Stress, health and health insurance

Digby passes along some depressing news:

Joshua Holland shares the good news for poor people:

In 2009, the British Medical Journal (BMJ) published a study that revealed what seems to be a shocking truth: those who live in societies with a higher level of income inequality are at a greater risk for premature death….

What happens is those lower down the economic ladder experience more stress. Their lives are much more stressful, and they secrete more stress hormones until they’re burned.Stress is our twenty-first century tobacco. As we understand more about stress biology and the impact it has on our lives, we are going to have to wage a campaign to reduce the amount of stress in our lives. In one survey, people in the US reported the fourth highest levels of stress in the world. That’s true despite all our smartphones and gadgets and conveniences and the ease of everyday life. It’s incredibly stressful for those who own all these gadgets, but the ones on the bottom suffer the most stress. Surveys of stress hormones find that they have the highest levels and they have the worst health outcomes. So the bigger the gap between the rich and the poor, the greater the stress on those lower down, and the higher you are up the economic ladder, the better off you are.


Sarah Kliff noted last week that being uninsured sucks goat balls:

There’s a very simple reason that Obamacare hit 8 million sign-ups: Being uninsured is horrible.

But even if the total number of Obamacare sign-ups isn’t especially important, the groundswell of enrollments is: it shows that the fundamental premise of the law — that people want health insurance — is correct. They’re willing to battle through a crummy website and a complicated law and endless political controversy in that process, too, if it means coming out with a health insurance policy at the end.

“That’s not a new idea that people want health insurance,” Perry says. “But that they would stick through so much hassle still amazes us.”

I’m a health insurance wonk.  It is what I do for a living, and it is what I write about.  But the best health insurance with perfect compliance means, on a good day with a favorable study 15% of health outcomes are attributed to having great insurance and great medical care.  Most of the rest is environmental and social.  The biggest driver is stress in a variety of forms.  Removing the stress of worrying about the trade-off between getting an ugly lesion checked out and potentially treated versus paying the rent will probably do more for aggregate health outcomes than actually treating the lesion.

29 replies
  1. 1

    What a great post. Richard I really value your commentary here on BJ.

    Besides the obvious benefits of being insured and getting needed medical care, I heard somewhere (maybe here) that around 1MM people can now leave jobs they dislike (or hate, more likely) but were holding onto just for the insurance. These people can now put their time where they want: into their families, their art, their activism, etc. That is such a vast liberation for them and for society.

  2. 2
    gbear says:

    This is the first thing I’ve read this morning. I’m at home today due to stress-induced depression from my job. I’ve been in the FMLA program for years over it (which has been a godsend) but as long as the stress level stays the same it’s been nearly impossible to shake the depression. I can relate to feeling ‘burned’.

  3. 3
    Mike in NC says:

    In my district, there are three right wing extremists seeking the GOP nomination for Congress, all of them vowing to deprive people of affordable health insurance. There must be scores if not hundreds of similar stories nationwide. Everything in this country is a matter of one step forward and two steps back.

  4. 4
    Emma says:

    I am being treated for estrogen-positive breast cancer. I would never be able to afford the meds I take without insurance. I thank God every day for a good job that offers it. I can’t imagine a woman my age (not yet eligible for Medicare and Medicaid) trying to cope.

  5. 5
    aimai says:

    I know you’ve already written about this, Richard, but I’ve noticed in reading over at Kos that a lot of people don’t really grasp how the Medical Loss ratio works, or what it is “for.” They believe that the Insurance companies can drive up their 20 percent by driving up the cost of health care to the consumer. It seems like a common misconception and a still roiling source of grievance among some commenters there. Can you write about the medical loss ratio provisions again and maybe discuss some of the ways the ACA tries to keep down premium costs over time? I thought I understood it well enough to argue your points over there but I’m pretty sure that I don’t. I did point peopel generally to your posts here but I couldn’t find exactly what I wanted to link to.

  6. 6
    GregB says:

    GOP platform plank 2014:

    If they have any dying to do, let them do it now and decrease the surplus population.

  7. 7
    Richard Mayhew says:

    @aimai: Sounds like a good post for tomorrow

  8. 8
    OzarkHillbilly says:

    @GregB: If all the poor and middle class die due to lack of insurance, doesn’t that mean the rich will have to pay the taxes?

  9. 9
    Belafon says:

    @OzarkHillbilly: Not necessarily, but they would have to do the work.

  10. 10
    bemused says:

    The middle class or barely middle class rightwingers frustrate me to no end. They are furious about any gov’t sponsored policy that helps themselves directly or indirectly, ACA, minimum wage increase (hell, a lot of them don’t believe in a minimum wage at all), food stamps, heating or rental assistance, you name it because the lazy are taking money out of their pockets. They are extremely resentful of their neighbors for being recipients of the most meager amounts of aid. They will take SS and Medicare because it’s their money and they deserve it. One white guy told me that no one should have the right to expect to get SS col increase and should work longer to get more in SS but will take it himself because he earned it!

    At the same time, it doesn’t bother them in the slightest that they are subsidizing billions of dollars of gov’t welfare dollars to the corporate, wall street and 1% Another white guy seemed to be very impressed that one of the Koch brothers got a philanthropy award from a (free market) foundation.

    In their rage filled minds, people getting any type of assistance are their freeloading enemies and I believe they wish their “freeloader” neighbors would just drop dead. I’d like to see them have to help bury those hated neighbors who die from lack of help but they would probably just dance on their graves.

  11. 11
    BGK says:

    Yeahbut yeahbut yeahbut some TED-talk Flat-World-Shithead told me that stress is a motivator and I should Turn That Frown Upside Down and it will make me fabulous! Also too, as it was a woman doing the TED-talking, if I disagree it’s because left-libtards run the real War On Women.

  12. 12
    Shakezula says:

    Poverty is violence. The LA Times has an article about at study that shows the genetic impact on African-American boys raised in poverty

    By the time they have reached the fourth grade, African American boys who have run a childhood gantlet of poverty, shifting family structure, harsh parenting and a mother’s low mood and educational attainment will have signs of premature genetic aging that can deepen their vulnerability to mental and physical illness, says a new study.

    Has anyone had time to read the NYT’s article on people in McDowell Co., WVa? I didn’t but I assume that the article concludes they’re all very fortunate indeed. Also, bootstraps.

  13. 13
    Just One More Canuck says:

    @GregB: Ebenezer Scrooge in 2016? Who would be his running mate?

    The problem is that Srooge repented, so he’s a RINO

  14. 14
    dr. bloor says:

    That’s true despite all our smartphones and gadgets and conveniences and the ease of everyday life.

    True, in part, because of all our smartphones, etc.

  15. 15
    dr. bloor says:

    The biggest driver is stress in a variety of forms.

    It’s a pity the health insurance industry has spent decades and millions lobbying for the dumbing down of professional mental health providers, and nickel-and-diming providers to death.

  16. 16
    bob h says:

    This is why they could probably dispense with the mandate and not affect enrollment.

  17. 17
    JustRuss says:

    the fundamental premise of the law — that people want health insurance — is correct.

    I really hate to ask this but….was this ever in any doubt? Seriously? I mean, was Fox & Friends bitching that Obamacare was destroying our most precious freedom of all, freedom from being healthy? Sadly, I won’t be that surprised if the answer is Yes.

  18. 18
    Richard Mayhew says:

    @JustRuss: Yeah, there were quite a few liberterians and assholes, but I repeat myself, who argued that the market showed a revealed preference by the uninsured to go uninsured as they valued food/rent more dearly than health insurance, so why should we interfere with the invisible hand bitch slapping the poor.

  19. 19
    🌷 Martin says:

    Not everyone is fighting against Obamacare. My state again steps up.

    In Los Angeles, Dr Mitchell Katz heads the county Department of Health Services. He has his own vision for how to cover those that Obamacare failed to capture: using existing community health centers and clinics to provide low-cost primary and preventive care to any uninsured individual who enrolls. He calls these “medical homes.”

    The medical home acts like a primary care doctor: it collects the medical records of uninsured patients, develops long-term relationships with them and refers them to specialists when necessary. The promise is to provide a steady supply of healthcare, keeping patients from waiting so long that they wait for catastrophic illness and only use emergency rooms to see a doctor at all.

    Some problems grow so large you just don’t know where to start tackling them. ACA has served to shrink the scale of the problem so that states and municipalities can attack it locally. Kentucky is a great example of that happening at the state level. LA is striving to do the same at the local level.

  20. 20
    Fair Economist says:

    Besides the obvious benefits of being insured and getting needed medical care, I heard somewhere (maybe here) that around 1MM people can now leave jobs they dislike (or hate, more likely) but were holding onto just for the insurance. These people can now put their time where they want: into their families, their art, their activism, etc. That is such a vast liberation for them and for society.

    But it’s not just them – it’s *anybody* who at some point might want a sabbatical, take an early retirement, or face extended unemployment. Now, with Obamacare, we all know that no matter what happens with our work situations, we can at least purchase health insurance at a fair price – and that’s less stress for everybody.

  21. 21
    LanceThruster says:

    I am so happy for my uninsured and underinsured friends and acquaintances. As Joe Biden said…this is a big f#ckin’ deal.

  22. 22
    aimai says:

    @🌷 Martin: What a beautiful project–and right in line with everything we now know about how to handle the extremely high cost of letting people’s illnesses fester and force them into the ER. I love the idea of a “medical home.” People are so frightened to face their own health issues–even if they have insurance it can be hard to get people to take a test that may reveal something scary, or to modify their diets or excercise or do anything. People need to feel safe and “at home” to be able to begin to handle that anxiety.

  23. 23
    Ruckus says:

    Betty Cracker made a comment the other day about insomnia and many of us wrote back that we had experienced a similar problem. Stress is a normal part of life. However, helping with that stress and finding a way to lessen it here in our wonderful culture is not. It should be because untreated it is the killer. It does it’s work slowly, robbing sleep, robbing productivity, robbing satisfaction with breathing. We can’t eliminate stress but we can do much better at getting rid of the reasons we can’t lower it naturally, being poor, a shitty job working for shitty people being the two larges causes. But in a modern society that takes health care. Total healthcare, mental, dental, vision as well as the rest of the body. I have yet to figure out why teeth, eyes and the brain are not considered part of the body by the health care insurance industry. Why is it any wonder why a lot of people seem angry all the time? Why is it any wonder why some seem angry that what little they have might be taken away at any time, it is for so many it’s easy to see that you might be next, for no reason.

  24. 24
    Richard Mayhew says:

    @Ruckus: What I’ve read is that stress is fine and typical if it produces fight or flight response where everything baselines back to normal in a couple of minutes. The killer is prolonged, recurring, regular stress that never baselines back to normal.

  25. 25
    Chris says:


    Yeah, these guys are an interesting lot. All the snobbery, entitlement and fuck-the-poor mentality of the country club set, but combined with a bitterness over the fact that they’re not in the country club, think they deserve to be, and think society’s been rigged to unfairly hold them back. And they’re right – it has. But we can’t blame the Master for these things, not when we want to be the Master someday, so let’s blame the poor, take it all out on them and dream about how that’s going to help us achieve that goal… even though all you’re doing is putting it farther out of reach (see social mobility in the U.S, lower than most Western nations and not by accident).

    Bonus points for hilarious self-awareness fail if they try to lecture you about the supposed “crab bucket mentality” of Teh Libruls.

  26. 26
    Patricia Kayden says:

    “But that they would stick through so much hassle still amazes us.”

    And good for them for sticking through all the hassle that the Party of the 1% has thrown in their way.

  27. 27
    Mnemosyne says:


    It’s also that, for all of the cries that depression or ADHD are “overdiagnosed,” at best they’re overdiagnosed for middle-class and upper-class white people. My mixed-race nephew was diagnosed at a young age with severe ADHD, and is bipolar to boot. His half-brother (same father) was also diagnosed with severe ADHD at young age. His father has spent his life in and out of prison and has never been diagnosed with any mental illness, but you don’t get two severely ADHD kids from the same genetic father by coincidence.

  28. 28
    Ruckus says:

    @Richard Mayhew:
    If a high stress diet becomes the normal rather than temporary.
    Sports is a good example, a relatively short time adrenaline rush followed by de-stressing and training for the next event. Being poor, always trying to figure out the next meal, roof, etc, there is no de-stressing for that. Having no health care, no de-stressing for that. Watching someone spend 200-300 thou for a car while walking to the store to save gas/money, the only stress relief for that is illegal.

  29. 29
    Ruckus says:

    @Richard Mayhew:
    On a related note, back in the late 80s in CA the workers comp program was broken. People were working a short time and then going to a doc who would prescribe stress from the job as being too much and the patient would get disability. Now a lot of jobs are stressful just by their very nature. Working on live high tension lines, a bit of stress. Running into burning buildings, a bit of stress. Working in an air conditioned office moving paper about, not normally stressful, although management can sure make it so. I’d say being a cop can certainly be a stressful job especially if you think that everyone out of uniform is a criminal and is going to shoot you.
    My point was that we normally work an 8 hr day 5 days a week in large part to avoid work being an over stressful environment. Making people work odd ever changing shifts that give them no life and paying them shit while the owners make billions is a stressful environment.
    I wonder why so many people are standing in line to purchase pot in CO? Might it be to de-stress a bit? No that can’t be it, it must be something else.

Comments are closed.