It almost goes without saying these days that America’s approach to providing health care is totally dysfunctional. The United States spends more money than any other country in the world while simultaneously insuring fewer people than every other industrialized nation. Meanwhile, it delivers poor outcomes, and the World Health Organization famously ranked it 37th in the world, this despite America’s enormous expenditures in the area.
Almost any analysis of the ways more successful countries go about meeting their health care needs points in the direction of implementing a single-payer system. Despite this, the United States is so far away from implementing such a reform that it is almost not worth talking about. In its place, advocates of universal healthcare are forced to defend piecemeal, sub-optimal, underfunded entitlements like Medicare and Medicaid as the only programs we have that even try to provide health insurance to vulnerable populations.
For those people, good news was delivered today in the form of a groundbreaking study on the impact of Medicaid from the National Bureau of Economic Research.
According to its authors, the study is uniquely positioned to analyze the effects of Medicaid because of a strange set of circumstances that recently played out in Oregon. The state government there decided that it was able to expand Medicaid coverage to non-disabled adults below the poverty line, but only up to 10,000 additional enrollees. A lottery was used to determine which 10,000 impoverished adults were lucky enough to warrant basic health coverage. As embarrassing as it is that we are having healthcare lotteries, the process generated the circumstances for a rigorously controlled experiment on the efficacy of the Medicaid program.
The study revealed very significant differences between those who won a spot on the Medicaid rolls and those who remained uninsured. Among the long list of findings in the study, the Center for Budget and Policy Priorities highlighted that those who received Medicaid were:
- More likely to receive doctor-recommended preventive care (for example, women were 60 percent more likely to have a mammogram);
- 70 percent more likely to have a regular office or clinic where they could receive primary care;
- 40 percent less likely to have to borrow money or leave other bills unpaid in order to cover medical expenses; and
- 40 percent less likely to experience a decline in their health over the last six months.
The coverage in the New York Times, National Public Radio, The Atlantic, and Slate offers more statistical tidbits from the study not quoted above. The findings in a nutshell are that those on Medicaid utilize more medical services, are in a better financial position, and report feeling healthier than those who were left uninsured. The other significant finding was a lack of evidence for the speculative claim that providing insurance actually saves money by catching diseases early in their development. However, because the study is only in its first year of data collection, it is not clear how suited it is to weigh in on a claim like that which is necessarily more focused on the long-term.
In many ways, the findings seem fairly obvious. Of course individuals with Medicaid insurance — as poorly funded and inadequate as it is — are better off than those with no insurance at all. Despite the seeming obviousness of it, opponents of Medicaid have often been bold enough to claim the opposite. For examples of such over-the-top claims, one needs to look no further than the Wall Street Journal’s Scott Gottlieb whose article titled “Medicaid Is Worse Than No Coverage at All” says about all you need to know about his credibility.
Even The Atlantic’s Megan McArdle had to do some backtracking today on her previous comments about the “Myth Diagnosis” that a lack of health insurance killed people. In a column today, she tries to save as much face as she can in light of this new study, by drawing a line between utilization of health care services and not dying. Just because those on Medicaid utilize more health services, McArdle argues, that does not necessarily mean that lives were saved.
Of course, even just a single statistic from the study is enough to reveal the vacuous nature of this incredulous effort to defend the indefensible. Trying to deny that a 60 percent increase in mammograms wont save lives that would otherwise be lost to breast cancer is about as absurd an argument I have ever seen.
So for those who take an interest in defending the non-ideal efforts of Medicaid to provide some care to the disabled and poor, today has been a positive day. When the purveyors of specious arguments that have tried to undermine the call for universal health insurance are as frantically grasping at straws as McArdle was today, it can only mean good things.