MisterMix posted about the Oregon Health Study last week, but I’m still croggled that so many Very Serious Pundits are… well, allowed to get away with a highly selective shading of the results. Here’s the NYTimes:
WASHINGTON — Come January, millions of low-income adults will gain health insurance coverage through Medicaid in one of the farthest-reaching provisions of the Obama health care law. How will that change their finances, spending habits, use of available medical services and — most important — their health?
New results from a landmark study, released on Wednesday in The New England Journal of Medicine, go a long way toward answering those questions. The study, called the Oregon Health Study, compares thousands of low-income people in Oregon who received access to Medicaid with an identical population that did not.
It found that those who gained Medicaid coverage spent more on health care, making more visits to doctors and trips to the hospital. But the study suggests that Medicaid coverage did not make those adults much healthier, at least within the two-year time frame of the research, judging by their blood pressure, blood sugar and other measures. It did, however, substantially reduce the incidence of depression, and it made them vastly more financially secure.
“There was this view that Medicaid coverage would not do much for the low-income uninsured, either because they had access to charity care or because Medicaid is not good insurance,” said Amy Finkelstein of the Massachusetts Institute of Technology. “This rejects that notion entirely.”…
As Jonathan Cohn explained, in the New Republic:
…The big news is that Medicaid virtually wiped out crippling medical expenses among the poor: The percentage of people who faced catastrophic out-of-pocket medical expenditures (that is, greater than 30 percent of annual income) declined from 5.5 percent to about 1 percent. In addition, the people on Medicaid were about half as likely to experience other forms of financial strain—like borrowing money or delaying payments on other bills because of medical expenses…
The other big finding was that people on Medicaid ended up with significantly better mental health: The rate of depression among Medicaid beneficiaries was 30 percent lower than the rate of depression among people who remained uninsured. That’s not just good health policy. That’s good fiscal policy, given the enormous costs that mental health problems impose on society—by reducing productivity, increasing the incidence of violence and self-destructive behavior, and so on….
But yet! adds the NYTimes:
The researchers found that Medicaid coverage did not significantly affect the prevalence or diagnosis of hypertension or high cholesterol, or the use of drugs used to treat those conditions. It significantly increased the probability that a person would receive a diagnosis of diabetes and be treated, though it did not reduce blood sugar levels noticeably…
So, the most common chronic, difficult-to-cure health issues remained chronic and treatment-resistant… at least over the limited two-year window. But participants were less susceptible to potentially crippling psychiatric disorder, and “vastly more financially secure”. This would seem to be a good thing, but the usual suspects (Cato, Douthat, McArdle, Tyler Cowen) are happy to explain that these results “prove” Obamacare is already a failure.
Jonathan Chait at NYMag has the best response I’ve seen:
… Okay: The case for Medicaid expansion is not as strong as I had thought. Now for the caveats: The case for Medicaid expansion is overwhelmingly strong. If a study found that puppies survive steep falls at a higher rate than expected, then you could say the case for throwing puppies out of skyscraper windows has marginally weakened, but would remain extremely strong. Indeed, data notwithstanding, either throwing puppies out of skyscrapers or throwing people off Medicaid are both acts of sadism.
The United States has very high levels of income inequality, a very stingy welfare state, and is the only advanced economy that does not guarantee access to medical care. The Oregon study does not raise particular questions about the efficacy of Medicaid; it raises questions about the efficacy of medical care in general. Measuring the impact of medicine is just really hard to do, yet almost nobody would volunteer to follow this frustrating fact to its logical conclusion and forgo the benefits of modern medicine.
And the Oregon study is not pushing the political debate toward a rethinking of the benefits of medicine writ large. It is only strengthening the hand of those who want to deny it to people who can’t afford health insurance. The Oregon study results from an unusual circumstance: The state had the budget to add 10,000 people to Medicaid, but far more who wanted to join, so it conducted a lottery. It is only the poor who can be subjected to Hunger Games–style experimentation with their health. In any other advanced country, in which medical care is a basic right, such an experiment would be wildly unethical.
It’s almost as if a certain subset of the Pundit population wants their fellow citizens to be broken in spirit and in wallet, isn’t it?
The prophet Nostradumbass
The ACA benefits the *wrong* kind of people, therefore there must be something wrong with it.
NotMax
Takers, takers, takers.
How dare they take health from those who earned it?
The prophet Nostradumbass
“No Cure for Cancer” – that a Denis Leary reference?
chrome agnomen
the ‘usual suspects’ would have been the same folks turning the thumbscrews, tightening the rack, lighting the auto-da-fe, during those good old inquisition days. people bereft of fellow-feeling. those who will never walk a mile in the another’s shoes. the pink slime of humanity. was ever a group more misnamed than the pundits?
Louis
Look I never comment here, and this is off topic as it gets, but this Guantanamo situation is atrocious. How is this able to happen?
I cannot overstate that from down here in new Zealand this makes America look terrible. It seems pretty clear that a bunch of entirely innocent people are going to die because America, and that is all of you, is holding them indefinitely for no reason other than the sick paranoia that infects your political reality.
This is pretty goddamn shameful. Much as I love you America, this will be a permanent blot. You will never regain your legitimacy in the eyes of the world if this happens, and you’ve already got a way to go. Now I know all the reasons for what is going on, but fuck me this is horrendous.
Anne Laurie
@The prophet Nostradumbass: Denis Leary used it, but I’d heard the jibe going back to my blue-collar Bronx neighborhood in the 1960s/70s.
Hal
Reminds me of that old BS internet meme from a couple of years back based on a letter written by an ER Doc in Mississippi (surprise).
http://www.dailykos.com/story/2012/12/08/1168277/-A-Crisis-of-Responsibility
Gosh, I wonder what race the patient was? I just can’t tell from his description, and the dog whistling is so loud, I can’t think straight. This “Doctors” opinion is the epitome of the Fox news crowd on Medicaid and the poor, even though I’m sure more than a few of them are in the same boat.
The prophet Nostradumbass
@Anne Laurie: Next, you’ll be telling us about how in your day you didn’t have the benefit of AT&T U-Verse.
chrome agnomen
@Louis:
a lot of stuff looks terrible in america from new zealand. i’m sitting in waikato district now, lamenting my too soon return to the states, homeless and unemployed. i keep telling these folks that they live in an advanced civilization.
NotMax
@Louis
In no way would I (nor have I ever) for even a single moment condone or support the creation, rationale, operation and continuance of the prison at Guantánamo and its associated cankered tentacles of sadism, bigotry, brutality and injustice.
However, am also compelled to ask if you are Pakeha?
PurpleGirl
The pundits may not realize it but getting diabetes, high cholesterol, and high blood pressure under control is a difficult thing. It involves more than just taking pills — indeed, your whole lifestyle and diet needs to change. And poor people will most often be unable to afford the better quality food they need to eat in conjunction with the pills. At least with Medicaid, they will learn they have the conditions (which are symptomless) and be able to get the medicine to at least keep them from the worst of the possible consequences. To really control the conditions requires much more money and patient education.
TriassicSands
That isn’t an accurate statement. The study was far too limited to “go a long way” toward definitively answering questions about Medicaid’s real, that is long term, helpfulness.
If conservatives want to argue that this proves that Medicaid is worthless or worse, then the message to them is clear — all conservatives should terminate the health insurance and avoid seeing doctors. Clearly, that is the way to be both healthier and richer.
gene108
I think the backlash against Medicare expansion has a rational basis: If the poor are not made to suffer, what reason do they have to try and better themselves?
Providing them with food, shelter and now medical care, they will happily continue to engage in the negative behaviors that led to their poverty, because in America – the shining city on the hill – anyone who works hard will succeed and only the morally bankrupt will fail.
CarolDuhart2
@PurpleGirl: And more than two years. It takes a while just to find out what medications work, even with health insurance. It took about 3 medicines before finding one that controlled by blood pressure, 2 stents, and finally taking my cholesterol medicine to get things right-over 10 years or so. It takes education, and tests, and so much more-all of which takes more than 2 years to get right.
The real problems is gaps in care for the low-income single. I had some health coverage when I was in college, but between jobs, only the emergency department care.
I believe if I had a consistent medical care during my 20’s and 30’s a lot of the things I have now might have been vastly mitigated. Which is why the payoff will be when all those 26 year olds can transition to Medicaid and keep getting medical care until they can get a job that pays for health insurance. The reduced numbers will show up then.
jon
Study Proves Conclusively: Some People Hate the Poor
raven
@NotMax: Utu!
Patricia Kayden
I don’t get the argument. How could extending Medicaid coverage through Obamacare be of no benefit to the poor? I guess when you only care about the rich, you become delusional.
Hoodie
Maybe not medical care in general, but the way medical care is performed in the US. I have been battling neck issues for the last several months. Fortunately, I have good insurance, but I have been through hideously expensive rounds of relatively futile diagnostic procedures and scattershot therapy. I’ve been able to finally get on a somewhat rational course of treatment at a local university hospital spine clinic, but I have basically no constraints on my ability to go to appointments, contact physicians, etc. I can imagine the confusing mess a medicaid recipient faces. The “free market” results in complete lack of coordination in treatment, difficulties in sharing information and huge transaction costs. All of the practices are consumed with billing. This is understandable to some extent because of the massive infrastructure involved, but it also is indicative of a lot of rent-seeking behavior. There is simply no way to make this market transparent, so administering it will be the biggest challenge for Obamacare. Having Republicans actively obstructing any efforts to do so will not help at all.
WereBear
The irony of all the wingnut welfare pundits decrying any hand extended to the poor would probably kill them…
if they got irony.
Amir Khalid
These are strongly positive outcomes. If that’s all Obamacare achieves by expanding poor people’s access to Medicaid, it’s still a magnificent success.
Hal
With blood pressure in particular, compliance is a huge issues. I’ve read 1/3 of prescriptions are never filled and something like 50% of people do not take their meds as directed. Plus, as others have said, two years is not nearly long enough to make any real conclusions. Still, you can count on the right wing to focus on one or two points of this study and turn it into a massive condemnation of medical coverage for the poor in general. Kind of amazing that there is this massive push by privileged members of Congress to deny as many Americans’s as possible benefits they will have for the rest of their lives.
WereBear
They do this to dehumanize the poor; to make them Very Different so they deserve their status. Never mind that most of them work, at wages that cannot stretch to feed them properly or have reliable transport, much less medical care.
No, they are different, and having access to medical care means nothing to them!
My first husband DIED because we didn’t have health insurance and we were not able to treat something that turned into a fatal condition.
Just knowing that’s not going to happen to my second husband certainly staves off that particular form of depression.
El Cid
Since letting people have Medicaid didn’t instantly heal them of cancer or diabetes or high blood pressure, clearly the whole thing is a big government scam, because free market health insurance is 100% guaranteed to instantly cure any chronic illness.
aimai
@WereBear: i feel the need to offer you a cyberhug.
I’d also like to point out that people who go on medicaid after a long time of not being covered are pretty much the same people who end up–if they live that long–getting onto medicare as seniors in those states where they have never had consistent health care until Medicare. We already know that those people (people without private health insurance or medicaid) end up sicker and more needy as seniors because we have the entire South to compare with the states up north where more people have health insurance during their younger years. It stands to reason that in a more perfect future, where people had health insurance extended to them from the beginning to the end without gaps in coverage, are going to be healthier and less stressed, less suicidal, and less financially at risk. But its going tot ake more than two years to see all the benefits. And as everyone else here has pointed out more simply when the benefits are to the poor and the costs are perceived to be to the rich the press will never cover this as an unalloyed good.
sal
If healthcare isn’t really that helpful, maybe those pundits and misjournalists who cite this study as evidence of same would have no problem giving up their own insurance, eh? Just makes sense.
WereBear
@aimai: cyberhug back, aimai, thank you.
I bring this up because we were Poor; in a system where we second-mortgaged our house to start a business, and struggled in its early stages with no extra money, NONE. We were small business owners and we were POOR… too bad Republicans love the small business owners who are at least millionaires.
The Republican message about entrepreneurship rings hollow when one risks their very lives to do this.
danielx
Suffering is good for you, because free markets.
Also, too – giving minimal health care to the poors is dangerous. Let them have health care and next they’ll be demanding safe workplaces, a living wage for a forty hour work week, voting rights and who knows what else…let the greedy bastards wear out grindstones with their noses and go broke trying to pay medical bills, it will keep them from noticing anything else, like how they’re getting fucked by the likes of Paul Ryan every goddamn day.
Louis
@NotMax:
White as bro!
But with beige children. That important to you?
E Huru Huru. Kamate Kaura .
JoyfulA
@WereBear: I have been self-employed, an entrepreneur of sorts, for decades, and I have known at least a dozen people in my field to take up a salaried job, at a lower income, because they needed health insurance they could not buy, usually because a child or spouse developed a “preexisting” condition.
Universal health insurance (or health care) would have enabled an entrepreneurial boom over the past 30 years. I wish you hadn’t suffered from this nation’s stupid, backward health care system.
A Humble Lurker
@Louis:
Not that I don’t agree with you, but how is what’s going on now any worse than the thing coming into being in the first place?
I’m just saying, to me the blot on our record’s been there since day one: it’s just a question of size and darkness now.
PurpleGirl
@CarolDuhart2: Yes, it takes time, very often more than two years, to find the right drugs and combination which works.
And I forget the cost of daily blood testing. The meters for blood glucose testing aren’t all that expensive (relatively speaking) but the test strips and lancets will set you back another hundred or more a month. I get my drugs at a NYC hospital pharmacy at discount but they don’t carry the test strips and lancets, so those I need to buy at an outside pharmacy at full price.
weaselone
@Louis:
I hear Obama is looking for a way to close Guantanamo. Unfortunately, Congress refuses to authorize funding and there seems to be a lack of volunteers for taking these individuals in.
I’m assuming the check from New Zealand along with the offer of New Zealand citizenship for all the detainees has been regrettably lost in the mail.
Amir Khalid
@weaselone:
When you can show that New Zealand bears as much responsibility as the United States for the creation and continued existence of Camp X-Ray, then I will consider this a reasonable reply to Louis.
gelfling545
So diagnosing and treating a potentially lethal condition is not a good thing? Particularly among people who have gone untreated for years? It’s medical treatment, not a trip to Lourdes.
YellowJournalism
@gelfling545: Yeah, I always thought that early diagnosis of these conditions and getting them under control are what keeps costs down later when the untreated would need more costly medical procedures and treatments, not to mention long-term care at an earlier age.
I think it boils down to this: How dare poor people get old!
Citizen_X
@gelfling545:
Well, there you go: they need more Jesus.
Upper West
I have chronic plantar fasciitis. Over many years, I have tried: arch supports, acupuncture (twice), cortisone injections, extra-corporeal shock-wave therapy (twice), physical therapy (at least three times), anti-inflammatory medication and most recently, surgery — a plantar fasciotomy. Nothing has helped.
My conclusion? My health insurance stinks.
NotMax
@Louis
Important? Not in that way, not in the least.
Not suggesting strict equivalence with Guantánamo by asking.
Was suggesting that wide and deep blots of systemic cultural injustice can, over time, be gradually diluted and scrubbed (but must never be forgotten).
ThresherK
@PurpleGirl: I’m just spitballing here: Has diabetes passed into the status of something that “only poor people have” (in thought, not in actuality)?
Realizing that petty shoplifting and vandalism is something kids from all economic strata may do is one thing, but when upper-middle-class kids do it it means one thing, and when working-class kids do it, it means something else.
Same thing with diabetes now?
If so, can one of our chattering classes ask one of their maids about it? Or maybe Bobo can talk to a cabdriver.
a hip hop artist from Idaho (fka Bella Q)
@PurpleGirl: Have you looked at Canada? You can get 200 for $20. Strips can be had for 300 for $145. Is that less than full price where you get them? I know that to be a reliable and reputable seller of other expensive things.
weaselone
@Amir Khalid:
Never said they bore as much responsibility as the US. Just find it curious that we have all of these innocent people locked up and suffering, but there isn’t exactly a line of other countries offering to help resolve the issue. Is there no general moral obligation to help these individuals regardless of one’s citizenship?
As a US citizen I bare some responsibility for the prisoners, but I no more voted for these individuals to be captured and detained indefinitely at Camp X-ray than someone in New Zealand. To the extent I have voted, it has been for individuals who I reasonably expected to work towards an end to the detention.
There’s an abundance of weeping and gnashing of teeth by both liberals in this country and similarly minded people abroad. Given actual actions, I have to conclude that like most people in the US, most foreigners are decidedly disinterested in the fate of the people at Gitmo. They are something to get righteously indignant about over coffee, cocktails and the internet and then to forget about.
gelfling545
@PurpleGirl: Perhaps some people interpreting this study need to be reminded that diabetes is a disease for which there is now no known cure. It can only be managed more or less successfully. Both my mother & my brother suffered from juvenile onset, both were scrupulous in their care, both had peculiarly unmanageable insulin response, both had excellent medical insurance and both eventually dies of complications but many years later than would otherwise have been the case without medical treatment. I don’t think the fact that my relatives eventually died of an incurable condition means that their medical insurance did them no good.
PurpleGirl
@a hip hop artist from Idaho (fka Bella Q): Thank you. I hadn’t thought of looking at a Canadian source, it is a good idea. I’ll look into it.
Amir Khalid
@weaselone:
I think Malaysia should definitely take back the one Malaysian (if I recall correctly) among the Camp X-Ray detainees. If he’s suspected of breaking Malaysian law in anything he did that got him there, he should definitely face trial here.
It would certainly be generous of New Zealand should they ever make an offer to resettle the detainees at Camp X-Ray. But
(a) NZ has no direct obligation to do such a thing, so it’s not hypocritical to remain silent.
(b) it’s presumptious to expect NZ to foot the bill for closing a US facility, simply because the US can’t muster the political will to allocate its own money.
StringOnAStick
Congress, in all their pants-pissing glory, decided that no gitmo detainees could be subjected to US civilian courts because apparently the US court system that they swore an oath to uphold is too worthless to give them the judicial result that they want for these people.
Amir, what do you think about the election results in your country; good, bad, mixed bag?
Mnemosyne
@ThresherK:
I think there is definitely a view that diabetes (especially Type II) is a disease of poverty that Those People get. It doesn’t help that genetic factors mean that it’s more common in minority groups (African-Americans, but also Latinos, Asian-Pacific Islanders, and Native Americans) than in most people of European descent, and in most white people’s eyes, minority = lower class.
Amir Khalid
@StringOnAStick:
Barisan won, which I’m not happy about. But with the smallest Parliamentary majority ever, fewer even than in 2008, and they lost the majority vote for the first time. This was the result I’d been expecting ahead of the election — Keadilan continuing to gain ground at the federal level, building on 2008 — and it’s a hopeful sign. Plus, the talk of election shenanigans by Barisan seems to be gaining credibility, and a stronger opposition might be able to force some needed electoral reforms.
There’s talk that Najib Abdul Razak might have to resign as PM over this poor showing. UMNO party VP Muhiyuddin Yasin would presumably take over as PM and party/Barisan coalition leader, unless they dump him too. But it’s Barisan, the world’s longest running ruling party, that Malaysians are getting tired of; not a particular leader. A change of leader, even if Barisan had someone charismatic and visionary to change to, might not make it any more popular.
Barry
@NotMax: One of my uncles was in the infantry in WWII and in the occupation for a year afterward. Everyone he talked to had some long-handled, elaborate rhetorical reason why they personally weren’t responsible for their government’s crimes. He didn’t care. That’s the position we’re in since Pres. Obama decided to “look forward, not backward” and defer prosecutions for torture.
No one cares why we think we’re personally not responsible for Guantanamo.
NotMax
@Barry
With all due respect, your uncle’s predilection for assigning collective blame dubs him a short-sighted twit.