By RICHARD SKOLNIK
Los Alamos

I write in response to the Mick Rich article published Jan. 1, “Rich: New Mexico From Bottom 10 To Top 10 In 10 Years.” (link)

All of us share Mr. Rich’s desire to see New Mexico improve its standing in health, education, and the economy. However, Mr. Rich’s suggestions about healthcare are certainly not a path for moving forward. Mr. Rich’s article noted:

“New Mexicans who enjoy nearly free healthcare have the lowest life expectancy. Yet our leaders want to expand free healthcare, to lower life expectancy for more people.” 

Such comments reflect a profound ignorance of the determinants of health. They also suggest a lack of understanding of the place of health insurance in helping to enhance people’s health, while protecting them from financial hardship.

The New Mexicans to whom Mr. Rich refers are not unhealthy because they have health insurance or because they get health services that are financed by or provided by the government. Rather, they are unhealthy because they are often low-income; they generally lack high levels of education; they often live in food deserts; and many families even lack access to basic needs, such as safe drinking water in their homes. In addition, New Mexico’s least healthy people often come from communities that have suffered high rates of social marginalization and discrimination, which have well known negative impacts on health. Such communities also face high rates of mental illness and alcohol and substance abuse disorders.

Programs such as Medicare, Medicaid, the Indian Health Services, and the Veterans Administration are meant to remove at least some of the barriers to healthcare that different groups face. These programs are also meant to help protect people financially from the costs of healthcare. This is especially important here, since the leading cause of bankruptcy in the US, like in some lower-income countries, is getting sick.

All other high-income countries and many middle-income countries have “universal health coverage,” which combines access to an agreed package of health services with insurance coverage. Our lack of universal health coverage is one reason that we spend more on healthcare as a share of national income than any other country but still have the lowest life expectancy among the high-income countries.

Mr. Rich’s assertion of a link between health insurance and lower life expectancy has no basis in fact. People who have such a view could benefit from spending some time in other high-income countries to see the quality of their life and how their health systems function. People who share Mr. Rich’s views could also benefit from living for some time on only a small share of their income, to see on a day to day basis the choices that some people face, of  “buying food or medicine”.

Editor’s note: Richard Skolnik is the former regional director for health for South Asia at the World Bank. He was the director of an AIDS treatment program for Harvard and taught Global Health at the George Washington University and Yale. He is the author of Global Health 101 and the instructor for Yale/Coursera’s Essentials of Global Health.