If you have heart disease or diabetes and you are uninsured you are worse off than those who are insured by several measures. Those are the kinds of health conditions that usually worsen with age, too, so you would expect this to be a bigger problem for the uninsured near elderly. But they don’t worsen for this group because when they hit 65 in the US they are no longer uninsured: they have the near universal health insurance coverage called Medicare, and as a result their health improves. Those are among the findings in a paper in the Journal of the American Medical Association (JAMA) by a team at Harvard Medical School:
J. Michael McWilliams, M.D., of Brigham and Women’s Hospital and Harvard Medical School, Boston, and colleagues assessed the association of acquiring Medicare coverage at age 65 years with trends in self-reported health outcomes from ages 55 through 72 years for previously uninsured adults, especially those with cardiovascular disease or diabetes. The researchers analyzed survey data, collected from 1992 through 2004, from the nationally representative Health and Retirement Study, which included 5,006 adults who were continuously insured and 2,227 adults who were persistently or intermittently uninsured from ages 55 to 64. Changes in health trends were compared for previously uninsured and insured adults after they acquired Medicare coverage at age 65 years. The areas of health surveyed included general health, change in general health, mobility, agility, pain, depressive symptoms, and a summary measure of these, along with adverse cardiovascular outcomes. (via Science Blog [NB: not the same as Scienceblogs.com])
Before they were eligible for Medicare, the health of the uninsured near-elderly got worse faster than their insured counterparts, being significantly so by the time they hit 65. Those with cardiovascular disease and diabetes, however, reported significantly better overall health, mobility and heart disease outcomes after getting on Medicare. The improvement was so rapid that in a few years, by the time they reached 70, the expected difference in the summary health measures between the previously insured and uninsured had been reduced by half.
The implications are that earlier insurance coverage would vastly improve the quality of life for the near elderly. It would also likely save money, but the reason to do it is because it’s the right thing to do. Whether health is a right or an entitlement is a sterile argument. It is, however, a social good in the sense that a healthy community makes the lives of everyone in it better. I’ve got my Medicare card. But I had to wait until I was old to get it. In the meantime I spent a huge amount of money getting coverage. I’d have gladly paid for it in my taxes. I wouldn’t have had to pay 50% more for the same coverage because of the 30% portion of my private health insurance premiums are administrative costs to a health insurance company whose every incentive is to deny me coverage.
Here’s my simple 2008 health care reform proposal: Medicare for All.