As is always true when the Wrong Outcome is arrived at, there are two angles to this story. One is the study itself, two is the media hackwork in the aftermath to spin the hell out of it before the Wrong Outcome leads to Wrong Policy.
First, the Wrong Outcome via Philip Klein. Oregon expanded its Medicaid program five years ago, then tracked more than 6,000 new participants for a year and a half to see if adding them to the rolls led to major improvements in their health compared to 6,000 people in a control group. Verdict: Nope, not really.
Do note, one of the co-authors of the study is ObamaCare architect Jon Gruber:
Specifically, researchers found that those who received Medicaid increased their annual health care spending by $1,172, or 35 percent more than those who did not receive Medicaid. Those with Medicaid were more likely to be screened for diabetes and use diabetes medication and to make use of other preventive care measures. The study also examined health metrics including blood pressure and cholesterol.
Ultimately, the authors concluded that, “This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured health outcomes in the first two years, but it did increase use of health services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.”
So, the study suggests that expanding Medicaid is one way of reducing financial pressure on low-income groups, but it’s costly and does not improve their health.
Another interesting finding was that though medical spending increased among Medicaid enrollees due to more prescription drug usage and doctors’ visits, the study “did not find significant changes in visits to the emergency department or hospital admissions.” This undercuts another favorite talking point of liberals, which is that expanding insurance actually saves money by reducing costly emergency room visits.
If you want a deeper dive into the findings, wonk out with Megan McArdle (“it’s actually bigger, and more important than Obamacare”) and Avik Roy (“it is positively unethical to take money from [the middle class] in order to fund a broken program that doesn’t improve health outcomes”). The point of Medicaid, needless to say, is to improve the health of the poor by expanding their access to health care; oppose the program as an expensive failure and, as surely as Paul Ryan wants to toss grandma off a cliff, you’re in favor of poor people suffering and dying. What’s a smart, right-thinking liberal to do in the face of a scientific study that cuts the legs out from under that reasoning? It’s goalpost-moving time:
AP headline on study finding Medicaid didn’t improve physical health: “Medicaid improved mental health for uninsured” bit.ly/162yTJw
— Philip Klein (@philipaklein) May 2, 2013
Medicaid fails almost entirely to achieve its objectives, at fantastic cost to taxpayers, but if there’s even a glint of welfare-state success to report, rest assured that the media will find it. And it’s not just the AP: Scroll through Shikha Dalmia’s round-up of lefty reporters doing their best to spin the study as some sort of win for the program. The lamest, per Gabe Malor, is the Times’s headline trumpeting the fact that Medicaid “increases use of care” — as if visiting the doctor, not improved health, is suddenly the yardstick of a successful health insurance program. Even the mental-health finding touted by the AP carries an asterisk. As Peter Suderman noted yesterday, some Medicaid recipients reported improved health after they enrolled even though they hadn’t been treated for anything yet. The reduced depression, in other words, may be due in part simply to the security they felt from gaining coverage … even though the care they eventually received ended up doing little for them. How’s that for a new justification for endless billions in health-care spending? The Medicaid safety net may not provide much safety, but the psychic boost from knowing that it’s there is worth the cost — even though there may be ways to achieve the same gains in mental health and diabetes detection through other means, at less expense.
Read Roy’s post linked above for a five-point response to liberal spin of the study. Righty wonks are treating this like a bombshell insofar as it might halt Democratic efforts to expand Medicaid under ObamaCare, but I don’t know. It might give confidence to Republicans in purple states, but the blue states will plow ahead. If they did ten more studies confirming this result, those would all be spun away too. This is an “identity” issue for Democrats — they’ll fight to protect the welfare state, whether it works or not, whether we can afford it or not — and as with abortion (or guns on the right), they won’t cede an inch on “slippery slope” grounds. Even if they were convinced that Medicaid isn’t worth the expense, they won’t relinquish a key political bludgeon against the right. Celebrate the result as a win for truth, but not because policy’s likely to shift dramatically.