Don’t confuse health care reform with public health

Requiring all Americans purchase health insurance, which the current bills hope to do, would not address the underlying socio-economic issues at the root of most public health problems. Income, social capital, employment status, and other factors have a stronger impact on population health than access to health care. People with more education and higher incomes are better able to avoid health risks. Poor children have higher levels of blood lead precisely because they live in older dwellings more likely to contain lead-based paint.

Indeed, access to health care can help individual patients, but can also aggravate some public health problems. Healthcare, like everything else in life, involves risk tradeoffs. Hospitals can help cure disease, but by their very nature can also help spread infections. Most of Toronto’s 2002 SARS cases were infected, for example, were health care workers and visitors infected by exposure to the virus in a hospital. High rates of surgical intervention increase the risk and spread of drug resistant infections like MRSA.

The current legislation would address none of these issues. In fact, its high cost, estimated at $2.5 trillion in decade after full implementation, could aggravate these issues by damaging the economy.

It would be nice if subsidizing private health insurers could somehow rebuild our damaged public health infrastructure. But such claims should be taken with more than a grain of salt.

George Avery, Ph.D., MPA, is an assistant professor of public health at Purdue University, and the author of “Scientific Misconduct: The Manipulation of Evidence for Political Advocacy in Health Care and Climate Policy” (Cato Institute).