth of your statement makes this study even more ironic.

[LetTimmySmoke]

13. The problem is that health care is a major source of jobs.

[ipaint]

14. No, it's a major money maker for wall street.

The jobs aren't going anywhere it's who gets to line their pockets with the hoarded profits from inflated prices.

[mmonk]

15. Our health care delivery system is the worst in the industrial world

as to delivery, and the outcomes do not match the cost which is much higher per capita. No American has any intellectually credibility being critical of other systems until it has something that is at least as equally cost efficient and equally effective as the country it is criticizing.

[dkf]

16. Is that what you get from this? A criticism of Canadian health care?

That isn't what he is saying. The study shows that access to health care is less important for health outcomes than having a higher education or secondarily wealth.

People further down the educational scale used more health services and had worse outcomes. So the correlation to health is tied more to educational status than access to health care.

[xphile]

17. And the conclusion is what? That because of that we should not care if some people have

NO access to health care at all?

Because that's an idiotic conclusion. There is no excuse for anyone to not have access to health care when they need it.

[dkf]

21. Obviously not.

But somewhere in the lifestyle of an educated vs non educated person is the better solution to the problem.

[mmonk]

23. No, not really. But the attempt to include everyone must be considered.

[bemildred]

18. As with lawyers and cops, the idea is to have as little as necessary to do with "health care".

More health care does NOT equal better health. The absence of any need for "health care" equals better health. And as the OP indicates, that comes from education and adequate financial conditions, and luck.

[LeftishBrit]

19. No one is saying that universal access to healthcare is ALL that is needed to keep people healthy..

let alone, that it establishes perfect equality between rich and poor. Nonetheless, that is no excuse for dismissing it as a vital goal.

According to the UN listings, Canada is 11th in the world life expectancy statistics. The USA is joint 36th. There are a number of factors in this, but access to healthcare is clearly an important one.

'the best way to make people healthier would be to get health-care costs under control so there's more money in the budget for things like early-childhood education and efforts to strip lead out of walls'

This is putting the cart before the horse. I would put it instead that public provision of early childhood education, lead removal and general pollution control, and ensuring adequate nutrition will mean lower costs of treating illness in children and adults (though possibly higher costs of caring for the elderly, as more people will live longer!) Cutting healthcare to supposedly increase funding for e.g. early childhood education is likely to just play into the hands of those who don't want too much spending on either, and would rather have more tax cuts for the rich, and more privatization. It's a classic strategy of the public-services-cutters to present the situation as one of 'there's only so much money for the public services; choose which one you want to fund!' Usually there would be considerably more money for the public services, if people seriously *wanted* to fund them.

[dkf]

22. Funny thing is it's probably secondary.

Maybe our system encourages the lower educated to live in a way that lowers their life span. That would be sick.

[Bragi]

20. "Health care" and "public health" aren't the same thing

There are many reasons why rich and poor people have health inequities. Mostly it has to do with economic and social factors that mostly determine health.

Acute health care -- what you get through the clinical "health care" system -- is focused on looking after people when they get sick.

If poor and rich are treated much the same through universal equal access to health care, then that helps, but it still doesn't deal with all the major factors (diet, lifestyles, exercise, built environment, etc) that actually determine whether or not a person is likely to get sick in the first place.

Which is why universal health care has to be seen as part of what's needed to eliminate health inequities, and not be seen as the complete and total answer to reducing or eliminating health inequities.

The complete and total answer is to address the underlying the economic and social inequalities that determine health outcomes, and that's case whether its the U.S, Canada, Europe or wherever.

[marmar]

24. Ezra Klein is the perfect example of what Chris Hedges calls "courtiers"

"They know that once self-delusion no longer works it is the iron fist that speaks. The solitary and courageous voices that rise up from these internal and external colonies of devastation are silenced or discredited by the courtiers who serve corporate power. And even those who do hear these voices of dissent often cannot handle the truth. They prefer the Potemkin facade. They recoil at the “negativity.” Reality, especially when you grasp what corporations are doing in the name of profit to the planet’s ecosystem, is terrifying."

http://www.truthdig.com/report/page2/recognizing_the_language_of_tyranny_20110206/