No, Obamacare Won’t Reduce Emergency Room Usage

Stockvault.netStockvault.netSupporters of Obamacare have long pitched the law as a way to address emergency room crowding caused by lack of health coverage. Individuals without health coverage, the thinking goes, have no place to turn when they need medical attention, and as a result they head to the emergency room. That creates crowding, which can strain medical resources. It’s also more expensive than an ordinary trip to the doctor. The theory was that by giving people insurance, Obamacare could mitigate this problem, allowing more people to skip emergency care facilities by relying on less crowded, less expensive doctors offices instead.

President Obama pitched a version of this idea in a speech last September, arguing that emergency room visits by the uninsured represented a hidden tax on everyone else. “When uninsured people who can afford to get health insurance don’t, and then they get sick or they get hit by a car, and they show up at the emergency room, who do you think pays for that?” he asked.

But the best evidence has never really supported the hope that the law would reduce emergency room usage. That’s because much of the law’s expanded coverage comes via Medicaid, the jointly run federal-state program for the low income and disabled. And Medicaid beneficiaries tend to visit the emergency room more often than the uninsured.

A new study of Medicaid beneficiaries in Oregon makes a strong version of this case. The study, published today in the journal Science, finds that adult Medicaid beneficiaries rely on emergency rooms about 40 percent more than similar uninsured adults.

"When you cover the uninsured, emergency room use goes up by a large magnitude," said Amy Finkelstein, a health economist at the Massachusetts Institute of Technology who served as a lead investigator on the study, in an MIT press statement accompanying the study.

There were no exceptions to the trend. "In no case were we able to find any subpopulations, or type of conditions, for which Medicaid caused a significant decrease in emergency department use," said Finkelstein.

We’ve seen real-world evidence that Medicaid increases emergency room utilization before, in states like California. But the Oregon study should settle any lingering debate. That’s because it was based on a randomized controlled trial (RCT), in which a cohort of uninsured were selected by lottery to receive Medicaid, and then compared against a control group of individuals who did not get coverage through the lottery. Randomized selection allows researchers to weed out potential selection effects that can be found in other types of studies; RCTs are considered the gold standard in social science research design. This was the first randomized study of Medicaid’s effect on emergency room usage.

The new study follows up on earlier published findings from the same group of Medicaid lottery winners in Oregon. Overall, the results suggest that Medicaid’s real benefits are fairly slim.

Beneficiaries report that they feel better after they are covered, and they are much less likely to be subject to large, health-related financial shocks. But the study also found that, even though utilization of health services—and thus health spending—increased for individuals with Medicaid coverage, there was no corresponding improvement in objective physical health measures.

Which means that Medicaid is mostly a way of insulating beneficiaries from financial shock, at the cost of more crowded emergency rooms and greater utilization of health care resources.

It’s not so much a health program as a financial buffer—and a costly one at that.

These findings ought to spark a rethinking of Medicaid’s value and effectiveness. It’s not enough to provide some positive benefit. It’s also important to ask whether there are other, better, less expensive and resource-intensive ways of achieving the same goal. If Medicaid is to be a financial smoothing program rather than a health-improvement program, then we ought to treat it like one, and make reforms accordingly.

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  • Live Free or Diet||

    No, Obamacare Won’t Reduce Emergency Room Usage

    I dunno. If the extra paperwork slows them down long enough...

  • some guy||

    The problem is that you usually fill out the paperwork after you receive treatment in the ER.

  • Contrarian P||

    That's a legal requirement. Under EMTALA, the ER is required to do a medical screening exam before they can even ask about your ability to pay.

  • waffles||

    When uninsured people who can afford to get health insurance don’t, and then they get sick or they get hit by a car, and they show up at the emergency room, who do you think pays for that?” he asked.

    So can I buy insurance just for this? Some of us move around a lot for work and don't build relationships with physicians. Emergency care is probably the only thing I need.

  • ||

    The way you buy insurance for that now is to just pay the penaltax.

  • SusanM||

    You mean insurance for catastrophes? Wonder if they used to have a name for that?

  • Jordan||

    Consulting my derptionary, it looks like it was called "substandard coverage." Thankfully, the Lightbringer has made that a thing of the past.

  • Auric Demonocles||

    Nobody liked those plans anyway.

  • Libertarius||

    What plans? Winston erased them from the record of existence.

    "In the beginning, there was Obamacare..."

  • ||

    How the hell did this study every get funded?

    This is the equivalent of a government funded study that looked for causes of global warming that were not greenhouse gases.

  • Contrarian P||

    I disagree. The claim has often been made that increasing insurance coverage will lead to decreases in emergency room visits as well as, overall, improving earth outcomes. Anecdotal evidence is a poor tool to guide policy making. Having actual evidence to counter the emotion laden appeals of universal health care is crucial to effective argumentation.

    The main reasons people go to emergency rooms for non-emergency problems are that unlike doctors offices, we are open 24 hours a day, you don't need an appointment, and all of the testing (labs, imaging, etc) are on site and you get results within minutes, not days. With a limited supply of doctors, particularly in primary care, the wait to get an appointment can be weeks or even months, especially once you dump millions of the newly covered into the mix. Simply providing people with insurance does not address any of these issues and so will do nothing to decrease ER visits. In fact, it's likely they will increase.

  • Contrarian P||

    Unless of course you mean how did a government grant get approved for a study that might show a contrary result to what policy makers want, in which case I think it's because they are so set in their beliefs that they never considered an adverse result.

  • Enough About Palin||

    millions of the newly covered

    citation needed

  • Contrarian P||

    Excellent point, but that's under the best case scenario, as I should have made clear.

  • Rhino||

    not exactly citation, but last i read, Obama says 2 million people have enrolled in the exchanges. Left out the part about 4.7 million people who's businesses are cancelling their insurance plans for employees.

  • blcartwright||

    yes.

    I've always had insurance, but the last time I was at a doctor's office was about 10 years ago for poison ivy. Every other thing that's gone wrong I've gone to the ER or Urgent Care, for exactly the reasons you detail.

  • brec||

    Re those Urgent Care facilities ... Are they required to treat everyone as E.R.s are?

    I have the impression, based on no actual research, that Urgent Care facilities are proliferating.

  • Adam330||

    It was an accident. Oregon had extra money in its budget for medicaid, so ran a lottery to decide who would get it. Some enterprising researchers realized that Oregon had just created a natural randomized experiment.

  • R C Dean||

    Who needs a study? ERs were slammed in Massachusetts after RomneyCare went into effect.

    You don't need elaborate analysis. You just need to look at what actually happened the first time we tried this.

  • Contrarian P||

    I agree the conclusions are logically obvious, but it's much easier to win arguments using data than by resorting to anecdote.

  • R C Dean||

    I don't consider the implementation of a very similar program in an entire state to be mere "anecdote", but even so, I'll take that kind of "anecdote" over a big steaming pile of data and analysis.

  • JWatts||

    "How the hell did this study every get funded?"

    Because Liberals were confident this study would prove the benefits of Medicaid. And because the study authors were scientists and not propagandists.

  • Rhino||

    much the same way they funded a study that proved government provided pre-k education (Head Start Program) had no beneficial effects after the kid passes first grade.

  • ImanAzol||

    Interestingly, there were repeated incidents of global warming before human greenhouse gas emissions. There were even warmer temperatures than the present, for 290 million of the last 300 million years. Shocking, I know.

  • Bo Cara Esq.||

    Of course it will not reduce emergency room visits. Combine this claim with the earlier post today about widespread political ignorance. On an NPR story about Obamacare 'navigators' it was said that one obstacle they faced to getting people signed up is that they assumed that with the passing of the law their health care was now entirely 'free' and they could show up whenever and for whatever they wanted and it would be 'taken care of.' That is not going to encourage people not to drop by the emergency room whenever they feel like it.

  • John||

    Emergency rooms are required by law to treat it. If you are poor, they are unlikely to ever collect the bill for doing so. So why would a poor person wait days or weeks to see a doctor then they can go down to an emergency room and see one in hours?

    Moreover, if you are being forced to pay for health insurance, you are more likely not less likely to seek treatment since you will rationally think "well I am paying for it so I might as well use it.". The idea that making people buy insurance will reduce overall healthcare costs has always been an insane one.

  • Bo Cara Esq.||

    Agreed.

  • NoVAHockey||

    and to be fair, it's likely the only time they have to go.
    I can work from the doctors office waiting room and it costs me nothing. why punch out when the alternative is to go after my shift to the place that's always open.

  • John||

    Because your doctor isn't there and you will have to wait for God knows how long. I have insurance and work. But I would only go to an emergency room if I were bleeding to death.

  • Lord Humungus||

    I was working on a car once, trying to remove the wiring added to the aftermarket rear view mirror. Instead of using my wire cutters, I grabbed my handy pocket knife. One slice the wrong way and I ended up removing a huge chunk of skin from one of my fingers.

    I could have gone to ER to get stitches - instead I wrapped it up nicely and went drinking that night. The idea of waiting around the ER for 2-3 hours for a 5 min job wasn't high on my priority list. (plus I was going to be hanging out with a lovely blonde).

    I still have a big ol' scar on that finger.

  • R C Dean||

    You don't go to the frikkin' ER for a cut finger.

    In all seriousness, that's what urgent care is for.

  • Lord Humungus||

    to my 20-something herr-de-durr, I thought ER was the place to go.

  • ||

    I was offloading a lawnmower from a liftgate in my last job, it started to fall backwards, and I reached up to grab it. The back of the seat sliced my pinkie finger to the bone, and I was perfectly ok with super gluing it up, but my work insisted that I go to the ER for stitches. They wouldn't even let me go to the VA hospital, which was closer and is where my doctor is, because the work policy mandated that I go to a certain hospital on the north side of town.

    A week later, I got my worker's comp urinalysis results back, which popped hot for cannabis, which I have been using for my service-related health issues since I've been out. So, I lost my job, and got stuck with medical bills I can't afford for an ER trip I didn't even want to make.

    I don't guess it's really entirely related to this thread (though I'm apparently one of those ER freeloaders, even though I do have coverage through the VA), but it's a handy story for the next time someone tells you that the whole medical marijuana issue is nothing more than a trojan horse for people who just want to get high.

  • Johnimo||

    Yeah, you've got a big scar, but how'd you do with the blonde. Tell us "the rest of the story."

  • some guy||

    And if we force all car owners to purchase collision/comprehensive insurance the wait times and prices at mechanics/bodyshops will drop. Honest!

  • Rhino||

    especially if insurance had to provide free oil changes and safety/emission inspections.

  • Ted S.||

    It is free. For them, at least; Obama is going to make those evil rich people pay for it.

  • Ryan60657||

    Article from the Economist from 2 weeks ago on the benefits of Randomized Control Trials (RCT):
    http://www.economist.com/news/.....om-harvest

  • Jerry on the boat||

    And subsidizing these same people to buy so-called "insurance" is not a hidden tax?!

  • CatoTheElder||

    So you had to go through the reasoning that because

    P(Medicare) .GT. P(uninsured .GT. P(private insurance)

    more Medicare AND more uninsured people under ObamaCare means more ER visits.

    There's a much simpler heuristic. Obama said there would less ER usage. Of course, there is going to be higher ER usage.

  • Gilbert Martin||

    "There's a much simpler heuristic. Obama said there would less ER usage. Of course, there is going to be higher ER usage"

    Hmmm.

    That got me to wondering.

    Has there ever been ANY declarative statement that Obama has made that wasn't a lie?

  • R C Dean||

    Its Obama's Razor:

    When deciding between two statements, the one that Obama has not made is the one that is true.

  • Tommy_Grand||

    good/funny

  • GILMORE||

    Emergency Rooms? Are you kidding? How about Ambulances too?

    e.g.

    (someone actually uses the term 'incentives'!)

    http://archive.wgrz.com/news/a.....nsive-Ride

    In NYC, a friend who worked as an EMT reported to me that over half their total ambulance calls were for Medicaid recipients (who don't pay), and much more than half the time those calls were for non-emergency issues, and were simply getting a free ride to the emergency room.

    He described multiple instances of kids with stomach aches, women with toothaches, etc. getting ambulance rides rather than simply taking the subway, often because arriving in the ambulance meant you were given immediate attention as opposed to put in a triage queue in a waiting room.

    This is just NYC. Examples abound from every single state.

    http://www.nhregister.com/gene.....ance-calls

    There have been numerous examples of people costing Medicaid $100K+ per annum simply in ambulance rides. No treatment- just overuse of ambulance services.

    Don't get me started on how @(#$*@# punchable Andrew Cuomo is in his slimy evasive answer. He's basically saying, "no ones going to start asking us to spend less, so give me a break with your 'Fight Back' style story"

  • John||

    If you provide a service for free, the poor and unsavory will abuse it. Who could possibly have seen that coming?

  • Jordan||

    Similarly, my wife had a guy check into the hospital complaining of chest pains. When he discovered that the hospital didn't have HBO pay-per-view, he magically recovered. Guess who got to foot the bill for all of his tests.

    She also has people go ballistic if she recommends they take some Advil and refuses to write a prescription for it. Imagine having to pay $2 out of pocket for your own healthcare! Outrageous!

  • John||

    The 1986 law that required hospitals to provide care regardless of ability to pay effectively turned every hospital into a charity hospital. And we wonder why healthcare costs went up? In the past a guy like that would have been told to go to a charity hospital and any cost of treating him would have been absorbed by the charity hospital. Now those costs are absorbed by whatever hospital he shows up to and passed on to everyone who doesn't depend on charity for their health care.

  • Bo Cara Esq.||

    That was a 1986 law? That means Reagan must have signed it. That surprises me somewhat. Did he have any comment on it? Was it a 'rider' to something else he wanted?

  • John||

    Yes it was. And Reagan signed it and it was "bipartisan". The bill was the result of an old fashioned yellow dog media scare campaign about poor people being turned away from hospitals and dying.

  • Auric Demonocles||

    Someone on here (R C Dean?) said that it wasn't even people being turned away, just rerouted to a charity hospital which might be further away.

  • John||

    Yeah it was stories of people having to endure an ambulance ride. It was a terrible bill and responsible for all kinds of harmful second order effects.

  • GILMORE||

    When you look at why the US healthcare system has so much ungodly waste and complexity built into it, it generally turns out to be the case that the source of the 'problem' was some other assholes 'solution' to some perceived social/economic 'injustice'.

    basically, this is how I became libertarian: the closer I looked at every Good-Government program or regulation of some portion of the economy, I was met EVERY SINGLE TIME with some appalling examples of waste/extortion/abuse and unintended negative consequences far outstripping the 'problems' they'd been implemented to solve.

    At the beginning I believed this was simply because of systemic complexity and 'poor execution'.

    As time passed, I realized it was because it was what they were designed to bring about = because all that waste creates *constituents*, and all that complexity gives MOAR POWER to the people doing the 'regulating.

  • Johnimo||

    GILMORE, you've stated the problem precisely. The answer is to totally deregulate healthcare: (1) no certificates of need for healthcare facilities, (2) allow healthcare IRAs, (3) no prescription requirements for drugs, (4) end the ban on drug re-importation, (5) allow health insurance across State lines, (6) recognize healthcare degrees from other countries, (7) repeal the law requiring ERs to serve without payment, (8) allow RNs to provide unsupervised healthcare .... and I could go on with the list of at least 20 need reforms.

    Therein lies the problem. Once freedom is suppressed, everyone forgets what it was like in the old, "pay-as-you-go" days.

  • R C Dean||

    Sounds like me, Auric.

    And, yeah, that's what was being done. Nobody was draggin po folks out of the ER and dumping them in the nearest snowdrift. They were being transferred.

    Aside from the risk management/liability issues (arranging for a transfer = low risk), that's about the only way to make them go away.

  • Auric Demonocles||

    Can you imagine the horror of having to endure an ambulance ride to get to a hospital?

  • Ayn Random Variation||

    I think the death of Len Bias may have played a part in the hysteria surrounding the bill. That was the year he died, and his death was blamed by some on not being routed to the closest possible hospital.

  • Adam330||

    It was part of an omnibus appropriations act.

  • NoVAHockey||

    I ran a call like that once. pulled into the hospital, guy got up and walked to his appointment. this is after he said the magic words "chest pain" to the 911 dispatcher and sent an ambulance and engine crew to his house. this was in maryland. I haven't' seen this in VA, which as some sort of nominal fee.

  • ||

    A ton of students I knew in Montreal would do this as well--call an ambulance to go to the ER when you had a sore throat or something. We were all required by the university to have insurance, but do you know what it would have actually taken to get a doctor to see you? If you're willing to wait months, you go to the doctor. If you're willing to wait a day, you walk to the ER. If you're only willing to wait hours, you call an ambulance. It was fucking insane.

  • John||

    When you look at how Obamacare is going to overload the system and make it so much harder to see a doctor, you can expect this to happen in the US.

  • Contrarian P||

    It happens here already, John. I had a young man who came in by ems several times only to sign out on arrival and head upstairs to visit his mother who was hospitalized. He'd then ask the floor staff, who had no idea how he got there, for a bus token to get home. No consequences ever happened.

  • Ted S.||

    A ton of students I knew in Montreal would do this as well

    Why would they do this in Canada, when they're so proud of how their health care system isn't like ours in the US??

    [/sarcasm]

  • Auric Demonocles||

    If you like your emergency room line, you can keep your emergency room line.

  • PRX||

    doctor's offices are open about 40 hours or less per week and ERs are open 168 and a lot of that 168 coincides with people's available time and you don't need an appointment. what's changed other than making people think it's free?

  • John||

    If you have insurance you are generally avoid the emergency room because the co-pays for that are often larger and you like seeing your regular doctor. But if you don't have insurance or are too poor to ever worry about the hospital collecting and generally don't bother to have a doctor anyway, why not?

  • NoVAHockey||

    "what's changed other than making people think it's free?"

    that's basically the ball game. it doesn't matter that most people won't abuse the system. it's strained enough as is that the marginal cases will overwhelm it.

  • creech||

    My ex's husband was an ER physician. He saw cases of sunburn, poison ivy, splinters, etc. etc. all of which could have waited for the local clinic to open. So, in order to avoid treating such cases in an expensive emergency room setting, why don't hospitals set up a 24 hour clinic attached to the ER where such mundane cases can be shuttled and handled less expensively?

  • NoVAHockey||

    they've been doing that.

  • John||

    Wall Mart and CVS are doing that. But they are allowed to turn you away if you can't pay. So they will never take away the burden created by the poor.

  • ||

    Those exist, though not as part of hospitals usually. We have a place called Patient First in a shopping center. 24/7, no appointments.

  • catmatmc||

    They just opened one down the street from me. 8Am-10PM every day of the week including holidays. I haven't been in that one but have used the MD Express down the street for everything from sports physicals to swimmers ear, sinus infections and even mono and a broken wrist. Been in twice on Sunday mornings. In and out in under 30 minutes. Longest I ever spent in there was an hour from start to finish. I have to drop the specialist co-pay rather than the regular office co-pay, but it is so totally worth it.

  • R C Dean||

    why don't hospitals set up a 24 hour clinic attached to the ER where such mundane cases can be shuttled and handled less expensively?

    Some have been. However, you still have to do the patient workup in the ED unless they just flat out tell you its not an emergency.

    And Gott help you if you send somebody to your urgent care clinic if they actually needed something from the ER.

  • Enough About Palin||

    If you like your emergency room visits you can keep them.

  • MiloMinderbinder||

    “When uninsured people who can afford to get health insurance don’t, and then they get sick or they get hit by a car, and they show up at the emergency room...."

    Isn't most everyone insured or not going to show up at an ER after being hit by a car? That's pretty much the definition of emergency.

  • Auric Demonocles||

    Well, if they get hit by a bus they might go to the maternity ward instead.

  • Contrarian P||

    That was hilarious. I notice we haven't seen him around recently, probably because every time he piped up he was smacked around like Glass Joe. I followed a link earlier in the week to Slate if I remember correctly, and there was Tony, spouting the same blitheringly idiotic crap. The best part was when a commenter asked him if he had come to more friendly environs because he was tired of being rhetorically bitch slapped over at Reason.

  • LarryA||

    A high percentage of people hit by cars are insured by the driver's liability policy.

  • GroundTruth||

    So then, what was the point of the whole Obumadontcare fiasco?

  • ||

    Rhetorical question?

  • Spoonman.||

    My daughter went to the NICU almost immediately after birth for something that thankfully turns out not to be a big deal.

    Today I noticed that along with the $46,000 charge for her stay in Level IV, there was a $5,000 charge for Level III nursery, even though she didn't leave the area she was in for a week and then came immediately home. So, I called the hospital to dispute that charge. Insurance hasn't decided how much they are going to pay yet. But $5000 is a big fuckup!

  • ||

    I don't think it's a fuckup. I think it's intentional overbilling. Similar thing happened to my dad, with my mom. Only thing, my dad paid the bill before insurance did, then the insurance paid it, so my dad was owed $X from the hospital. He had to harass and cajole the shit out of them to get his money, and when they did finally send a check, it was useless (it was made out to "Louise". Just "Louise", no last name, no nothing. And did I mention that neither my mom or my dad's name is Louise? My mom's middle name is, but she never used it in any situation ever).

    My dad says they do these things because neither the consumer nor the insurance company is likley to either notice or question it. It's a nice little scam.

    The internal investigations department of the hospital was just like the IA team at a typical police department - totally uninterested.

    He then filed a complaint with the Attorney General and threatened to go to the media.

    I should ask him what ever happened with that.

  • ImanAzol||

    If you call up and ask for an itemized bill, and call or show up to go through the bill, your share will drop rapidly, as it eats up valuable billing time. We disputed $15 for a pitcher of water (that the nurse filled in the sink. Tapwater, not sterile, not even bottled). They wanted $46 for surgical gloves, I asked them what brand, and said I'd buy them a box of 100. Ten minutes later, our $2000 copay was $500.

  • fiftyville||

    With the sky-high deductibles on Obamacare policies, you may as well use the emergency room and get your money's worth.

  • R C Dean||

    Because paying $2K out-of-pocket in the ER for something that an urgent care clinic would take care of for $300 is "getting your money's worth"?

  • ImanAzol||

    Yes, because every visit after that is free. And if you're poor anyway and don't have the $2000, they can't collect.

  • The Late P Brooks||

    And Medicaid beneficiaries tend to visit the emergency room more often than the uninsured.

    You don't suppose it's because the receptionist at the doctor's office hangs up on them as soon as they say, "Medicaid" do you?

  • The Late P Brooks||

    There has to be a reason hospitals do not respond to this "overload" by instituting some form of sorting process at the door. Obviously, there is no meaningful incentive to keep those people out of the emergency room.

  • GroundTruth||

    There use to be until Reagan signed "Emergency Medical Treatment and Active Labor Act"... if you couldn't pay and didn't have insurance, you didn't get treated.

  • brec||

    Really? Before that law those who couldn't pay were was uninsured were denied care? There must have been at least a few exceptions to that. I wonder how many exceptions there were?

  • brec||

    *were uninsured

  • ImanAzol||

    They were sent to charity hospitals, unless they were bleeding to death on the spot.

  • JeremyR||

    They were turned away and sent to charity hospitals.

    Was that perhaps a better option than what we have now? Maybe, if you didn't happen to die on your way to another hospital because the closest one wouldn't take you.

  • Sevo||

    Folks, we had a non-centralized process for assuring everyone with some modicum of medical care for at least serious stuff; the folks who couldn't (or wouldn't) afford the care or the insurance simply waited until something was bad enough to make them put up with ER delays and lack of privacy. We (who had insurance or paid for care) paid for it as a surcharge on top of our medical insurance or care costs absent the huge frictional costs of the new gov't bureaucracy.
    It was, like the market, messy and it worked. And, by comparison to O'care, it was less intrusive, in all likelihood cheaper, and probably provided as good a care as poor people are gonna get; it was certainly superior to getting a place in the queue in Canada or England.
    So now we have the worst of both worlds and some sleaze-bags lying to us about how we should love it.
    I'd love to jam the forceps up some asses.

  • The half assed economist||

    I have not had a chance to read all the comments. But in order to lower the costs of emergency room care we need an alternative which could be in retail outlets and many states have these. To get more of these the barriers to entry must be reduced and that might be done by repealing the Certificate of Need regulations that exist in many states.

  • JPyrate||

    So if I pay the penaltax that means I can use the ER for free right ? =D

  • blcartwright||

    “When uninsured people who can afford to get health insurance don’t, and then they get sick or they get hit by a car..."

    If Obamacare would only have required people to be covered for sickness or accidents, it might not be so damned unaffordable.

  • Johnimo||

    I know this is pie in the sky dreaming, but how about a constitutional amendment that says, "The Congress and the States shall make no law respecting the providing of healthcare."

    I can assure you that healthcare would IMMEDIATELY become affordable, very affordable.

  • JeremyR||

    But that's not ever going to happen.

    Between licensing doctors, medical devices, drugs, lawsuits, patents, the government meddles way too much in it for there to be a free market when it comes to medicine.

    Pretty much every other country in the world somehow manages to provide universal health care and pay much, much less.

    It's not like it's something that hasn't been done before, and our system is the best in the world. It's almost literally the worst in the world. It's the most expensive at least (and with Obamacare, it's going to get even more so).

  • Rhino||

    Sounds like, even though Medicaid covered people use more healthcare resources, they aren't any more healthy than the uninsured.

  • thorax232||

    Give everyone access, force the costs on everyone else, demand goes down? I don't think so.

  • arbe59||

    "These findings ought to spark a rethinking of Medicaid’s value and effectiveness."

    But you know they won't.


    "If Medicaid is to be a financial smoothing program rather than a health-improvement program, then we ought to treat it like one, and make reforms accordingly."

    Medicaid was designed as a vote-getting dependency program, not a financial smoothing program, and it's been working beautifully for 49 years. Don't touch it lest it stop working.

  • ||

    Its too early after the introduction of Obamacare to conduct a study of this nature and have results that have any validity that can be reproducible. An example of my meaning would be saying your 1 month old cannot recite the alphabet therefore he or she will never be able to do so. It is going to take time for the system ranging the patients to the health care providers to adjust. Of course ER utilization will never completely stop because full Dr offices with prescheduled visits, however most facilities have urgent care centers in place to take care of the the minor complaints, as well as there are freestanding clinics focused on providing care to the patients for the patients who can not see their physicians in a timely fashion. The article did not indicate whether these patient's were lumped in with the emergency room visit group or not, which would also change the validity of the study.

  • Christophe||

    Did you read the article at all? The point is that it studied the effect of a randomized granting of *Medicaid* to recipients, demonstrating that giving people free ER access (even if you also make doctor visits free too) leads to more ER use.

    The Obamacare angle is that part of PPACA *is* medicare expansion. Which is almost certainly going to result in the effect mentioned.

  • ConservativeNotRepublican||

    Everything this administration touches turns to crap, as The Great One so aptly puts it:
    www.youtube.com/watch?v=Wqw8enpiEIE

  • Charles Hurst Author||

    Let me explain something. The Medicaid entitled patient abuses the ER. Most are on welfare and have nothing better to do than hang out for every sniffle that comes their way. I know this as I was a provider--for 13 years.

    Barry believes that one man who is successful should pay for another who isn't as much. Or that many shouldn't pay at all. And the ones that are paying--the producers, aren't hanging out in the ER every other day.

    And the bottom line is he believes in the entitlement mentality. I
    worked as a provider for 13 years. There are a few exceptions but the
    Medicaid patient is the largest abuser in the system.

    But a Marxist isn't really interested in fair. I've written extensively about the mindset--based on history. The Marxist is interested in propagation of professional victim hood. The more entitled it produces (ie expanded Medicaid) the more government not
    only controls but has excuse to rob the producer. Right down to a contraceptive payment. While denying a newborn. Classic Karl strategy that the almighty Progressive denies so adamantly. If we continue this course, my fiction will become a reality. And our nation will fall. Don't agree with me Mr.Progressive? That's ok.

    Because history does.

    Charles Hurst. Author of THE SECOND FALL. An offbeat story of Armageddon. And creator of THE RUNNINGWOLF EZINE

  • Tangman01||

    Sorry, but you're simply wrong, and your 13 years experience don't make you right. This is not about Marxism. You are Already sharing your hard earned pay with the great unwashed. They Already visit the emergency room. If you'd like that to continue, then keep the status quo. If you'd prefer to give people the means to make better decisions, then this is the best means available. It Is, however, insufficient without education, better jobs and time to develop. The current system took 100 years to get to this level of busted, and it won't be fixed in 90 days. And of course, people like YOU are no help....

  • Tangman01||

    The study is flawed, OR the question being asked is flawed. Medicaid is Precisely designed to address the financial shock of health expenses, so apparently that works, as this article admits. But Medicaid on its own does not a) set you up with a pcp, b) educate you about preventative medical care, or c) change your income, educational level, diet, or exercise regime. Here in My state, most primary care phyiscians will not take new Medicaid patients because the pay is too low. This is not an issue with Obama care, but with Medicaid, and congress could fix that if they wanted. Most Medicaid recips, therefore, have no pcp and they are not likely to Get one in the short term. This includes the poor, and the elderly. The elderly living in LTC facilities, for example, are routinely sent From the LTC to the emergency room for Any medical issue, a counterintuitive situation, but true nonetheless. Over Time -- the word quoted in this article but then conveniently ignored was "eventually" -- these sorts of habits can and probably Will change, if given the chance. Keep in mind that obamacare is already a semi-gutted plan, and it's short comings and delays are largely due to republican sniping and medical industry inertia. What this study reveals is not that Medicaid & obamacare are a waste of money. What it reveals is that after decades of unaffordable "pound of cure" healthcare, 40% of Americans don't know how to use the system properly if given the chance to do so.

  • Babyscatz||

    Seeing that the new Obamacare policies have much higher out-of-pockets and deductibles, folks will continue using emergency rooms.

  • REMant||

    Just shows that the uninsured are either stupider or more honest, because most of us know that such treatment is usually written off by the hospitals.

  • ||

    America If you lose your coverage, your doctor, your insurance, your job, BLAME a Democrat. If your rates go up astronomically and you can’t get what you were promised……Next time you go and vote...remember WHO did this to YOU! DEMOCRATS!

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