Bad News About Health Care from Oregon

There are basically three basic goals toward which recent efforts at health care reform were aimed. Two of them are economic: the American health care system costs too much and people need to be protected against the financial burden of health care. The last is about medicine: people will be healthier if they have better access to health care.

It is doubtful that ObamaCare can deliver substantial progress toward the first two goals. It does almost nothing to reduce overall health care spending and it while it will mean that some patients will be relieved of some of the costs of treatment, it is also clear that most of us will pay a lot more.

What about the last goal? Does expanding health insurance and in effect cheap or free care improve the health of the recipients? The state of Oregon recently ran what was, unintentionally, as good a test as one could devise. They provided funds to add 10,000 new people to Medicaid. A lottery determined who would get the slots. Health care experts signed up 6,400 of those who won the lottery and 5,800 of those who entered but didn't win.

This provided a large sample. It met the criteria of a random, controlled test, since the two groups were selected by lot the one provided a control group to compare outcomes with the other. If access to medical care without financial burden improves health outcomes, this is where you would be able to see it in glowing color.

Meagan McArdle reports the sad news. Here is a passage she quotes from the study.

We found no significant effect of Medicaid coverage on the prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for these conditions. Medicaid coverage significantly increased the probability of a diagnosis of diabetes and the use of diabetes medication, but we observed no significant effect on average glycated hemoglobin levels or on the percentage of participants with levels of 6.5% or higher. Medicaid coverage decreased the probability of a positive screening for depression (−9.15 percentage points; 95% confidence interval, −16.70 to −1.60; P=0.02), increased the use of many preventive services, and nearly eliminated catastrophic out-of-pocket medical expenditures.

McArdle explains:

No statistically significant treatment effect on any objective measure: not blood pressure. Not glycated hemoglobin. Not cholesterol. There was, on the other hand, a substantial decrease in reported depression. But this result is kind of weird, because it's not coupled with a statistically significant increase in the use of anti-depressants. So it's not clear exactly what effect Medicaid is having. I'm not throwing this out: depression's a big problem, and this seems to be a big effect. I'm just not sure what to make of it. Does the mere fact of knowing you have Medicaid make you less depressed? For that matter, I'm not sure what the policy implication is. If you wanted a program to cure depression, Medicaid is probably not what you'd design.

The data is in. Expanding medical insurance did not make an appreciable difference on any objective measure. The three conditions mentioned above are precisely the ones that we are very good at treating. One reason for this is that people in the control group usually obtained access to treatment when they sought it.

I thought from the very beginning of the ObamaCare drama that the real problem was not that Obama was a closet socialist but that neither he nor the Democrats in Congress were bothering to ask any of the most important questions. They knew what was wrong with the health care system: not enough government control. They knew exactly what to do about it. They had known all these things and so didn't bother to think about them. They have known them for so long that they cannot remember not knowing them. It's not what people think that gets us in trouble. It's what they know that just ain't true.

Comments

[Ali Rahmani]

This is really a bad news. Hope they can work it out.

[Donald Pay]

"The data is in."

The study analyzes two years of data, which is really not enough time to tease out what is happening. The importance of covering more people is to PREVENT, not TREAT, long-term conditions. Thus, the data might allow you to conclude that the Medicaid expansion has actually worked in that it has prevented conditions from coming to the point of being diagnosable.

[Ken Blanchard]

Donald: apparently the Medicaid prevention effect you conjure up is so powerful that it works even on people who don't get Medicaid, since the outcomes were the same for both groups.

What the data allow you to conclude is that there is not, as yet, any evidence that expanding health insurance makes people healthier. Yes, its only two years of data; I am betting that it would have impressed you if the results were more favorable to the expansion of health insurance.

[Donald Pay]

I'm not sure what happened to my earlier post, but I'll try to recapitulate and add to it. A followup to the McArdle piece has been posted at the Atlantic. It seems to indicate that, indeed, I was probably more in the ballpark than you. There were consistent, yet not statistically significant, health improvements based on measured lab tests for those were were enrolled in the Medicaid program.

http://www.theatlanticwire.com/politics/2013/05/oregon-medicaid-study/64816/

When you consider that most of the Medicaid cohort had been seen very few times during that two year period, the fact that you get a consistently good decrease in all parameters, even if not yet statistically significant, is a tremendous result for such little input.

McArdle and a lot of the elites who seem to cluck over this study, have obviously never dealt with the issue having to pay medical bills when they didn't have, and probably never would have, the money to pay them. That's a recipe for instant depression, and much more, as I found out when covering the story of a single woman who needed to have emergency surgery when I worked for a weekly paper in the 1990s. At any rate, the mere fact that a person does not have to dodge calls from collection agencies is something that has an immediate affect on depression.

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