How the Oregon Medicaid study should change our thinking
A bunch of people sarcastically asked whether I was planning to drop my health insurance. The answer is no, because my employer pays for it. But if the question is “Has this caused you to revise downward your estimate of the value of health insurance?” the answer has to obviously be yes. Anyone who answers differently is looking deep into their intestinal loops, not the Oregon study. You don’t have to revise the estimate to zero, or even a low number. But if you’d asked folks before the results dropped what we’d expect to see if insurance made people a lot healthier, they’d have said “statistically significant improvement on basic markers for the most common chronic diseases. The fact that we didn’t see that means that we should now say that health insurance, or at least Medicaid, probably doesn’t make as big a difference in health as we thought.
Certainly, this bolsters my belief that health insurance should provide financial protection from catastrophic events, not wrap-around first-dollar coverage. Those who used to read me on The Atlantic may recall that the McArdle Plan for Healthcare involved the government picking up the tab for any medical expenses above 15-20% of income: simple, progressive, and aimed at the actual problem we know health insurance can fix. Unfortunaely, Obamacare made that sort of coverage functionally illegal.
Which brings me to another belief I should update. Three years ago, after Obamacare passed, I predicted that Obamacare would not result in significant reductions in mortality. I now think that this is more likely to be right than I did before.