health insurance does not equal health

Tuesday, August 1, 2017

Dear Politicians. Let me ask a question. If every person in our country had health insurance, would we be any healthier?

-Mark Cuban. Twitter. 7/30/2017

Dear Mark,

Thank you for such an insightful question. Unfortunately, I am not a politician and cannot provide you their perspective, but I do care for patients on weekends, in the middle of the night and whenever they perceive an emergency to exist.  And I wish that I had a satisfying and uplifting answer toyour question. But I do not. The reality is that health insurance and access to health care does not equate to health. This is not an opinion based upon fact but instead, from anecdotal personal experience and bolstered by a few cherry-picked statistics.

Ideally, access to health education and disease prevention would begin before birth and continue through childhood and adolescence so that each person was delivered to adulthood with the best chance of living a healthful life. The concept that health insurance availability alone will reach such a goal fails to account for societal ills and governmental agency policies that are add odds with providing a highway to healthy adulthood.

Beginning with pregnancy, there are too many unlucky babies born to mothers who abused alcohol, opioid narcotics or tobacco during pregnancy. The numbers can be staggeringly high.

  • 21,700 babies were born in 2013 (latest statistics available from the CDC) with neonatal abstinence syndrome, where the newborn goers through narcotic withdrawal because of the mother’s drug abuse. Short term complications include poor growth, dehydration and seizures; the long-term problems are uncertain since there is not enough data yet available.
  • Fetal alcohol spectrum disorder affects between 0.2% and 1.5% of all births in the US. In 2002, the lifetime cost per infant was more than $2 million and a yearly cost to the health care system of more than $4 billion.. In some western European countries, the incidence of fetal alcohol syndrome can be as high as 5%. It seems that universal healthcare can’t stop the adverse effects of alcohol abuse.
  • 10% of mothers smoke during the last 3 months of pregnancy. This affects placenta development and can lead to premature deliveries and low birth weight babies. Other issues include congenital heart problems and cleft lip. There is also increased numbers of asthma, pneumonia and SIDS (sudden infant death syndrome)

Tobacco continues to rear its ugly head in teenage years, when most people begin smoking. More than 90% of people have their first cigarette before age 18. Each year more than 450,000 people die from smoking related deaths, from cancer to heart attack and stroke, to COPD and emphysema.

“The overwhelming amount of death and disease attributable to tobacco is caused by addiction to cigarettes – the only legal consumer product that, when used as intended, will kill half of all long-term users,” – FDA Commissioner Scott Gottlieb

And not to be forgotten, the cost of alcohol abuse in lives lost and broken. More than 10,000 people die each year as victims of a drunk driver. 1.1 million people were arrested for drunk driving. In Wisconsin, known for its beer and binge drinking, there were more than 5,100 alcohol related crashes in 2015, resulting in 2,872 injuries.

US obesity rates have increased to affect nearly 40% of all adults and 17% of all children. Complications include heart attack, stroke, diabetes, sleep apnea and cancer.

Mr. Cuban, you’ve asked a profound question. Regardless, of how many people have health insurance, there is no guarantee that they will pursue a healthy lifestyle. The question then might be asked whether personal choice should affect access to the full spectrum of possible health care available. Most recently, one health authority in England has decided to withhold elective major surgery from people who are morbidly obese or who smoke.

When Congress debates the merits of one health insurance system over another, they forget to consider perhaps the most important intangible. There is an unlimited and insatiable demand for health care and unless society is willing to pay for it all, one day, choices will have to be made about who gets what care.  Welcome to the world of rationing.




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One Response to health insurance does not equal health

  1. Sam says:

    Poignant and well written.
    This country will have to grapple with rationing at some point in the not too distant future.

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