MisterMix posted about the Oregon Health Study last week, but I’m still croggled that so many Very Serious Pundits are… well, allowed to get away with a highly selective shading of the results. Here’s the NYTimes:
WASHINGTON — Come January, millions of low-income adults will gain health insurance coverage through Medicaid in one of the farthest-reaching provisions of the Obama health care law. How will that change their finances, spending habits, use of available medical services and — most important — their health?
New results from a landmark study, released on Wednesday in The New England Journal of Medicine, go a long way toward answering those questions. The study, called the Oregon Health Study, compares thousands of low-income people in Oregon who received access to Medicaid with an identical population that did not.
It found that those who gained Medicaid coverage spent more on health care, making more visits to doctors and trips to the hospital. But the study suggests that Medicaid coverage did not make those adults much healthier, at least within the two-year time frame of the research, judging by their blood pressure, blood sugar and other measures. It did, however, substantially reduce the incidence of depression, and it made them vastly more financially secure.
“There was this view that Medicaid coverage would not do much for the low-income uninsured, either because they had access to charity care or because Medicaid is not good insurance,” said Amy Finkelstein of the Massachusetts Institute of Technology. “This rejects that notion entirely.”…
As Jonathan Cohn explained, in the New Republic:
…The big news is that Medicaid virtually wiped out crippling medical expenses among the poor: The percentage of people who faced catastrophic out-of-pocket medical expenditures (that is, greater than 30 percent of annual income) declined from 5.5 percent to about 1 percent. In addition, the people on Medicaid were about half as likely to experience other forms of financial strain—like borrowing money or delaying payments on other bills because of medical expenses…
The other big finding was that people on Medicaid ended up with significantly better mental health: The rate of depression among Medicaid beneficiaries was 30 percent lower than the rate of depression among people who remained uninsured. That’s not just good health policy. That’s good fiscal policy, given the enormous costs that mental health problems impose on society—by reducing productivity, increasing the incidence of violence and self-destructive behavior, and so on….
But yet! adds the NYTimes:
The researchers found that Medicaid coverage did not significantly affect the prevalence or diagnosis of hypertension or high cholesterol, or the use of drugs used to treat those conditions. It significantly increased the probability that a person would receive a diagnosis of diabetes and be treated, though it did not reduce blood sugar levels noticeably…
So, the most common chronic, difficult-to-cure health issues remained chronic and treatment-resistant… at least over the limited two-year window. But participants were less susceptible to potentially crippling psychiatric disorder, and “vastly more financially secure”. This would seem to be a good thing, but the usual suspects (Cato, Douthat, McArdle, Tyler Cowen) are happy to explain that these results “prove” Obamacare is already a failure.
Jonathan Chait at NYMag has the best response I’ve seen:
… Okay: The case for Medicaid expansion is not as strong as I had thought. Now for the caveats: The case for Medicaid expansion is overwhelmingly strong. If a study found that puppies survive steep falls at a higher rate than expected, then you could say the case for throwing puppies out of skyscraper windows has marginally weakened, but would remain extremely strong. Indeed, data notwithstanding, either throwing puppies out of skyscrapers or throwing people off Medicaid are both acts of sadism.
The United States has very high levels of income inequality, a very stingy welfare state, and is the only advanced economy that does not guarantee access to medical care. The Oregon study does not raise particular questions about the efficacy of Medicaid; it raises questions about the efficacy of medical care in general. Measuring the impact of medicine is just really hard to do, yet almost nobody would volunteer to follow this frustrating fact to its logical conclusion and forgo the benefits of modern medicine.
And the Oregon study is not pushing the political debate toward a rethinking of the benefits of medicine writ large. It is only strengthening the hand of those who want to deny it to people who can’t afford health insurance. The Oregon study results from an unusual circumstance: The state had the budget to add 10,000 people to Medicaid, but far more who wanted to join, so it conducted a lottery. It is only the poor who can be subjected to Hunger Games–style experimentation with their health. In any other advanced country, in which medical care is a basic right, such an experiment would be wildly unethical.
It’s almost as if a certain subset of the Pundit population wants their fellow citizens to be broken in spirit and in wallet, isn’t it?