The recently published randomized research on the impact of having health insurance raises a fascinating question about whether we should start to think about we might think of legal insurance as a health benefit.
The research itself, very well summarized by Leon Neyfakh in the Boston Globe, comes to the surprising conclusion that health insurance does not improve general health levels, but that it very significantly improves mental health. In other words, reducing uncertainty about access to health care improves mental health. According to this description of the research, which randomly assigned people in Oregon to medicaid, “people with access to Medicaid were a whopping 30 percent less likely than their counterparts to screen positive for depression.”
As the article goes on:
For Gruber and Chandra, the Oregon findings point to a striking conclusion: The coverage itself was what made the difference. In other words, the individuals in the Medicaid group—whose risk of catastrophic medical expenses was almost entirely eliminated—were less depressed simply because they had insurance.
“People who are uninsured live under constant daily stress,” said Gruber. “They’re worried about getting sick, and they’re worried about paying the bills if they get sick. And I think that manifests [itself] in many aspects of life, including…depression.”
Gruber’s belief is supported by a large body of research showing that stress in general, and financial hardship in particular, frequently lead to the onset of mental health problems. In 2010, Sidra Goldman-Mellor, a postdoctoral fellow at the Center for Developmental Science at the University of North Carolina at Chapel Hill, systematically surveyed the medical literature and reported that “dozens of studies have found statistically significant associations between negative economic transitions and depression.” One of the studies cited was a survey of Mexican-Americans, which found that the odds of experiencing an episode of clinical depression for the first time ever were five times higher for people who had lost their jobs during the 7 to 12 months before the survey.
Financial crises like bankruptcy and mortgage difficulties are linked to stress and depression as well. A study by Kenneth Kendler, a psychiatry professor at Virginia Commonwealth University, found that individuals who had experienced a major financial setback were almost seven times more likely to experience the onset of depression during the subsequent month. Kendler also found that unlike other traumatic events—the death of a loved one, for instance—financial catastrophes tend to be continuous, not discrete events, and thus can cause depression several months down the line.
So the obvious question is: would reducing the risk of these other forms of crises — or more accurately reducing the risks of overwhelming consequences from those crises — by providing legal insurance have a similar impact.
If there were a “civil Gideon” that would be equivalent to such insurance. But because it is always a struggle for a poor person to get legal aid now, of course, our current system does not provide such a potential benefit for anyone.
While a randomized study of the impact of legal insurance would be very expensive, there are surely ways to do some initial research into the extent to which fear of financial disaster triggered by legal problems might be contributing to depression.
That might provide a new way of looking at the benefits of, and argument for, legal insurance, particularly as part of employment and job-training packages.