Ezra Klein pinch hits for the med skeptics

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 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.

Ezra seemed to backtrack a little in a later post but I can see he really wants to come over to the skeptical side. Don’t let Tim Carney’s abrasiveness scare you away. The skeptics really are a nice, internally consistent bunch.

I, for example, have never paid a dime of my own money for my own health insurance. I have always chosen the lowest quality health plan when rolled into my employment package and no health plan when not.

Really quickly I’d also just like to plant another seed. There are clear cases when medical care saves people’s lives. However, if access to more medical services isn’t associated with a longer life, then we have to take seriously the proposition that medical care is also causing a significant number of deaths. I’ll get into the life expectancy of Christian Scientists in another post.

All that having been said, what I really wanted to talk about the possibility of education improving health outcomes.

Ezra goes on

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.

Arnold Kling cosigns on the general concept education for health

My guess is that if you want to improve health outcomes in the United States, ignore health insurance and focus on literacy. Even if it has nothing to do with whether or not they can follow a doctor’s written instructions, my guess is that better literacy has a positive impact on health outcomes.

I am skeptical about a fundamental link here. I suspect we have two things going on.

First, education confers status and status is related to health outcomes. For example Oscar winners live longer than those simply nominated. How this link occurs is not totally clear. It seems that the hormones associated with stress and disappointment – cortisol for example – reduce long run health. However, this may not be the mechanism. No one really knows at this point.

Second, for a long list of reasons there is correlation between education and physical attractiveness. Physical attractiveness is by evolutionary design a proxy for health. Which to say, healthier folks are more likely to become well educated.

This makes me doubt that power of health improvements from increasing education.

In general it is just damn hard to improve health outcomes. Our bodies are the product of about 4 billion years of evolution. Just making sense of how they work is hard enough. Making them work better is a herculean task.