Quote-of-the-day mailing list
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Subject: qotd: U-shaped curve of health status and coverage
Date: Tue, 2 Oct 2012 10:07:43 -0700
From: Don McCanne <firstname.lastname@example.org>
To: Quote-of-the-Day <email@example.com>
United States Census Bureau
Current Population Reports
Health Status, Health Insurance, and Medical Services Utilization: 2010
By Brett O'Hara and Kyle Caswell
There is a U-shaped relationship between health status and having any
type of health insurance coverage. Among all people who reported
excellent health, 85.0 percent were insured. For those who reported good
health, 80.2 percent had health insurance coverage. Finally, 85.1
percent of people who reported poor health also had health insurance
This U-shaped relationship for the overall insurance rate is partially
attributable to trends in the type of health insurance coverage. For
example, 15.7 percent of people with excellent health reported having
only public insurance, compared with 44.7 percent of people with poor
health. On the other hand, the percentage of people with excellent
health who had private health insurance was 69.3 percent, compared with
40.4 percent of people in poor health.
Comment: This seemingly mundane observation from this Census Bureau
report provides great insight into the problems with health care
financing in the United States.
It is astonishing that a country that spends so much on health care
would have a U-shaped curve, or any curve for that matter, on the
relationship between health status and whether or not one is insured.
Considering our financing system, the curve is easy to understand.
People in excellent health also tend to have favorable socioeconomic
circumstances that would result in higher enrollment in private
insurance plans. Likewise, people in poor health tend to have less
favorable socioeconomic circumstances that would result in higher
enrollment in public insurance programs. People in good health would
fall in between and thus would lie in the trough of the U-shaped curve,
with lower rates of insurance than those well off and those benefiting
from government programs.
If we had a decent health care financing system, wouldn't those in good
health be as well covered as those in excellent health and those with
public programs? More importantly, shouldn't either end of the U-shaped
curve reach 100 percent coverage? And wouldn't the trough be wiped out
so everyone with good health were covered as well?
The Affordable Care Act might shift the entire curve up as more are
covered, but the 30 million who will remain uninsured will perpetuate
the bizarre U-shape of the curve. We need a flat line, at the top, with
100 percent coverage. That's everyone, like we would have in an improved
Medicare for all.