The message here is that what matters most in healthcare and improvements in health as measured by live expectancy and quality of life aren't the high-cost, intensive interventions of advanced medicine, but the basics:<p><i>Ms. Currie can’t be sure what precise factors have led to the reductions in death rates for poor young Americans, but she has some theories. Public health insurance, through the Medicaid and Children’s Health Insurance programs, expanded to cover more children and pregnant women throughout the 1980s and 1990s. Research has shown measurable benefits to the children with access to the program: There was less infant mortality; they were hospitalized less often as they grew older; they were more likely to finish high school and attend college; and they earned more money in early adulthood. Those studies all suggest a real health benefit from the insurance program.</i><p>what matters?<p><i>Access to healthcare.</i><p><i>Access to healthcare during pregnancy.</i><p><i>Access to healthcare at childbirth.</i><p><i>Reductions in environmental contamination.</i> Smoking. Lead. Pollution.<p>This is consistent with the data of the past 150 years: the greatest improvements in health come <i>not</i> from medicine, per se, but from public health and sanitation measures.<p>Clean water.<p>Municipal sanitation. (Getting rid of horses, and their offal and carcases, helped a lot as well.)<p>Food quality.<p>Refrigeration.<p>For all the commotion made about vaccines in the past few years, <i>and yes, vaccines are absolutely a good thing and you and your children should have them,</i> there were vast improvements in life expectency <i>long before</i> vaccines became available.<p>As there were <i>long before</i> antibiotics became available.<p>And much of the improvement in health among <i>adults</i> since 1950 is attributable to similar causes:<p><i>Less smoking.</i><p><i>Less alcohol consumption.</i><p><i>Better access to healthcare.</i> Among those who had little to no access initially: the poor and minorities.<p><i>Vaccinations.</i><p><i>Better nutrition.</i><p><i>Fewer environmental contaminants.</i> Especially leaded gasoline and paint.<p>It's a sobering message for those who are looking to high-tech, high-intervention methods for healthcare miracles. Evidence strongly suggests you'll be disappointed.<p>Though your doctor may appreciate the billing potential.