The purpose of health insurance is not to provide or 'buy' health care; it's to finance health care in a manner that improves individual economic well-being. In other words, it's a way to share risks and smooth out expenditures.
I'd be more interested in the relationship between health insurance and financial well- being. I'd also question whether it's the possession or availability of health insurance that is most at issue. Someone who has made a choice on health insurance is self-selecting and might be more healthy, other things equal. I would also be interested in how the sample deals with dead people. If I forego health insurance and then require massive health care expenditures that I cannot finance or otherwise obtain, and I die, am I implicitly excluded from the sample, or are there too few people of this sort to matter.
Ultimately the statement that the employed and self-employed are otherwise identical, but for health insurance, seems self-refuting. Obviously they are not equal, so there must be some reason that one group tends to have more insurance than the other.
mbs
This should be called "frontiers of specious reasoning". Perry and Rosen take two simple facts:
1. Self-employed people are more likely to be uninsured than people with wages/salaries. 2. Self-employed in the MEPS survey had similar health outcomes to wage/salary earners.
They leap to the argument that health insurance does not matter. There is no necessary logical connection and there is not much of an indirect one (there are many obvious confounding factors to determine health outcomes in MEPS, e. g. self-reported health status, different baseline health status of the two populations, self-selection over insurance with groups--69% of self-employed are insured, etc.).
Health outcomes depend on the complex interactions of economic, social, environmental and individual factors. Health care actual plays a small role as its function is predominately reactionary. Health insurance plays a limited role in simple "access to health care" as well.
The other factors for determining health outcomes play a large role in any attempt to correlate health insurance status and health outcomes. The direct conclusion of many studies has been there is strong, significant statistical association between health insurance status and health outcomes. However, I have argued that while obviously true the other correlated factors with lack of health insurance--i.e, lower income, lack of power/control over work, lack of knowledge over risks, greater exposure to risks, etc.--are more important for bad health outcomes than "lack of health insurance" directly.
This is even more obvious if you look at different health outcomes across the widely different types of health insurance. Marta posted some links on the appalling state of medical quality in the U.S. a few times on this list. What is lacking in those studies is any analysis of the distribution of poor quality medical care on the sickest and poorest people in the United States.
Trying to indirectly address the relation between employment class, insurance status, and health outcomes only creates a poorly reasoned bit of misdirection. The other day someone asked "how could Mickey Kaus be so confident and so logically confused"? It's simple, grant money.
Peace,
Jim
At 01:57 PM 6/8/01, you wrote:
><http://papers.nber.org/papers/W8316>
>
>The Self-Employed are Less Likely to Have Health Insurance Than Wage
>Earners. So What?
>Craig William Perry, Harvey S. Rosen
>
>---- Abstract -----
>
>There is considerable public policy concern over the relatively low rates
>of health insurance coverage among the self-employed in the United States.
>Presumably, the reason for the concern is that their low rates of
>insurance lead to worse health outcomes. We use data from the Medical
>Expenditure Panel Survey conducted in 1996 to analyze how the
>self-employed and wage-earners differ with respect to insurance coverage
>and health status. Using a variety of ways to measure health status, we
>find that the relative lack of health insurance among the self-employed
>does not affect their health. For virtually every subjective and objective
>measure of health status, the self-employed and wage earners are
>statistically indistinguishable from each other. Further, we present some
>evidence that this phenomenon is not due to the fact that individuals who
>select into self-employment are healthier than wage-earners, ceteris
>paribus. Thus, the public policy concern with the relative lack of health
>insurance among the self-employed may be somewhat misplaced.
"Raise your glass
Raise your fist
Raise the dead
Life's too fucking short to paint it anything but red"
--from Waco Brother's "Corrupted" (original unpublished version, lyrics by Jon Langford)