happiness is access to medical care

Dartmouth economist David Blanchflower finds lack of access to a doctor (because of inability to pay) to be an important source of unhappiness in the United States, even for people with high incomes.

The inability to see a doctor is [a] highly significant [determinant of happiness], … even when a full set of controls are included for income, labor status, smoking, exercise and BMI etc.. ….

To explore this issue further [I estimate effects] … by income group. The effect of not seeing a doctor is significant in each of the equations. Particularly impressive is the fact that this is the case even for those in the highest income category [>=$75,000] … , even if they are in very good or excellent health. The effects are broadly of the same orders of magnitude … [–] approximately the same as the difference between zero income and income of $75,000 or more or between working as an employee and having been unemployed for at least twelve months.

These effects are larger than the effects from the equivalent amount of money that the service would cost, because the person could simply pay for them. But that is to be expected as what is being picked up is not the cost of the coverage itself but the service needed. So health insurance, say costs $10,000 a year but if an individual falls ill, the cost could be half a million dollars. Hence the need for insurance.

They, or a member of their family, have just experienced a negative health shock. The uncertainty around subsequent health care expenses could be causing this big fall in happiness. By falling ill, the person who needs the treatment experienced a major negative income and wealth shock. Not having access to a doctor lowers life satisfaction and worsens mental health. And by a lot, even controlling for income, education and many other controls. This is true even for people with high incomes. Hence, providing health care coverage for all will likely raise the health and happiness of the nation.

David G. Blanchflower, “Happiness and Health Care Coverage”, IZA Discussion Paper 4450 (September 2009).

Professor Blanchflower analyses data for the years 2005 through 2008 from the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS was established in 1984 by the Centers for Disease Control and Prevention (CDC). More than 350,000 adults in all 50 US states are interviewed each year by telephone.

In 2008 15.6% of all BRFSS respondents –up from 13.6% in 2005– answered “yes” to the question “Was there a time in the past 12 months when you needed to see a doctor but could not because of cost?”. Noteworthy is the fact that 8% of respondents with health care coverage were among those answering this question in the affirmative. “Presumably”, suggests Blanchard, “this arose because of large deductibles or because of restrictions on access to doctors of choice through HMOs”. Health care is often rationed, even for those with private insurance.

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