Hidden Costs, Value Lost Uninsurance in America (2003) / Chapter Skim
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6. Social and Economic Costs of Uninsurance in Context
6. Social and Economic Costs of Uninsurance in Context
Pages 105-122
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From page 105... ...
This concluding chapter brings these various elements of costs consequent to uninsurance together, along with the anticipated costs and benefits of expanded coverage. Consolidating this information allows the Committee to consider whether allocating scarce social resources to expanding coverage to the more than 41 million uninsured Americans is worthwhile, and how it compares with other investments our society already makes in health- and life-enhancing services and interventions.
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From page 106... ...
The Committee concludes that adopting a policy of universal health insurance coverage would be a societal expression of values and norms that are deeply, if sometimes obscurely, embedded in American culture and history.1 Box 6.1 at the end of the chapter consolidates the Committee findings from previous chapters as well as this one. SUMMARIZING COSTS AND COMPARING INVESTMENTS IN HEALTH Conclusion: The estimated benefits in terms of the value of healthy life years gained by providing coverage to those currently uninsured are likely greater than the incremental societal costs of the additional health care services that they would receive if insured.
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From page 107... ...
The tip or smallest band indicates the number of uninsured individuals who die prematurely because oftheir uninsured status, an estimate from the Committee's second report, Care Without Coverage. The next two bands add in the number of acutely and chronically ill persons under age 65 who receive less adequate and effective care because of their lack of coverage, as documented in the Committee's second report and its third report, Health Insurance Is a Family Matter.
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From page 108... ...
The annual incremental cost of the services the current uninsured population would use if health insurance coverage were universal cannot be compared directly with the annualized present value of the cumulative future benefits of coverage because they are expressed in different metrics. The final step in the Committee's analysis of economic costs is to consider the potential benefits of providing the uninsured with coverage together with the incremental costs of the additional health services that would improve their health.
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From page 109... ...
Converting the Committee's benefit-cost figures for the health value gained relative to the incremental cost of additional health services with coverage yields an incremental cost per QALY of between $50,000 and $180,000. This range reflects two different upper and lower bounds: one is the difference between the cost based on public versus private coverage and the other the high- and lowbound assumptions about differences in the underlying health status of demographically similar insured and uninsured populations.
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From page 112... ...
Claims about cultural values and implicit social norms are particularly likely to be challenged as lacking adequate empirical grounding; nonetheless, the Committee believes it would be irresponsible to remain silent on normative issues and attempts to articulate American cultural and political normative underpinnings and their implications for the health policy choices Americans now face. That some of the benefits of expanding health insurance coverage to the entire population are not quantifiable makes them no less important to our strength and integrity as a democratic national community.
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From page 113... ...
SOCIAL AND ECONOMIC COSTS OF UNINSURANCE IN CONTEXT TABLE 6.3 Cost-Effectiveness Ratios for Selected Life-Saving Measuresa 113 Intervention Comparator Cost per Target Population DALY Saveda Annual colorectal No screening People 50-75 $22,000 screemng Frontal airbags with Manual belts Drivers of $30,000 manual belts (50% use) passenger cars Radon mitigation No testing or Home residents with $71,000 in homes mitigation radon levels above 20 psi/liter Dual passenger airbags Driver side only Front right passenger $75,000 Coronary angioplasty No Patients with mild angina $136,000 revascularization and one-vessel disease Universal coverage Annual mammography 16.5 % uninsured population under age 65 Currently uninsured $50,000-$180,000 Annual clinical Women ages 55 - 65 $186,000 breast exam Annual mammography Annual clinical Women ages 40 - 50 $297,000 breast exam Methylene chloride Limit of 500 ppm Workers exposed to $235,000 exposure limit of methylene chloride 25 ppm Solvent-detergent to No solvent eliminate AIDS virus detergent and other infectious diseases Patients undergoing $384,000 plasma transfusion Screening to prevent Universal Health care workers $606,000 HIV transmission to precautions in acute care setting patients Annual Pap smear Pap smear every Women ages 20-75 $2,000,000 2 years Lap/shoulder belts No restraints (9% use)
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From page 114... ...
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From page 115... ...
, disparities in access to and the quality of health care of the kind that prevail between insured and uninsured Americans contravene widely accepted democratic cultural and political norms of equal consideration and equal opportunity. Any kind of accounting of societal costs and benefits from the investment of economic resources in a policy like universal health insurance relies on some kind of unit of value: money, years of life, QALYs, or personal utility.3 Health care is valued for its contribution to personal health.
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From page 116... ...
Experimental studies of distributional choices in health care suggest that people favor equity of some form in this arena.4 Egalitarian distributive choices in experimental settings have been demonstrated for goods, including health care, to which the notion of need, rather than that of taste or preference, applies (Yaari and BarHillel, 1984~. Presented with the hypothetical scenario in which respondents were asked to allocate a fixed amount of pain medication between two people, identical in all respects, including level of pain except that one could not metabolize the pain medication as well as the other, more than three-quarters of the respondents chose to allocate the medication so as to equalize the pain experienced by each of the individuals (Kahneman and Varey, 1991~.
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From page 117... ...
Poor health or disability reduces the range of opportunities and life choices open to us, while health care can restore to us a wider range of opportunities and reasonable plans for life than we might have without it. Because equality of opportunity to realize our own life plans and ambitions is a widely shared American ideal, Daniels' account is particularly helpful as a way to explain and to justify giving health care and, derivatively, health insurance coverage, a special place in collective provision.
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From page 118... ...
Medicare, Medicaid, and the State Children's Health Insurance Program enjoy widespread public support and approval (NASI, 1999~. Three-quarters of Americans responding in recent nationally representative opinion polls identified increasing the number of Americans covered by health insurance as a "very important" goal for Congress and the President (Kaiser Family Foundation, 2003~.
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From page 119... ...
In light of the information and analyses that the Committee has developed about choices we have not made as a society, as well as those that we have made to invest heavily in health care, we cannot excuse the unfairness and insufficient compassion with which our society deploys its considerable health care resources and expertise. Providing all members of American society with health insurance coverage would contribute to the realization of democratic ideals of equality of opportunity and mutual concern and respect.
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