Health care doesn't keep people healthy -- even in Canada

By Ezra Klein

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 researchers ran the data two ways: High-income patients vs. low-income patients, and highly educated patients vs. less educated patients. Over the course of the study, the high-income patients were only 35 percent as likely to die as the low-income patients, and the highly educated patients only 26 percent as likely to die as the low-income patients. And the problem wasn't that the low-income and low-education patients were hanging back from the health-care system. Because they were getting sick while their richer and better educated counterparts weren't, they actually used considerable more in health-care services.

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.

You don't want to over-interpret this data. It's possible that in the absence of insurance, the gap would be much wider. Indeed, there's good evidence suggesting that's true. Nevertheless, this should make us very skeptical about a world in which we're spending almost one out of every five dollars on health-care services. Universal insurance is crucial both for certain forms of health care and for economic security. But as I've argued before, it's probably not the best way to make people healthier. 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.