So let's not do it right? It's been definitively shown that Medicaid doesn't work. This is how conservatives operate. If anything comes out that could possibly correlate with what they want to believe then it's proven. Sumner's doing the same thing with yesterday's job numbers: the bottom didn't fall out so Keynesains are wrong for having warned against the sequester and the sunset of the payroll tax holiday.
http://diaryofarepublicanhater.blogspot.com/2013/05/sumners-continues-to-spike-ball-on.html
In this Oregon study, conservatives have all they need to here. Currently there is a fight over ObamaCare that's slated to be implemented next year. Specifically on the question of the Medicaid expansion that ACA offers, a number of Republican states are saying no-though not all.
"The Oregon study is giving ACA opponents some fuel for their fire in that it seems to suggest that there's not a lot of difference between those who are on Medicaid and those who aren't. What we have here in Oregon is the gold standard of economic research: an actual natural experiment-both random and controlled. A few years ago the state had some funds to provide Medicaid to 10,000 new recipients; however there were 90,000 who were eligible so the state actually held a lottery."
In any case the ObamaCare opponents have seized on this study as quickly as Sumner did yesterday's job numbers:
"That’s where the new study comes in. Opponents of the expansion think the results back up their arguments. The Cato Institute's Michael Cannon, for example, says the study " throws a huge 'STOP' sign in front of ObamaCare’s Medicaid expansion.
http://www.newrepublic.com/article/113087/medicaid-expansion-oregon-study-shows-benefits-mostly#
As Cohen argues, they're arguing pretty selectively. They're also ignoring the benefits that the study shows in terms of relieving economic strain for those who got onto Medicaid-and also a drop in depression.
While they think that the findings on health discredit liberals who tout Medicaid, the study actually discredited a claim that many conservatives have made: that Medicaid pays so little in insurance that recipients simply can't find treatment.
"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."
Conservatives certainly aren't making a lot of noise about it actually really helping recipients ameliorate financial distress though it discredits their premise that Medicaid recipients can't find healthcare at all.
However, they are all over the fact that the study seems not to show much in the way of physical health gains:
Again, it's great that we got a real experiment for once-through the tragedy of all those who couldn't get Medicaid in Oregon of course-but the last thing that's called for are rash conclusions, certainly not ideological talking points by cherrypicking the findings. It's obvious that if you get healthcare it's better for your health than not getting it-otherwise how do we explain the surge in life expectancy of the 20th century?
Somehow, conservatives think this is a big win for their opposition to universal health insurance. Why? What it suggests is that the health benefits of ANY kind of health insurance are somewhat hard to identify over a two year period; so, are you about to give up your own insurance, or is your best bet that having that insurance is still a very good idea? And the financial benefits are a big part of that! Since you are going to treat your illnesses, better not to bankrupt yourself in the process, right?
http://krugman.blogs.nytimes.com/2013/05/02/medicaid-nonsense/
In another post entitled Fire Insurance is Worthless, Krugman notes:
" After all, there’s no evidence that it prevents fires."
http://diaryofarepublicanhater.blogspot.com/2013/05/sumners-continues-to-spike-ball-on.html
In this Oregon study, conservatives have all they need to here. Currently there is a fight over ObamaCare that's slated to be implemented next year. Specifically on the question of the Medicaid expansion that ACA offers, a number of Republican states are saying no-though not all.
"The Oregon study is giving ACA opponents some fuel for their fire in that it seems to suggest that there's not a lot of difference between those who are on Medicaid and those who aren't. What we have here in Oregon is the gold standard of economic research: an actual natural experiment-both random and controlled. A few years ago the state had some funds to provide Medicaid to 10,000 new recipients; however there were 90,000 who were eligible so the state actually held a lottery."
In any case the ObamaCare opponents have seized on this study as quickly as Sumner did yesterday's job numbers:
"That’s where the new study comes in. Opponents of the expansion think the results back up their arguments. The Cato Institute's Michael Cannon, for example, says the study " throws a huge 'STOP' sign in front of ObamaCare’s Medicaid expansion.
http://www.newrepublic.com/article/113087/medicaid-expansion-oregon-study-shows-benefits-mostly#
As Cohen argues, they're arguing pretty selectively. They're also ignoring the benefits that the study shows in terms of relieving economic strain for those who got onto Medicaid-and also a drop in depression.
While they think that the findings on health discredit liberals who tout Medicaid, the study actually discredited a claim that many conservatives have made: that Medicaid pays so little in insurance that recipients simply can't find treatment.
"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."
Conservatives certainly aren't making a lot of noise about it actually really helping recipients ameliorate financial distress though it discredits their premise that Medicaid recipients can't find healthcare at all.
However, they are all over the fact that the study seems not to show much in the way of physical health gains:
"But one place improvement did not appear was physical health. And this was something of a surprise. The Oregonians on Medicaid were clearly getting more medical care—in particular, more preventive care. This was consistent with the previously reported results. But the researchers found no statistically significant impact on blood pressure, cholesterol, or blood sugar levels and diabetes. The researchers caution that some health effects might take a longer time to materialize. Plus it’s always possible that the limited sample size makes it hard to detect health effects that, by their nature, will affect a small group of people. But, at the very least, these results make predictions of increased health benefits from Medicaid more speculative. (It also suggests that Medicaid needs improvement, which is an argument its defenders make all the time.)"
Yet it's clear that the methodology of the study is not unimpeachable. The only gauges of physical health were blood pressure, diabetes, and hypertension. How do we know that the people tested were already suffering from say high blood pressure? Indeed it seems that many of them weren't. If they weren't there's no reason to expect much improvement.
"Average blood pressure was a bizarre thing to measure. You have to remember that most people who get health insurance are healthy. They’re not going to get “healthier”. The average blood pressure in the control group was 119/76. That’s normal! You would only expect that it might improve in those with a high blood pressure. So I might have looked for an effect in those patients with hypertension. 16.3% of people in the control group had a systolic over 140 or a diastolic over 90. In the Medicaid group, that dropped to 15%. If they wanted to look at average pressures, why didn’t they single out the hypertensive people? I don’t know."
Another thing to remember is that this is the first study of its kind. Conservatives simply want to bash Medicaid to undermine ObamaCare. However, as The Incidental Economist points out, it's not as if we have any data at all on Medicare or private insurance, so how can we declare definitely that there are "flies on Medicaid?"
Do ACA opponents also believe that Medicare gives no physical benefits? How about private insurance? Do they believe someone is better uninsured or covered by private insurance? As we have no source of comparison how can Medicaid be damned? Are we all just as good off with no medical care?No one would claim that. How else have gotten life expectancy up? It's a very interesting an important study. However, more work needs to be done. It would certainly be very helpful to do a similar study of Medicare and private insurance.
It's also not true that there was no improvement in physical health-as measured by blood pressure, diabetes, etc, just that the improvement wasn't "significant." But what does "significant" mean in this context?
"Kevin Drum makes an important point. The finding that the study found no significant improvement in physical health turns heavily on the meaning of the word “significant”:
http://www.washingtonpost.com/blogs/plum-line/wp/2013/05/02/a-war-over-medicaid/In fact, the study showed fairly substantial improvements in the percentage of patients with depression, high blood pressure, high cholesterol, and high glycated hemoglobin levels (a marker of diabetes). The problem is that the sample size of the study was fairly small, so the results weren’t statistically significant at the 95 percent level.However, that is far, far different from saying that Medicaid coverage had no effect. It’s true that we can’t say with high confidence that it had an effect, but the most likely result is that it did indeed have an effect…Bottom line: It’s more likely that access to Medicaid did improve health outcomes than that it had zero or negative effects. It’s just that the study was too small to say that with certainty.
Again, it's great that we got a real experiment for once-through the tragedy of all those who couldn't get Medicaid in Oregon of course-but the last thing that's called for are rash conclusions, certainly not ideological talking points by cherrypicking the findings. It's obvious that if you get healthcare it's better for your health than not getting it-otherwise how do we explain the surge in life expectancy of the 20th century?
Somehow, conservatives think this is a big win for their opposition to universal health insurance. Why? What it suggests is that the health benefits of ANY kind of health insurance are somewhat hard to identify over a two year period; so, are you about to give up your own insurance, or is your best bet that having that insurance is still a very good idea? And the financial benefits are a big part of that! Since you are going to treat your illnesses, better not to bankrupt yourself in the process, right?
http://krugman.blogs.nytimes.com/2013/05/02/medicaid-nonsense/
In another post entitled Fire Insurance is Worthless, Krugman notes:
" After all, there’s no evidence that it prevents fires."
"But strange to say (as Mark Thoma points out in correspondence), people seem to think it’s a good idea anyway."
"I leave the relevance of this thought to the Medicaid discussion as an exercise for readers."
http://krugman.blogs.nytimes.com/2013/05/02/fire-insurance-is-worthless/
Let's finish off with some good advice:
"So chill, people. This is another piece of evidence. It shows that some things improved for people who got Medicaid. For others, changes weren’t statistically significant, which isn’t the same thing as certainty of no effect. For still others, the jury is still out. But it didn’t show that Medicaid harms people, or that the ACA is a failure, or that anything supporters of Medicaid have said is a lie. Moreover, it certainly didn’t show that private insurance or Medicare succeeds in ways that Medicaid fails."
http://theincidentaleconomist.com/wordpress/oregon-and-medicaid-and-evidence-and-chill-people/
Let's finish off with some good advice:
"So chill, people. This is another piece of evidence. It shows that some things improved for people who got Medicaid. For others, changes weren’t statistically significant, which isn’t the same thing as certainty of no effect. For still others, the jury is still out. But it didn’t show that Medicaid harms people, or that the ACA is a failure, or that anything supporters of Medicaid have said is a lie. Moreover, it certainly didn’t show that private insurance or Medicare succeeds in ways that Medicaid fails."
http://theincidentaleconomist.com/wordpress/oregon-and-medicaid-and-evidence-and-chill-people/
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