The public-health crisis we’re facing won’t be solved by access to health insurance.
In 2016, two truths were revealed at once. First, the percentage of uninsured Americans hit a record low — a mere 8.6 percent. In 2010, almost 50 million Americans lacked health insurance. By the beginning of 2016 that number had plunged to 27.3 million. This is, truth be told, the fruit of Obamacare and indeed is the very reason why the GOP is having so much difficulty in its struggle to repeal and replace it. People like having health insurance, and health insurance makes us healthier, right?
But that brings us to the second truth that was revealed in 2016. Even though Americans allegedly enjoyed unprecedented access to insured health care, the nation’s death rate in 2015 actually increased. More Americans were insured, but more Americans died. Why?
A clue comes from Princeton economists Anne Case and Angus Deaton, the same people who shocked America two years ago with research showing the remarkable rise of the death rate among middle-aged white Americans. This week, they released new research showing that the trend continues. “Deaths of despair” are “surging” in the United States. The chart below is nothing short of stunning:
Even worse, other data show younger-age cohorts are at significantly greater risk of death by drugs, alcohol, or suicide than their elders were: Men and women in early middle life began exhibiting by their twenties the same kinds of death rates from drug, alcohol, and suicide as were formerly reserved for much older men enduring the stereotypical “mid-life crisis.”
Indeed, these charts may actually understate the extent of “deaths by despair.” The obesity epidemic is carrying with it increases in chronic health conditions, including diabetes and heart disease, and make no mistake — obesity is exploding in the United States. The YouTube video below silently and ominously charts a stunning, national increase:
As Congress debated Obamacare repeal, I had lunch with a local critical-care doctor who seemed oddly indifferent to the outcome. His is a world dominated by addiction. “If it weren’t for addicts,” he says, “I wouldn’t have a job.” The intensive-care unit is overrun with people addicted to drugs, to alcohol, to food, and to tobacco. Insurance matters to the economics of the hospital, but it doesn’t matter so much to the quality of its patients’ immediate care or to their ultimate health outcome. They’re killing themselves, and the best health care and the most luxurious “Cadillac” health plans won’t stop their slide into oblivion.
It’s too simple to say that health insurance and the current debate in Washington doesn’t matter to public health. It obviously does. But it’s fair to say that it may well matter less than healthy marriages, strong families, decent jobs, and a vibrant faith. Deaton described the plight of the white working class well: “Your family life has fallen apart, you don’t know your kids anymore, [and] all the things you expected when you started out your life just haven’t happened at all.” And so, to “soothe the beast,” you turn to substances, to food, and — sometimes — ultimately to death itself.
Just as there is no simple solution to this crisis, there is no simple explanation. For every attempt at a short summary — it’s about jobs; it’s about marriage; it’s about welfare and dependency — there’s an answer that complicates the picture. For example, black families have had more economic struggles (and have had more out-of-wedlock births) than white families, yet for years their death rate fell while the white rate rose. Could the vibrancy of the black church and the apparently (substantially) greater religiosity of black Americans help explain a degree of healthy resilience in the face of economic, familial, and racial adversity? As the Pew Research Center notes, “African-Americans are markedly more religious on a variety of measures than the U.S. population as a whole, including level of affiliation with a religion, attendance at religious services, frequency of prayer and religion’s importance in life.”
Unless our citizens can find a way to soothe the despair, the great health-insurance debate from 2009 to 2016 may end up a mere footnote in public-health history. At the end of the day, neither the best nor the worst insurance can cause a man to put down his pills, throw out his whiskey bottles, or walk more and eat less. When the human heart aches, an insurance card won’t ease the pain.