May 2, 2013

A similar study of Medicaid in Oregon last year had a very different outcome.

As soon as I saw Medicaid headlines appear at the top of the right-wing leaning Memeorandum I knew it was a fakeout. More Bad News for Obamacare: Study Finds Medicaid Has No Effect on Measured Health Outcomes For some reason, Reason thinks this study hurts Obamacare.

This is huge, and stunning, even for critics of Medicaid: A randomized-controlled study published in the New England Journal of Medicine by a group of the nation's top health policy scholars has found that Medicaid has no measurable effect on any of the objectively measured physical health outcomes the study examined.

Another screaming headline from yet another LIbertarian tank Cato which says: Oregon Study Throws a Stop Sign in Front of ObamaCare's Medicaid Expansion

Today, the nation's top health economists released a study that throws a huge “STOP” sign in front of ObamaCare's Medicaid expansion. — The Oregon Health Insurance Experiment, or OHIE, may be the most important study ever conducted on health insurance. Consistent with lackluster results from the first year, the OHIE’s second-year results found no evidence that Medicaid improves the physical health of enrollees.

Do conservative and libertarian cranks (I don't know why we bother to categorize them differently) actually believe that having health insurance immediately improves your health only after two years? Has anybody whoever bought health insurance done so because just having it magically improves our health? I thought I bought health insurance for the 'insurance' part. So that if I get sick, I won't become destitute over it. And in only two years that's exactly what they found.

First, the study found that Medicaid patients had lower rates of depression. That's a good health outcome! Second, Medicaid "nearly eliminated catastrophic out-of-pocket medical expenditures." This suggests that poor people without Medicaid do get treated for catastrophic problems, but mostly in emergency rooms. Medicaid is certainly an improvement here even if the health outcome is the same.

Overall, I'm a little unclear about what the conservatives who are crowing over this study really think. They obviously believe that access to healthcare is a good thing for themselves. (At least, I haven't heard any of them swearing off doctor visits.) But you can't have it both ways. If it's a good thing for us middle-class types, it's a good thing for poor people too. Conversely, if it's useless for poor people, then it's useless for the rest of us too. So which is it?

UPDATE: Austin Frakt and Aaron Carroll have read the full study and have some more detailed thoughts here. Notably, it turns out there were improvements in blood pressure, glycated hemoglobin, and cholesterol, but the size of the study was fairly small, so the results weren't statistically significant. Specifically, as Sam Richardson tweets, "#Oregon point estimates: Reductions of 30% in depression, 18% in high HbA1c, 17% in high chol, 8% in high BP. Big effects, little power." As Austin and Aaron note, this is very, very different from saying there was no effect..

The always awesome Jonathan Cohn writes in detail: The New Study that Republicans Who Reject Medicaid Must Read. A report indicates just how important it can be in improving poor people's lives. You'd think libertarian thinkers would draw the same conclusions, but I guess I use the word thinkers too liberally. Why is this study bad? Just because. I repeat, just because right wingers pray that it is. There is no basis in fact to assume otherwise because the report only makes the case that Medicaid helps the poors.

Digby writes:

Yeah! Nothing we can do, folks! These people are just going to die. In fact, if we really want to save money we could put the poor animals out of their misery and save the cost of those inevitable hospitalizations when these diseases go completely untreated.

Cohn lays out all the reasons why this report actually proves we should expand Medicaid, and he wonders why conservatives and libertarians are so eager to dismiss it. I'll tell him why: conservatives think these poor people are lazy and deserve what they get and the libertarians just don't care about them at all. That's all there is to it. After all, it's not as if any of them have any answers. They simply assume that there will always be lots of poor, sick people around for whom they have no responsibility. For conservatives the only question for society is how to punish them for their lack of initiative and for libertarians they're simply of no concern at all. Either way, the end result is that nobody should have to give up even one nickel to help pay for the poor --- and if something happens and you find yourself among them, you're on your own.

These people believe that's just the way life is. The only way to get decent medical care and fully protect yourself from financial calamity is to get rich. Really rich. It's the catch-all answer for everything that ails you. Anyone who doesn't has only herself to blame.

Paul Krugman writes: Medicaid Nonsense

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