Politics & Policy

Medicaid’s Oregon Trail

The Left, science, and the inevitable failure of Obamacare

Medicaid is already a $450-billion-per-year program, and a major chunk of the coverage expansion Obamacare promises comes by way of expanding it. So it would be nice to know if it worked, right? On Wednesday, a group of researchers released a new study on expanded Medicaid eligibity that suggests that it, sort of, well, doesn’t. Here’s what you need to know about it.

What the Study Doesn’t Show

The Oregon study compared health outcomes along several measurable indicators — including blood pressure, blood sugar, and cholesterol level — between people enrolled in Medicaid and the uninsured. What’s nice about this study is that the experimental and control groups are randomized, or close to it, because the state held a lottery to enroll a proportion of those newly eligible for Medicaid. There is some potential for bias in the fact that only some of those who “won” the lottery actually enrolled, but this should tilt in favor of Medicaid proponents, because people who are likelier to enroll are also those likelier to need treatment.

So what difference did the study show in health outcomes between Medicaid patients and the uninsured? Almost none at all. Specifically, they found no statistically significant reductions in hypertension, high blood sugar, high cholesterol, or broad markers of cardiovascular health. And this was despite the likelihood that the Medicaid enrollees were sicker to start with and the fact that, as Avik Roy points out, Oregon’s Medicaid program pays doctors better than most states do, thus increasing access to care (21 percent of Oregon doctors won’t take new Medicaid patients, compared with 31 percent nationwide).

What the Study Does Show

So does the study show any benefit to Medicaid? Sure, it shows an increase in health-care spending and treatment consumption, an improvement in subjective reports of mental well-being, and “reduced financial strain.” In other words, the only statistically significant results of the study show that 1) subsidizing something causes people to spend less of their own money on it, and to use more of it, and 2) that this makes them marginally happier. But since none of these measures seem to actually make people healthier, it might be better to just cut checks for them or put Prozac in the water.

How the Left Is Spinning It

The current study is actually a two-year follow-up to a 2011 study that showed more or less the same thing: greater feelings of well-being and reduced financial strain, but little in the way of tangible health benefits. When the original study came out, left-leaning health wonk Ezra Klein called it “the most important health-care policy experiment since the 1970s” and “the gold standard in research.” He titled his post on the subject “Amazing Fact! Science Proves Health Insurance Works.” Klein and others anxiously awaited the new data, which many sincerely expected would confirm the effectiveness of Medicaid and, by extension, Obamacare. So what are they saying now? Klein’s Wonkblogger Sarah Kliff admitted the basic result but threw in a sly adverb to suggest the study showed only that Medicaid doesn’t improve outcomes “quickly.”

Others on the left spun like whirling dervishes. Mother Jones’s Kevin Drum wrote that “the study showed fairly substantial improvements” (emphasis his) but that “the problem is that the sample size of the study was fairly small, so the results weren’t statistically significant.” Au contraire: The sample size is impressively large for a randomized social-scientific study like this — which is why the Left used to love it — but never mind that. Drum is basically saying that the study shows improved outcomes if you throw out widely accepted statistical methodology.

Other lib spinners moved the goalposts. Paul Krugman, for instance, wrote that “until now the claim of right-wingers has been that Medicaid makes you sicker.” He concluded: “Above all, you should bear in mind that if health insurance is a good idea . . . Medicaid is cheaper than private insurance. So where is the downside?” Well, cheaper for some, anyway, though we might ask whether “it won’t make people sicker” is a robust enough justification for a program that will cost the federal government, and especially the states, more than $7 trillion over the next ten years.

Jonathan Gruber’s response was perhaps most striking of all, since he is an architect of Obamacare, co-author of the study, and a kind of Obi-Wan Kenobe for lefty health wonks. “The most important thing the Affordable Care Act will accomplish,” Gruber said, “is end the daily stress and uncertainty that face individuals who are uninsured.”

Let that sink in for a moment.

What All This Means for Obamacare

So there is no evidence as of yet that Medicaid controls health-care costs. Just the opposite, in fact: It encourages greater consumption of health-care services. And there is no evidence that it significantly improves (physical) health outcomes. (In this finding, it comports with many other studies.) So what does this mean for the rest of Obamacare?

Well, remember, if all the states had implemented the Medicaid expansion, half of the coverage expansion promised under the Affordable Care Act would have been accomplished through it, and much of that in states with Medicaid programs stingier than Oregon’s. In other words, they are going to be brought into a program, at great cost, that has shown no sign of improving people’s health, even at its most generous. And since these incoming Medicaid patients are by definition poorer and tend to be sicker than average, they represent a modest baseline against which to measure any improvement. The framework of mandates, price controls, and subsidies meant to cover everyone else under Obamacare is likely to be even less effective at improving outcomes, since by definition it will cover a group that is already relatively better off, financially and health-wise.

But all of this is okay, we are told, as long as you feel healthier. So go ahead and think about a trillion in new spending, wall-to-wall premium hikes, individual mandates, abortion mandates, the regulatory vise on small business, and the “train wreck” (as Max Baucus describes it) that is implementation, and tell me: How do you feel?

Daniel Foster is NRO’s news editor.

Daniel FosterDaniel Foster is a former news editor of National Review Online.

Most Popular

World

Jared Kushner Was Right

Over the past several years, a new certainty was added to death and taxes: Jared Kushner would fail in his role as the administration’s Middle East point man. It caused considerable merriment among President Donald Trump’s critics (and even some of his well-wishers) when he put his son-in-law in charge of ... Read More
World

Jared Kushner Was Right

Over the past several years, a new certainty was added to death and taxes: Jared Kushner would fail in his role as the administration’s Middle East point man. It caused considerable merriment among President Donald Trump’s critics (and even some of his well-wishers) when he put his son-in-law in charge of ... Read More
Law & the Courts

Barr Is Right About the Prosecution Power

Attorney General Bill Barr gave a speech at Hillsdale College on Wednesday that attracted a lot of attention. Much of that attention was for his ill-considered remark (in a question-and-answer session following the speech) that "Other than slavery, which was a different kind of restraint, [the pandemic lockdowns ... Read More
Law & the Courts

Barr Is Right About the Prosecution Power

Attorney General Bill Barr gave a speech at Hillsdale College on Wednesday that attracted a lot of attention. Much of that attention was for his ill-considered remark (in a question-and-answer session following the speech) that "Other than slavery, which was a different kind of restraint, [the pandemic lockdowns ... Read More

Snobs or Mobs?

A   lot of us were feeling pretty good about the future of the media in late September of 2004. Dan Rather and the CBS news division had just tried to derail George W. Bush’s reelection campaign with some genuine fake news — based on fake documents — and, in spite of the manful attempts of ... Read More

Snobs or Mobs?

A   lot of us were feeling pretty good about the future of the media in late September of 2004. Dan Rather and the CBS news division had just tried to derail George W. Bush’s reelection campaign with some genuine fake news — based on fake documents — and, in spite of the manful attempts of ... Read More

The Mystery of Robert E. Lee

No one who ever met Robert Edward Lee -- whatever the circumstances of the meeting -- failed to be impressed by the man. From his earliest days as a cadet at West Point, through 25 years as an officer in the U.S. Army’s Corps of Engineers and six more as a senior cavalry officer, and then as the supreme ... Read More

The Mystery of Robert E. Lee

No one who ever met Robert Edward Lee -- whatever the circumstances of the meeting -- failed to be impressed by the man. From his earliest days as a cadet at West Point, through 25 years as an officer in the U.S. Army’s Corps of Engineers and six more as a senior cavalry officer, and then as the supreme ... Read More
U.S.

Zoomers and the Constitution

A 2019 study by the Pew Research Center compared generational views on key social and political issues, focusing on the similarities between Millennials and Generation Z. The topics probed include race relations, diversity, climate change, capitalism, socialism, and the role of government. This last item, ... Read More
U.S.

Zoomers and the Constitution

A 2019 study by the Pew Research Center compared generational views on key social and political issues, focusing on the similarities between Millennials and Generation Z. The topics probed include race relations, diversity, climate change, capitalism, socialism, and the role of government. This last item, ... Read More
World

How Trump Changed U.S. Foreign Policy

On September 16 the editorial board of the New York Times did the impossible. It said something nice about President Trump. “The normalization of relations between Israel and two Arab states, the United Arab Emirates and Bahrain, is, on the face of it, a good and beneficial development,” the editors wrote. ... Read More
World

How Trump Changed U.S. Foreign Policy

On September 16 the editorial board of the New York Times did the impossible. It said something nice about President Trump. “The normalization of relations between Israel and two Arab states, the United Arab Emirates and Bahrain, is, on the face of it, a good and beneficial development,” the editors wrote. ... Read More
Film & TV

The Convictions of Jim Caviezel

‘I didn't get invited by Hollywood to come to this industry,” actor Jim Caviezel says. It was God — not the executives, the talent agents, nor the filmmakers — that gave him his acting talent. “God believed in me, that He wanted me to be an actor. I felt it in my heart very deeply.” A man of deep ... Read More
Film & TV

The Convictions of Jim Caviezel

‘I didn't get invited by Hollywood to come to this industry,” actor Jim Caviezel says. It was God — not the executives, the talent agents, nor the filmmakers — that gave him his acting talent. “God believed in me, that He wanted me to be an actor. I felt it in my heart very deeply.” A man of deep ... Read More