The epileptic with zero anti-convulsant levels, the diabetic with sky-high blood sugar, the vasculopath with tachycardia clenching a hand against the chest. Every physician knows that people without health insurance don’t do well. But what is the worth of a physician’s wisdom compared to that of a Byzantine sage?
In the March issue of the Atlantic, Megan McArdle claims that “half of the uninsured are affluent, lack citizenship, or are already eligible for programs in which they hadn’t bothered to enroll.” This is contrary to my experience. The uninsured, by and large, are ineligible for government assistance or can’t afford insurance, while the “affluent” are uniformly insured, as are 41% of illegal immigrants.
McArdle complains that we “forgot to ask the fundamental question” which apparently, is not why 40 million people are uninsured in the U.S., but whether health insurance saves lives. To her intellectual subtlety, this is merely a “myth” or “syllogism.” She superficially criticizes a couple of old studies and disparages “heart-wrenching anecdotes,” convinced that only controlled trials comparing the insured to the uninsured are satisfying ways to settle the issue. This is a total misunderstanding of the scientific and ethical foundations of medicine. Compelling evidence shows that lacking access to health care limits longevity and quality of life (partly summarized by Ezra Klein and in an unpublished letter to the Atlantic). In fact, I am concerned about the cognitive competence of anyone who believes that an uninsured person with a significant chronic condition isn’t at risk of premature death.
The advantages of health care, McArdle maintains, are erased by medical mistakes. There are two problems with such reasoning, besides its mathematical impossibility: first, the uninsured are also exposed to medical mistakes (frequently, at emergency rooms, an accident-prone and costly way to dispense care). Second, exposure to physicians, nurses and pharmaceuticals -rather than health insurance- is the actual “risk” evoked. Must we conclude, to be logically consistent, that health care is dangerous or trivial?
Despite accepting that mortality is a gross indicator of outcomes, McArdle deploys this very marker to debunk the notion that health care coverage is good. But extreme examples are distracting. Let’s take somebody with a “latent” disease, like McArdle herself: if regular check-ups fail sparing “an early grave,” less tangible issues like symptomatic relief or reassurance can ameliorate outcomes.
Finally, McArdle explains that the uninsured are more likely to engage in risky activities, apparently under the impression that the insured (i.e., all firemen, cops, and Holiday on Ice skaters) don’t. Her premise is tendentious enough to make us wonder if McArdle’s prejudices are at work here instead of her calls for probing and rejecting preconceived ideas. In fact, her argument carries the scent of a familiar cliché: “the uninsured are risk-takers; if they get sick, that’s their fault and responsibility.” The originality of her views is crowned with this pearl: “lack of health insurance has no more impact on your health than lack of flood insurance.” Detailed statistics are unnecessary to unmask such fallacy.
When patients say they can’t afford tests or prescriptions, a p value is hardly relevant. We dwell in a real world, not amid the vapors of sublime thought.
The pious Byzantine scholars were caught debating angelical scatology by invading Turkish armies. But societies whose illuminati make careers out of empty speculation must confront a rude awakening: real problems don’t dissipate with sophist concoctions within the warm confines of an ivory tower. McArdle’s preoccupation is argument modeling, not truth seeking. If health care is so dangerous, she should decline the “generous insurance” provided by the Atlantic− no doubt, a sinister plot.