Americans may be surprised to learn that little solid evidence exists to support the claim that expanding health insurance will improve the health and financial security of the uninsured; that someresearch calls into question whether broad coverage expansions improve health at all; and that some research even suggests that the overall benefits of such expansions may not be worth the cost. We lack definitive evidence because no developed nation has ever conducted a study that randomly assigns people to receive health insurance in order to control for other factors that might affect these outcomes. Until now.
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In 2008, Oregon decided to enroll an additional 10,000 people in its Medicaid program via lottery. The nation’s top health economists pounced on the opportunity to compare medical consumption, health outcomes, and financial stress among “able-bodied uninsured adults below 100 percent of [the] poverty [line],” some of whom were randomly assigned to Medicaid and some of whom were not. The Oregon Health Insurance Experiment is particularly relevant because, starting in 2014, President Obama’s new health-care law will enroll another 16 to 20 million such people in Medicaid.
Today, the OHIE researchers released their results after year one of the experiment.
As one might expect, Medicaid coverage led to higher medical consumption. The likelihood of having a hospital admission rose from roughly 7 percent to 9 percent. Average outpatient visits rose from 1.9 to 3. Mammograms for women over age 40 increased from 30 percent to 49 percent, and diabetes screening increased from 60 percent to 69 percent. Average spending was about 25 percent (or $778) higher for Medicaid enrollees in the first year.
Other findings were less intuitive. For example, medical consumption was no higher in the first half of the year, suggesting there was no “pent-up demand” for medical care. Though President Obama hasclaimed that broader health-insurance coverage and consumption of preventive care would lead to a reduction in emergency-room visits, the OHIE found no discernible difference in ER use between Medicaid enrollees and the control group.
What benefits did all this medical care purchase? As one might have expected, Medicaid reduced financial strain. The likelihood of having out-of-pocket medical expenses fell from 56 percent to 36 percent, while the likelihood of having to borrow money or skip paying other bills to pay for medical care fell from 36 percent to 21 percent. Enrollees’ likelihood of having any type of unpaid bill sent to collection fell from 50 percent to 45 percent.
What about health? Though the president has claimed his health-care law will “save lives,” the OHIE detected no evidence that extending Medicaid to 10,000 adults did so in the first year. On one hand, we might not expect to see any effect just one year into the experiment, since mortality rates among adults aged 19 to 64 are relatively low. On the other hand, this finding is consistent with a previous study, coauthored by one of the OHIE researchers, that found no evidence that Medicare (which covers a much older and sicker population) saved any lives even ten years after its introduction. (In future years, OHIE researchers will be able to report on other objective measures of health such as blood pressure and cholesterol levels.)
On subjective measures of health, the likelihood of screening positive for depression fell from 33 percent to 25 percent, and the share reporting their health to be good or better rose from 55 percent to 68 percent. However, two-thirds of the improvement in self-reported health occurred almost immediately after enrollment, before any increases in medical consumption. The authors posit that much of this improvement could reflect “an improved overall sense of well-being” rather than “changes in objective physical health.”
This is all very well, but tragically the vast number of people, even soi-disant 'conservatives', are ignorant or in denial of the following:
1. Programs to cover medical costs, whether true insurance or gov't-based, exist because people perceive medical costs to be too high for them to purchase out of pocket routinely.
2. Medical costs are high primarily because of two things: the Medical Practice Acts of the various states, and the FDA. These twin pillars supporting high medical costs inflate the costs of doing medical business, and grossly restrict competition in medical business. This naturally drives up the cost. Don't think those are the main reasons? Let's try eliminating them and find out. What, you don't think you're smart enough to find reasonably safe and effective medical care without the assistance of the gov't? Grow up.
3. Regardless of the cost of medical care, it is unConstitutional for the Federal gov't (and foolish for the various states) to pay for, regulate, provide for, or legislate concerning medical care (with the obvious exception of provisions for the military, etc).
I keep waiting for 'conservatives' to finally focus on the main thing: the gross violation of our own foundational Law that we have tolerated for decades.
Medical costs have risen for one simple reason, no one cares because we pay less and less for our medical care. Who ever asks how much a treatment or procedure is going to cost? As long as insurance covers it, it's fine, right? As long as someone else is paying, go ahead, get that procedure. If you applied the free market principles, you'd shop around and find the best price. Competition is what lowers prices, not monopolies.
"Programs to cover medical costs, whether true insurance or gov't-based, exist because people perceive medical costs to be too high for them to purchase out of pocket routinely."
Here is the fallacy behind what we presently call health insurance. Until people pay for their own routine care, the cost will continue to climb. In the 1950s and 60s, insurance paid for unexpected events, like heart attacks or cancer. When it began to pay for routine care, cost climbed steadily. What we have now is prepaid care and that ensures poor quality and high cost.
The French have a hybrid system that provides the best quality in the world. The health plan pays a fixed reimbursement to the member AFTER the member has paid the doctor. The amount paid to the doctor is negotiated in most cases. If I want the best care, I can go to the best specialist in Paris but I will have to pay more.
What we have now is a system that increases cost with no equivalent effect on quality.
The Oregon study is suspect in one part of the report. Medicaid patients fill ERs and I would expect an increase with increased eligibility.
The author writes that “… it is no small irony that they themselves dove head-first into evidence-free policymaking.” Why is that irony? What does the author expect? The author writes this article with the assumption that Democrats are looking for the best policies by which to govern. That may be coy with the goal of being objective. Fine. But it is obvious throughout the entire debate on the Obamacare Legislation that “best policy” was not the objective. The objective was to expand their political power base through statism, regardless of the effectiveness of policy. Let us call a spade a spade.
Yep, good thing we now know that getting "health care" is a scam. Why even have it? It won't increase your "outcomes". Now that we've tested this on the poor, we can all now save ourselves a lot of money and just forgo coverage and not worry it will affect our health. Why didn't someone figure this out before? We sure have wasted a lot of resources on this wasteful "going to the doctor" thing.
It is astonishing to me that anyone would call into question whether "expanding health insurance will improve the health and financial security of the uninsured."
The majority of bankruptcies are due to health costs.
Uninsured middle class people are charged 3, or 5 or even 10 times (really) for the same service at a hospital as insured persons.
Talk to any doctor who works in an emergency room. He or she will tell you that they frequently see persons who have delayed treatment for an illness or wound because they could not afford to go to a doctor, and only after the illness or wound became much worse did they finally go to a hospital ER.
Finally, it is beyond me that the author could write this article without mentioning pre-existing condition exclusions, and how they prevent many working middle class people from obtaining insurance.
I'm uninsured and considerably lower than "middle class", and I rarely had to pay for medical services. The lower class (including many illegal aliens) are actually a resourceful bunch, and they will take advantage of various government programs. My grandmother went to the hospital because of a dizzy spell and the local hospital treated her to a round of MRI, shots, IV fluids, etc.
The doctors, nurses and pharmacists that I talk to complain about ultra demanding patients hoarding resources and services. What part of the country do you live in where citizens wait until deathbed to go to the hospital.
Most small businesses do not hire unionized workers and therefore do not pay for their healthcare. Hence, the attraction for illegal labor. Healthcare costs have doomed the auto industry for obvious reasons.
What part of country do you live in where people ONLY go
