I found Robin Hanson’s take on the Oregon Health Insurance Experiment stimulating, and I’d be eager to read a response from one of the scholars and commentators who have concluded that Oregon’s effort demonstrated the value of coverage expansion. Hanson’s language is decidedly unsentimental, which could be an example of Hansonian counter-signaling on his part.
Broadly, Hanson considers the Oregon experiment in the context of the famous RAND experiment:
The RAND experiment was mainly on random people, though it over-sampled from people with the lowest 20% of income. The Oregon experiment, in contrast, is on very sick and poor folks. For example, “healthy days per month” above refers to to how people answered a survey question on the number of days in the last 30 that poor physical or mental health impaired their usual activity. On average people in this study were impaired for ten days per month! 28% of them have asthma, 30% high blood pressure, and 56% depression.
They are also very poor, with an average yearly income of $11,790. 67% have a high school education or less, and 55% are unemployed. While only 13-17%of Americans spend less than the federal poverty income level, 70% of these folks spend below that level, and 40% of them spend less than half that level. Just how poor, sick, and just plain dysfunctional these folks are is shown by the fact that only 30% of lottery winners actually managed to get insurance. For example, “only about 60 percent of those selected sent back applications.”
But if medicine is good for the poor and sick, can’t we presume it is good for everyone? No, because the most significant overall health result found in the RAND experiment was that medicine hurt the poor and healthy! [Emphasis added]
Hanson’s post is a good example of what he means by “overcoming bias.”