posted on:  5/3/2007     revised: 3/9/2010

For more than two decades I have been frustrated by politicians and policymakers who try to address problems in the U.S. health care system simply by changing the laws that control health insurance. Again and again, they act as if the two issues were one and the same. It is much easier to regulate insurance than to address the real systematic problems underlying health care, so this approach has affords a "cop out" that is just too easy for legislators.

But how important is insurance to health care? How closely are the two issues related?  Is there really a relationship between health insurance and access to health care? Hard facts have been hard to find.

A 2007 report published by the reputable employee benefits and actuarial firm Milliman says that the average person who is uninsured uses an average of $2,262 in health care services (paid and unpaid) in a year. The average person with health insurance uses $3,580 worth of health care. That's means that a person who has health insurance is likely to use 58% more health care than a person without health insurance. The relationship in consumption is logical and understandable. But what it does not indicate is that a lack of health insurance prevents access to health care. This study confirms many other indicators in showing that those without health insurance are able access some substantial level of health care. In fact the data in this study shows that health insurance coverage is a minor factor in access to health care.   

We must acknowledge that access to health care is not solely or primarily dependent on insurance coverage. The link between access to health care and health insurance is a loose connection. Lack of access to health care is caused by entirely different reasons, and we need to turn public and political attention to these issues. These issues are not easy or simple to address, and attempts at real reform will strike at the very core of our social values. Ultimately, we will need to make life and death decisions with regard to the level of care that we will provide as a base level of care for all our citizens. That determination can be made independently of insurance and, in the end, insurance will not be a factor in the level of health care that we provide as a society to all of our citizens. But as long as we continue to focus on ways to reform health insurance, we will not progress toward a solution to our nation's health care problems.

keywords:   health care reform

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Copyright 2010 by Tony Novak. Originally produced and published for the "AskTony" column syndication prior to 2007. Edited and independently republished by the author in March 2010. All rights reserved.