Medicaid study provides support for the program

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.

Good labor news for once: Connecticut mandates paid sick days

Connecticut Governor Dannel Malloy announced Tuesday that he had signed into law a bill which requires employers to provide paid sick days to their workers. The bill is the first of its kind in the country. Under the new rules, firms with 50 or more employees are required to provide their workers one hour of paid sick time for every 40 hours worked, up to 40 paid sick hours a year.

Along with Vermont’s single payer healthcare bill, this bill is one of the few bright spots in what has otherwise been a brutal year for poor and working people. Providing paid sick days to all workers has so many far reaching benefits that at least 21 nations already legally require it.

In addition to being fundamentally humane and moral, paid sick days decrease the spread of contagious illnesses. Workers who cannot afford to take time off when they are sick end up going into work despite being ill, potentially infecting those whom they interact with at their jobs. As the Economic Policy Institute points out, highly paid workers are typically already provided paid sick days, and so this bill will have more significant impacts for low-income employees. Ellen Bravo of Family Values @ Work makes the point that it is precisely these kinds of low-income workers — restaurant workers, service workers, and child-care providers — who interact with the public the most, making paid sick days a universal benefit for all of us who can now avoid catching whatever they might have.

As with all worker-friendly improvements — even those as seemingly uncontroversial as this one — business groups claim it will spell doom and gloom for the economy. According to Bridgeport News, the Connecticut Business and Industry Association lobbied against the bill, saying that it would “further hurt the economy and drive away business.” Joe Brennan, a lobbyist for the group, is quoted in the Associated Press story forecasting a coming dystopian world of mandated vacation time and work breaks.

Indeed, what a horror that would be. If Brennan is right, Connecticut’s support for paid sick days may have put it on the precipice of a slippery slope to the humane working conditions already standard across Western Europe.

In addition to Brennan’s unintentionally self-parodying comments, the familiar, less humorous set of business objections were also raised. As mentioned above, the threat of businesses fleeing from the state to escape the burden of providing minimally humane working conditions has been floated out. The bogeyman of higher prices to accommodate the paid sick days was highlighted in the MarketWatch article about the change. The article also featured Heritage Foundation talking points saying that ultimately workers would be forced to pay for the sick days in lost future raises — you know, those raises that fast food workers are always getting.

These lines of rhetoric of course are predictable. The race to the bottom logic so pervades our present political discourse that anyone paying close attention could probably tell you what the business opposition to any given set of worker-friendly initiatives is. But this is nothing new. The history of labor in the United States has been saturated with industry objections to positive worker treatment from the very beginning. As Philip Dray records in his book There is Power in a Union, identical objections about economic destruction were made against the now-celebrated movements to shorten the workday, improve workplace safety, and provide minimal wages.

Initiatives tagged as business-destroying and burdensome share a history with all the great workplace improvements of the last two centuries. Connecticut’s mandatory sick pay initiative is the newest member of that club, and hopefully many more like it — perhaps with identical bills in other states — will soon follow.

NEA plays the least worst candidate game in Obama endorsement

The largest teachers’ union in the United States, the National Education Association, voted over the weekend to endorse President Obama’s 2012 reelection bid. This last year has proven perilous for teachers across the country as primarily Republican-led attacks have sought to strip them of their collective bargaining rights, and blame them for the budget shortfalls caused by the recession.

In addition to attacks on compensation and union rights, Republicans have long been on the forefront of an effort to privatize public schooling through the implementation of voucher programs. Given the attacks — both new and old — on public education and teachers from the Republicans, the 72 percent vote in favor of endorsing Obama comes as no surprise.

However, the vote was really one made out of desperation. Although Obama has not been leading a charge to cut the pay and union representation of teachers, he has consistently echoed support for charter schools and standardized testing. The teachers then had to choose between a Republican party that wants to cut their compensation, destroy their union, and get rid of public education altogether, or President Obama who endorses the failed charter school movement and standardized testing as a means to evaluate teacher performance.

Faced with this awful choice, the teachers had no option but to “pick the least evil” as middle school teacher Bertha Foley described it in today’s New York Times.

The charter school movement that Obama endorses has been an unmitigated disaster. Often premised on the claim that teacher unions are causing public schools to fail, these sometimes private, sometimes public, alternative schools have popped up across the country to solve our education woes. They have received enormous public relations boosts from sympathetic documentaries like Waiting for Superman, and are closely linked to other failed educational reform efforts like Teach for America.

Whatever one thinks about the teacher-blaming, school-blaming slant of the charter school movement, the data which indicates a widespread failure of charter schools speaks for itself. The Stanford Credo Study (pdf) on charter schools — the largest study of its kind — analyzed 70 percent of the charter schools in the country. It found that only 17 percent of charter schools perform better than their public school counterpart, with 37 percent performing worse, and 46 percent performing about the same. More than twice as many charter schools perform worse than their traditional counterpart than the number of schools that perform better.

Reliance on standardized testing has similar problems, and relies on unfounded premises that are equally weak. Although standardized testing evaluates something, it is less than clear what that something it evaluates is. Good or bad performance on a small set of questions is not broadly indicative of how much a person has learned.

The heavy emphasis on testing leads to narrow curriculum aimed at beating the test, and the heavy reliance on the scores to evaluate teachers is senseless and encourages cheating. Let us not forget the recent debacle of Michelle Rhee whose miraculous standardized test improvements as superintendent in the troubled Washington DC schools were revealed to have been a fraud.

Despite the obvious problems with these approaches to improvement, Obama keeps on pushing them as a way to better achievement outcomes. Blaming schools and teachers is a convenient way to pretend that the problem is being addressed. It also allows us to distract ourselves from the reality that poor performance in school is clearly driven — at least in part — by childhood poverty. Children who are forced to endure the conditions of poverty at home do not perform as well in school as those who are better off.

The NEA then is put in a precarious position where both major political parties have adopted inadequate policies that put them in the crosshairs. While I wont criticize the NEA for playing the least worst candidate game, there is something sad about the fact that they even have to.