The term has been used to explain why social safety nets such as welfare should be smaller rather than larger but it can also be used on the flip side of the equation to explain why too little in the way of social safety nets can encourage employers to disregard worker safety or health. It is also a term that may eventually become synonymous with the Affordable Care Act. That’s because economists are interested in whether or not having medical care available will actually cause people to care less about caring for their health if their poor health is covered by insurance.
A recent article by Dr. Sanjay Gupta suggests that government officials who expect to see better health outcomes from the Affordable Care Act may actually see the opposite. Gupta refers to the research results from the state of Oregon when it expanded its Medicaid coverage in 2008. What researchers found over a two year period was that coverage generated no significant improvements in measured physical health outcomes while increasing the use of health care services and thus public costs. On the plus side, having coverage raised the rates of diabetes detection and management, lowered the rates for depression and reduced financial strain for those individuals who were selected.
Which is to say that the Affordable Care Act will not be the magic pill that improves Americans’ health outcomes. It really is going to take people taking personal responsibility for their health and recognizing that no matter who pays the financial costs of their poor health decisions, they will pay the ultimate costs because poor health decisions ultimately impact whether or not you will be a burden on your children, whether or not you will be forced to access care in a nursing home and whether or not you can protect your assets from long term care and uncovered medical costs.
