The Maine Legislature is likely to discuss if not actually act on a bill this session to extend health insurance to all residents of the state through single-payer reform. Opponents of this change say the cost is too high and, besides, the uninsured get care, just not through the same means as the insured. A study last fall in the New England Journal of Medicine raises doubts about this second point, making it evident that the cost of not receiving care significantly higher than assumed.

It is clear from many studies that when people lose their health insurance, they get health care less often. What hasn’t been clear – and no offense is meant to the medical community here – was whether this population was less healthy. A team led by Dr. David W. Baker of MetroHealth Medical Center in Cleveland in October published their results of following more than 7,500 adults ages 51 to 61.

According to the NEJM, “Both the continuously and intermittently uninsured participants were more likely to have a major decline in self-reported overall health between 1992 and 1996 than the continuously insured participants.” More specifically, the uninsured were more likely to have difficulty walking or climbing stairs. The researchers observe that other factors, such as a skepticism about medical care, could influence the health outcome differences among the insured and uninsured, “However, even under the extreme assumption that 20 percent of the uninsured participants were unaware that they had a chronic disease (e.g., hypertension) because they had received less medical care than the insured participants, the increase in the risk of a major decline in overall health remained significant.”

Once a person gets sick enough to lose a job, he or she can find health coverage through public resources. By that time, however, the cost of care has risen considerably because the seriousness of the illness has increased, and the cost to taxpayers can be higher than it would have been had the uninsured person been covered all along. Restricting health coverage, it turns out, appears to be a shortsighted way to save money.