I think conservatives have to convene an emergency round table and conduct a thought experiment, immediately, because this Medicaid study is going to be cited a lot:
When poor people are given medical insurance, they not only find regular doctors and see doctors more often but they also feel better, are less depressed and are better able to maintain financial stability, according to a new, large-scale study that provides the first rigorously controlled assessment of the impact of Medicaid.
This second paragraph made me laugh:
While the findings may seem obvious, health economists and policy makers have long questioned whether it would make any difference to provide health insurance to poor people.
Hah! Maybe policy makers could have asked, I don’t know, some poor people? No. That would be too easy. Instead they asked each other:
Some said that of course it would help to insure the uninsured. Others said maybe not. There was already a safety net: emergency rooms, charity care, free clinics and the option to go to a doctor and simply not pay the bill. And in any case, the argument goes, if Medicaid coverage is expanded, people will still have trouble seeing a doctor because so few accept that insurance.
He said/she said. No one knows the answer, and it will forever remain a mystery. But, as it turns out, poor people, when contacted, were happy to help:
Those with Medicaid were 35 percent more likely to go to a clinic or see a doctor, 15 percent more likely to use prescription drugs and 30 percent more likely to be admitted to a hospital. Researchers were unable to detect a change in emergency room use. Women with insurance were 60 percent more likely to have mammograms, and those with insurance were 20 percent more likely to have their cholesterol checked. They were 70 percent more likely to have a particular clinic or office for medical care and 55 percent more likely to have a doctor whom they usually saw.
The insured also felt better: the likelihood that they said their health was good or excellent increased by 25 percent, and they were 40 percent less likely to say that their health had worsened in the past year than those without insurance.
I’m mostly teasing. I’m glad they did the study, and I’m glad the NYTimes printed the story. I’m always pleased and surprised when we bother to study some real live poor people when we’re deciding whether they might benefit from access to basic health care.
How the study came about is actually pretty interesting:
The study became possible because of an unusual situation in Oregon. In 2008, the state wanted to expand its Medicaid program to include more uninsured people but could afford to add only 10,000 to its rolls. Yet nearly 90,000 applied. Oregon decided to select the 10,000 by lottery. Economists were electrified. Here was their chance to compare those who got insurance with those who were randomly assigned to go without it. No one had ever done anything like that before, in part because it would be considered unethical to devise a study that would explicitly deny some people coverage while giving it to others.
Poopyman
Hmmm. The basic thrust of your post, Kay, makes me think that our ruling class (using the term loosely) are complete and total idiots.
ETA: No, this is not my first inkling. It’s more like another forceful reminder that we’re still ruled by idiots. The policy makers and the press both.
BDeevDad
Are you crazy, they don’t go to doctors. Who knows what diseases they are carrying.
Brachiator
Too bad there were not more economists electrified with figuring out the challenge of how to get more health care coverage to poor people. Jackasses.
Linda Featheringill
Very nice study cited. It deserves to be referred to and quoted a lot. Hurray.
NonyNony
Let that sink in for a minute.
…
…
Here, let me put some emphasis in
…
Let’s just note that we live in a world where it’s unethical for academics to devise a study to give medical coverage to some people and not to others but apparently there’s no problem with our governments deciding based on arbitrary rules (or even random chance) to give some people coverage and others none.
We truly do live in a fucked-up world.
BGinCHI
It costs more in the long run to let poor health, poor infrastructure, and lack of investment in basics continue.
There are no conservatives in this country. If there were, they would be clamoring for spending on these money-saving, conservative ways of allocating resources.
The right is populated entirely by ideologues whose ideology is based on fact-free beliefs.
I don’t know how we get through a day anymore.
Rommie
The obvious solution is to “encourage” all the docs to not take Medicaid, and then, lo and behold, it’s “proven” just another wasteful government program. We can’t encourage the peasants to use the best health care in the world, after all, or it’s not the best anymore.
But yeah, I get your point. Really, policy makers expected a different outcome? Poor people with access to medical care would choose not to do so, because…shut up, that’s why? Keeping the narrative far far away from any positives of UHC is more important to them than anything else, rational or not.
arguingwithsignposts
Why is that never an option in these studies?
elmo
While we’re at it, I wonder if people on food stamps actually eat food?
Or if people on housing assistance really want to live in houses, instead of under bridges?
Such weighty questions being pondered by our Galtian overlords…
Derf
A reminder:
Last month poor jobs report and our hero John Galt Cole was there to breathlessly report it. Apocalyptic terms and all.
https://balloon-juice.com/2011/06/01/double-dip-here-we-come/
This month good jobs report and nothing but crickets from John Galt Cole. No, he would rather focus on the latest feined outrage from the pro lefties being the Greenwald reading libertarian sympathizing concern troll that he is. Stay classy John Galt Cole. I have nothing but contempt for your sorry ass excuse for a blogger!
http://www.bloomberg.com/news/2011-07-07/u-s-stock-index-futures-extend-gains-after-adp-report-shows-jobs-growth.html
http://www.bloomberg.com/news/2011-07-07/jobless-claims-in-u-s-decreased-more-than-forecast-last-week-to-418-000.html
cckids
In what world do these people live? As a verified Uninsured Person, docs, clinics, etc demand the cash up front. If you don’t have it, GO AWAY. Sux to be you. Sure, if it is an emergency, there is the ER, but most health issues do not need that. And, again, contrary to the opinions of many, most uninsured/poor people are not flocking to ERs for care of the common cold or every scratch. People (like me & mine) take care of everything possible. I’ve gone the steri-strip/NuSkin route on more than one injury that truly needed stitches, rather than get the bill for the ER. Because, they will come after you for the money. They’ll treat you, sure, but they do expect to be paid.
Rant off. Sorry, few things push my buttons like this idiocy.
Yevgraf
Jesus will fix it all in the afterlife, so there’s no need to try and bother fixing it now.
WereBear
Another incredible insight brought to you by Captain Obvious!
urizon
This just in: Poor people are better off when given access to employment and cash.
stuckinred
BGinCHI
Had a 3 hr wait at Midway so we took the El to Wrigley. I asked the people behind us how long till we came out of the subway and she was a painter that was here until 92 and knew all kinds of people we do!
spudvol
Poor people will just trade their insurance for T-bones and Cadillacs anyway.
kay
I really am teasing. I understand they need a good sample, or whatever. It’s just amazing that we’ve been “debating” this for so long, without any real facts.
Tea Party House members are busy writing screeds in Politico about how poor people are worse off with Medicaid….”some say….”
Baud
By the way, FTA:
Dems controlled Oregon at the time, FWIW.
BGinCHI
Stuck, you still here??
stuckinred
BGinCHI
Nah, we went to Urbana for a gathering of the tribe. Makes me really glad I quit drinking when I did!
pete
@Brachiator (3): Too bad there were not more economists electrified
Most of them thoroughly deserve it, but I’m squeamish, I’d just lock ’em up.
The Moar You Know
Who gives a shit? They’re poor. God hates poor people.
Let them eat cake, or something.
/wingtard
Linda Featheringill
cckids #11
On the contrary, I thought your comments were very calm and reasonable. That may be because I’ve lived through all of that and know that you speak the truth.
Please feel free to “rant” again when the need arises.
ed drone
@ baud (18)
Well, what it was worth was medical care for 80,000 people who needed it, that’s what it was worth.
Ed
elmo
@cckids: Exactly. And even granting for the sake of discussion that “there’s always the emergency room,” the people who say that like it’s a solution have apparently never heard of chronic health conditions like diabetes, asthma, heart disease, arthritis, seizures, MS, or lupus (it’s never lupus). Let alone things that aren’t “emergencies,” but are going to kill you, like cancer. I’ve never been in an ER that is set up for ongoing chemotherapy.
And those are just things I came up with off the top of my head. Now what about people with more unusual conditions, like dystonia (muscles don’t work right), degenerative myelopathy, neuropathy, and other things that respond well to ongoing treatment, but without constant medical help render people completely disabled?
And never mind that a lot of those kinds of conditions are MORE prevalent in poor communities because of poor nutrition, chemical exposure, and a lifetime of backbreaking work?
But never mind. They can always go to the emergency room.
Elizabelle
Um, it should be shocking.
trollhattan
@25.elmo – July 7, 2011 | 2:50 pm · Link
About that. When are Republicans going to work on repealing that anti-Freemarketz law? Let’s clear the riffraff out of our clogged emergency rooms so they can better serve the Creators.
Brian R.
On a related note, I just saw a news article by a reporter with a shitty track record for telling the truth, citing a “Democrat with a familiarity for the thinking of the Obama administration,” and that brave anonymous source said that Obama was going to disband Medicare and use the funds to build himself a gold-plated rocketship!
Let’s all freak the fuck out over that for a while now too!
Someone call TPM so they can report on how Nancy Pelosi is outraged that she wasn’t informed of the president’s plan!
Rick Massimo
Actually, what they’ll do is wait about a year and then start citing the study themselves: “Wait’ll you hear what completely obvious BS studies the government is funding now! They actually SPENT MONEY to find out whether people with health insurance go to the doctor! HAW! Bear DNA! Volcano monitoring! Etc.!” When life gives you Your-Policies-Kill-People, you make Your-Policies-Kill-People-ade.
I took my son to the emergency room last year. Then I got a bill for $768. And I HAVE health insurance.
rikryah
sometimes I look at what folks ‘ study’ and go..
‘how can I get in this racket? I’d do it for 25% of the price they paid. ‘
ET
There are a lot of people who think people are poor because they are lazy and seem to want to be poor. For them it necessarily follows that this desire to not better themselves includes health care. As if being poor equals wanting to also be in bad health and not seek better health care.
Baud
@Ed
Agreed. I do not subscribe to the no-difference-between-the-parties theory of American politics.
PeakVT
I think conservatives have to convene an emergency round table and conduct a thought experiment
Kay made a funny.
What they’re really doing is holding strategy sessions at some think tanks on how to spin the report. They’ll fax some talking points over to Faux late this afternoon and they’ll be in circulation by tomorrow morning.
jonas
NPR covered this in depth on Morning Edition today and did an admirable job of hammering home the point that the conservative criticism of Medicaid can pretty much be called full of shit in light of this new study.
Facts. You can use them to prove anything that’s even remotely true.
wazmo
Of course, the CATO boys are all over this report:
http://www.cato-at-liberty.org/obamacare-supporters-are-over-interpreting-oregon-medicaid-study/
BGinCHI
Interesting letter to Josh Marshall at TPM by one of his readers. Some smart points here:
” I read your piece today on the Democrats failure of the political aspect of politics this morning. I think you need to take a step back and look at the larger picture. Nate Silver’s piece today makes clear that the terms conservative and Republican are converging with everyone else favoring the Democrats. In this scenario, turnout composition explained the results in 2008 and 2010 more than population realignment.
I bring this up because I think we will look back at this moment as the chaotic time that the old order turned to the new. In my opinion, we are seeing the remants of the soon-to-be old power structure see their grip on power slip with the predictable response of ever greater efforts to hold power through cohesion, projections of power, and inflexibility. I would change the term pollsters use here from enthusiasm to desperation or fear. The end is coming. The demographics are clear. Majority minority is marching closer every day. Their team is the long-term loser, the horse and buggy to the Model T. We are now in the Battle of the Bulge phase of this transition. I don’t think the transition will be smooth nor do I think that Democrats can’t lose elections, but the behavior seems to fit to me. Democrats will compromise because the future is theirs while Republicans have to hold on to every vestige of their order remaining as though their lives depend on it…because it does. Tomorrow is not bright for them.”
That last part deserves a bold:
cleek
i blame Obama
Spike
@PeakVT:
While carefully avoiding the brutal truth that the last thing they want is poor and/or brown people feeling better, being less depressed and better able to maintain financial stability.
Lolis
I relied on Medicaid for about eight years. Since I am considered disabled, no private insurer would cover me. I fear any cuts to Medicaid because this is truly the most vulnerable populations. I am deeply against any cuts to Medicaid but I also know that Republicans control the House so things will get cut that I don’t like. I just expect Democrats to fight hard. I am not confident that is happening right now.
Calouste
NotW fallout keeps continuing:
The Guardian now reports that former NotW deputy editor turned David Cameron’s communications director Andy Coulson will be arrested tomorrow. (He went to work for Cameron after he stepped down in one of the first iterations of this long-running drama.)
I wouldn’t be surprised if the UK government is going to fall over this affair. Cameron is a bit toooo close to Murdoch and the LibDems must sense an opportunity to recover their voters if they make a stand at the right time. The approval or not of Murdoch’s take over of BSkyB, Britain’s largest broadcaster, is probably going to be the breaking point. Can’t see Cameron going against uncle Rupert and withholding the approval, but it’s hugely unpopular at the moment.
arguingwithsignposts
fixed
WyldPirate
@Poopyman:
There. Fixed.
El Cid
It’s very difficult to do these sorts of studies given that the subjects, poor people, are not capable of human communication, and at best can make simplistic grunts and require much time to be trained to punch large buttons for fruit or to play with a kitten or have the trainer visit them.
Elizabelle
Kay: thanks for bringing this article to our attention.
It’s pretty straightforward and relatively short. Would be good for printing out and distributing a few copies to one’s wingnut friends and relatives, and then get them to discuss the topic as factually as they can. And limit them to facts, not opinions.
You just cannot defend a system that withholds healthcare from tens of millions of Americans.
Other nations went universal healthcare because it holds costs down in the long run.
Our Christianist brothers and sisters don’t seem to want to discuss that.
jl
I should fear to tread here, since part of my degree is for economics (the other is statistics), and I see a lot of hating on economists here. I will strike back! Though no time for links.
Derf: the ‘good’ jobs report is barely good enough to employ additional population. If we keep up with jobs reports this good, it will mean elevated unemployment for a very very long time.
wazmo: Not sure what part of your comment is your thoughts and what is quoted from the CATO nonsense. The study must be pretty good, since all CATO can do make some comments that imply that they don’t read much research on health economics. Medicaid is means tested for enrollment, but to get benefits for large expenses, enrollees may have to draw down their wealth. Research indicates that most people would prefer to have higher incomes and get really good health insurance, rather than stay poor to enroll in Medicaid, and then risk having to spend down their assets in case a health disaster occurs.
There are also several papers, all showing completely consistent results, that CONTINUITY OF CARE is important in keeping health status good and health expenditures down. That is one reason that McCain’s idea of raising the Medicare age is bad, and will probably cost money, it will delay good continuous care to people in late middle age. Any program that allows continuity of care will have some impact in reducing per capita health care costs.
Generally, CATO’s stuff on public health and medical economics is completely unreliable, from what I have seen, because they cannot do, or choose not to do, the mathematics correctly.
No time to get links, but will try to remember to provide them later.
Poopyman
@BGinCHI:
Damn, I wish I’d written that.
Keith
@NonyNony
This does however illustrate that free marketers actually do favor the scientific method – whenver the poor and sick can be used as a control group that is.
Thoughtful Black Co-Citizen
Hospitals don’t have to treat anyone who doesn’t have an emergent condition. However, it still costs money to triage people who come in the door.
Both of which usually get money from You-Know-Where.
‘Cos, you know, the scheduler NEVER asks a potential new patient if he has insurance and doctors HAVE to take anyone who calls for an appointment. Oh wait, that sentence was 100% false.
I love that the choices are:
Rip off a health care provider (hospital or doctor).
Add a further burden to already overburdened free providers (that usually aren’t equipped to deal with complex health issues).
Gosh, if only there were some way to check the stats!
Han's Solo
@ET: Exactly. If poor people really want health insurance they’ll start making more money and buy health insurance…
Republican logic… Ayn Rand was a monster.
AAA Bonds
I’m struck with the image of dead British dockworkers swarming out of the Atlantic and scouring the East Coast as they search for the beating demon’s heart of Maggie, buried deep beneath the Capitol.
Citizen_X
Unfortunately, the mysterious substance foxnewsite makes one completely impervious to Captain Obvious’ powers.
Felinious Wench
The study doesn’t get into this, but healthy women tends to have a positive ripple effect in single parent households (duh). Lack of health care hits poor women HARD, and thus, their kids. This is huge for them.
Brachiator
@The Moar You Know:
Let’s bring back the Workhouse!
I’m sure the Republicans would gladly get behind this plan.
‘Course, when Jeebus said it, he actually provided the cake.
jl
Also a comment on the ethics and the sorry state of health economics in the U.S. Conservative free market health economics in the U.S. has been very heavily influenced by work done by Mark Pauly, who drew and X on a piece of paper, and asserted that the market for health was just like the market for ice cream cones. And that comprehensive health insurance was really just a subsidy to consume health care. (Edit, in plain language, any public policy to encourage comprehensive health insurance was like giving people tax money to buy more ice cream cones, and they would eat more ice cream that was economically efficient) As far as I know there was no detailed theoretical analysis or empirical evidence, just this X on piece of paper (that stood for free market supply and demand market equilibrium analysis), and an assertion. But radical unregulated free market economists and policy makers and business people had an X on a piece of paper published in a peer reviewed journal, and they ran with it.
That started the experiments in introducing even more unregulated, or lightly regulated free market polices in the health care market and health insurance market. Health insurance is more lightly regulated than, for example, life insurance. We see the results today.
Pauly took back his analysis awhile ago, and said that he now recognizes his influential analysis is ‘incomplete’ and he recognizes the importance of the more comprehensive analysis by Kenneth Arrow that said health care was NOT like other goods, and unregulated free markets would not work well.
The only designed randomized controlled trial of different types of health insurance coverage in the U.S. (The RAND health insurance study, by Joseph Newhouse) produced evidence that high deductible ‘consumer driven’ plans increased the mortality rate of poor people with chronic diseases by 10 percent. Newhouse himself has written that this is an important finding of the study. Sloppy policy analysts like Ezra Klein have said that there is no evidence that these kinds of policies harm health, but he is WRONG. So, with that history, there is not way any review board will permit another designed randomized controlled trial that risks forgone health care, and an increased mortality rate.
ThatLeftTurnInABQ
@Wazmo #35:
quoting cato:
Translation from dogwhistle-ize: Lazy bucks buying T-bone steaks.
You know what alternative policies would provide a better cost/benefit ratio for the taxpayers? Just shooting the poor bleeders and rendering their body fat to make candles and soap, that’s what. Bullets cost next to nuthin’ and the candles and soap will return a tidy profit. Fucking cato, why can’t they just come right out and say it already? The poor should die and decrease the surplus population.
wazmo
@dl: got caught by a malformed blockquote-that’s all CATO’s view-and their website where they posted this does not allow for responses.
Han's Solo
Because who would dig their graves, rich people?
Mike in NC
Yeah, that always works out so well!
Citizen Alan
Elmo @ 9
Of course. Those T-bone steaks won’t eat themselves.
scav
Oh, I’m liking this. Nice tight relationship between NoTW and WSJ with critical role and responsibility to phone hacking stuff thrown in as dessert.
And, yeah Mike in NC, I liked the option of simply not paying the bill being thrown out as a viable one. Must work because its a capitalism-based not-paying-your-bill rather than a socialism-based not-paying-your-bill. Or something like that.
ThatLeftTurnInABQ
Jay Gould knew the answer to this one.
jl
Life expectancy stagnating in the U.S.: it dropped by 0.1 year in 2008, and increased slightly by 0.2 years in 2009.
I’ve been hearing predictions at epidemiology, public health and similar conferences for a number of years that life expectancy would stagnate and then decline in the U.S. if current trends continue. These were epidemiologists, actuaries, and doctors, (and even statisticians) making predictions about the future, which are hard. But looks like they may be right.
National Vital Statistics Reports
Volume 59, Number 2 December 9, 2010
Deaths: Preliminary Data for 2008
by Arialdi M. Miniño, MPH; Jiaquan Xu, M.D.; and Kenneth D. Kochanek, M.A. Division of Vital Statistics
Page 2:
Life expectancy decreased by 0.1 year from 77.9 years in 2007 to 77.8 in 2008.
National Vital Statistics Reports
Volume 59, Number 4 March 16, 2011
Deaths: Preliminary Data for 2009
by Kenneth D. Kochanek, M.A.; Jiaquan Xu, M.D.; Sherry L. Murphy, B.S.; Arialdi M. Miniño, MPH, and Hsiang-Ching Kung, Ph.D; Division of Vital Statistics
Page 2
Life expectancy increased by 0.2 year from 78.0 years in 2008 to 78.2 in 2009.
The pdf reports are found on this page:
http://www.cdc.gov/nchs/nvss/new_mortality.htm
I cannot believe I missed these reports. Found a reference to them on some blog, Atrios of Daily Kos, not sure which.
Edit: I will be watching for new data from other countries that have health care social insurance death machines oppressing their enslaved populations to see how the U.S. ranking in life expectancy changes. For example, the s * c * * l * s t Swiss, or the death worshipping Taiwanese, or the commie Australians and New Zealanders.
bemused
BGinCHI,
The barrage of machinations the new GOP governors and legislatures launched right out of the gate seems to bear that out. I have thought that it all smelled of frantic desperation to cause as much damage as possible as rapidly as possible knowing they had a short window of opportunity.
Sly
Shorter Cato: “Medicaid may offer increased health care access and improved results for its enrollees, but this may make them lazier than they already are and someone might get a benefit that they do not deserve. A truly effective paradigm for addressing health issues among the poor must be aligned with our childish impulse to cut off our nose to spite our face.”
gene108
Healthier, less depressed people, with financial stability are also more likely to get themselves off the couch and vote; unfortunately for Republicans, they probably will not vote the right way and therefore must be kept from voting.
RalfW
No. No. No. You need to wire up the politicians. They need the shock therapy.
Cris (without an H)
I seem to recall the G.W.Bush administration arguing that this is a Bad Thing. When people go to the doctor more often, it’s a waste of money! It’s overuse! Or something. They were actually positing that preventive care is undesirable.
This has always been fucking astounding. Like, jaw dropping. This line comes from people who claim to be pro-business, who claim to champion personal responsibility, and they’re saying with a straight face that it’s a reasonable option to not pay your bill?
What’s the emoticon for “head explodes?”
MattR
@jl: What am I missing here?
How did we get from 77.8 in 2008 to 78.0 in 2008?
On a related note, I don’t have the source handy anymore but I suspect it was via Krugman. Also it is not a direct quote, but instead is how I paraphrased it in an email.
ericblair
This is from the party who doesn’t want to raise the debt ceiling.
Besides, the solid financial strategy of MegaCorp stiffing small business suppliers and subs then daring them to sue it out of them is pretty well established at this point. If you’re a small business these days you better come to grips with being paid late, short, or not at all by Big Bidness. The GOP is the deadbeat party.
LongHairedWeirdo
See, that’s why you shouldn’t just *give* them health insurance! So they have incentives to work hard and be able to find regular doctors and see them more often, and feel better, be less depressed, and be better able to maintain financial stability!
(The sound of that horrible, mechanical screaming noise in the background was my irony-o-meter dying a horrible death.)
Brachiator
@Cris, 67:
Yep. In California, these people move to woody areas, refuse to get insurance, and when brush fires occur, they expect state firefighters to save their homes, and are first in line to get disaster area benefits. Some of them are very upfront about letting the government and other taxpayers underwrite the risk of their living in potentially hazardous areas.
elmo
I’ve used this:
@8(
Valenciennes
After every single sentence I had to tamp down the urge to yell “FUCK YOU” over and over.
Would that my uninsured mother could “simply not pay the bill” for the chemotherapy she isn’t getting.
jl
@68 MattR
I haven’t had time to read the reports in detail. Probably a statistical adjustment to mortality rates in the intervening months between reports. Life expectancy may not really have dropped, but it is growing so slowly it is within statistical discrepancy. Vital statistics don’t have sampling errors, since the vast majority of deaths are supposed to be recorded.
What is important is that the decline in mortality rates in the U.S. continue to lag behind those in other high income countries.
I did have time to do a quick comparison of the U.S. to high income European countries (20 countries) and Japan. For 2007 to 2008 the life expectancy from birth grew by 0.182 years for women, and 0.288 years for men. Data for those figures from OECD Health Statistics.
Edit: so probably an increase of about 0.24 for men and women in other high income countries, compared to something between decline of 0.1 and increase of 0.1 in U.S. So, either way, the U.S. is not doing well in life expectancy. There was a brief period of catch up by U.S. for women in late 90s early aughts, but that seems to be over now.
El Cid
The problem here is that if the poor were to simply vanish or all die off, this would remove a huge population of people to hate, look down upon, and blame for everything.
Triassic Sands
Aw, Kay, you know facts won’t change a thing for Republicans. They’ll go right on quoting fantasy and denying empirical and historical evidence. That, it turns out, is the easy route when you’re too stupid to follow even the simplest fact-based arguments.
HyperIon
Mais non!
Peggy
Life expectancy in the US does not increase the way it does in real first world countries- such as Europe and Japan. An Obsidian Wings post described how in more than one fifth of US counties, female life expectancies are getting shorter.