Health Insurance Reform Has Little Impact on Actual Health

that medical care, let alone health insurance, is not the only—or even the most important—determinant of health. Rather, the key to better health and smaller health disparities lies in the air we breathe, the food we eat, and the cigarettes we do or do not smoke. Which means that the key public policies for improving health must be those that tackle these sources of poor health through pollution regulation, or soda and cigarette taxes.

This point was made clear by data from Oregon, where the state ran a lottery for health insurance coverage in 2008. The process was similar to a clinical trial for a new drug, in which some patients are randomly assigned the new drug and others are assigned an older drug or a sugar pill.

And once we realize that everyone in America can access medical care, it becomes much clearer why formalizing this access – whilefor other reasons – is unlikely to make an important difference for people’s health, or substantially reduce the large disparities in population health. You may get an inkling of where Fuchs was going with this comparison when we tell you that the two states were Utah and Nevada. And that the residents of Utah were the ones enjoying much better health.

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