Does Health Insurance Save Lives?

Whoever is elected in the upcoming presidential election will either implement the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148) or try to repeal it. In a discussion on Kaiser Health News, Senator Tom Daschle said that if Mr. Romney is elected, he can do a lot to disable PPACA even if he can’t get Congress to repeal it, such as:

  • use the reconciliation process to change items that affect the budget;
  • direct the agencies to rewrite the regulations; and
  • eliminate it from his budget.

Depending on the composition of Congress, he may be able to get some of the changes he wants piece by piece.

Mr. Romney questions the fundamental premise on which PPACA is based— that having health insurance saves lives.  Recently, he said:

“We don’t have a setting across this country where if you don’t have insurance, we just say to you, ‘Tough luck, you’re going to die when you have your heart attack.

“No, you go to the hospital, you get treated, you get care, and it’s paid for, either by charity, the government or by the hospital. We don’t have people that become ill, who die in their apartment because they don’t have insurance.”

It is not quite that clear cut however. First, if you have a medical emergency and go to the hospital, under the Emergency Medical Treatment and Active Labor Act (EMTALA) (Soc. Sec. Act sec. 1867), the hospital must stabilize your condition. But once it is stabilized, it doesn’t have to provide all the care you need. It does not have to arrange follow-up care once you’re out of danger from that heart attack.  And if you need screenings for cancer or diabetes and it’s not a medical emergency, the hospital is not required to provide them.

Second, there’s no law that says the hospital can’t bill you. Failure to pay a hospital bill can damage your credit. One of the most common causes of bankruptcy is unpaid medical bills.

Charity, the government, or the hospital—Which government programs pay for hospital bills you can’t afford? There is Medicaid, for which most people are not eligible. State and local governments sometimes have programs for the medically indigent or uncompensated care. As a last resort the hospital “pays” if no one else does, and but it must pass the cost on to the rest of us. Governments and charities operate some hospitals, but others are for-profit enterprises.

Does heath insurance lead to better health status? The Centers for Disease Control (CDC) published a study that made a clear connection between unemployment and lack of insurance, and between uninsured status and poorer health.  A small percentage of the uninsured have been excluded for preexisting conditions, but many more go without because of the cost. They gamble, and sometimes they lose. But do we really know who is paying for that loss?