NEVADA VIEWS: Income, not insurance, the key to health

With health care access a key issue for voters, the presidential candidates are highlighting their proposals for reform. Some promote a single-payer, “Medicare for All” kind of system. Others want a public health insurance plan as an option so people can choose between their private coverage and government coverage. Whose ideas will do the most to improve the health of Americans?

To answer that question, we need to look at the candidates’ proposals to address income inequality, not their proposals to reform the health care system. For while it is commonly thought that access to health care makes for good health, that’s not the case. It is true the uninsured are sicker than the insured, but it’s not because they are uninsured. It’s because they are poor.

During the first Democratic debate, U.S. Sen. Cory Booker presented the conventional wisdom on the connections among health care, health and income — if people get sick and lack insurance, they do not receive the health care they need. As a result, they stay sick and lose their jobs. “People who do not have good health care do not succeed at work,” Sen. Booker observed.

And indeed there is a critical connection between health and income. In the United States, men in the bottom 1 percent of the income distribution have a life expectancy 14½ years shorter than men in the top 1 percent. The income disparity in life expectancy exists even within small geographic areas. In Cincinnati, Indianapolis and Louisville, residents in the bottom 25 percent of the income distribution live about 8½ years fewer than do residents in the top 25 percent. (In Las Vegas, the gap between the bottom and top 25 percent is 6½ years.)

But giving the indigent health insurance won’t change that very much. Indeed, the life expectancy of lower-income persons is not correlated with the amount of health care they receive or even with the quality of care they receive. Nor do their mortality rates change when they become eligible for Medicare.

Rather, their health improves when their economic status improves. Income has a greater effect on health than health does on income. Raising the minimum wage for the employed, or providing welfare benefits for the unemployed, makes them and their family members healthier. Similarly, when low-wage families receive income supplements through the earned income tax credit (EITC), infant mortality declines, and there is a decrease in the likelihood of low-birthweight newborns.

And the benefits for children from increases in their family’s financial status extend throughout the children’s lives. Parental income plays a key role in determining a child’s health even into adulthood.

So, yes, everyone should have access to good health care. But what they need even more are policies that will save them from having to see a doctor in the first place. When it comes to ensuring that people are healthy, universal access to a good income is much more important than universal access to health care.

— Dr. David Orentlicher, M.D., is the Cobeaga law firm professor and co-director of the UNLV Health Law Program at the Boyd School of Law.