Obamacare

More Bad News for Obamacare: Study Finds Medicaid Has No Effect on Measured Health Outcomes

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Whitehouse.gov

This is huge, and stunning, even for critics of Medicaid: A randomized-controlled study published in the New England Journal of Medicine by a group of the nation's top health policy scholars has found that Medicaid has no measurable effect on any of the objectively measured physical health outcomes the study examined.

In its second-year results, the Oregon Health Insurance Experiment, which randomly selected 10,000 people in Oregon to get Medicaid (only about 6,300 actually got the benefit), and then compared them with a randomly selected control group, found that those who got Medicaid did not on average have healthier blood pressure, cholesterol levels, or diabetic blood pressure control than those who did not get Medicaid. Those with Medicaid did see some reduction in out of pocket health expenses. They were also less likely to be diagnosed with depression. 

The Medicaid recipients also ended up utilizing a lot more health care—care that has to be paid for—than those who didn't get coverage. But they didn't use the emergency room any less than the control group. 

This study is perhaps the best and most important study of Medicaid's health effects ever conducted, and it has huge implications for public policy—in particular for Obamacare's Medicaid expansion, which is supposed to account for about half of the law's increase in health coverage. Obamacare supporters had used the results from the study's first year, which showed large gains in self-reported health, to argue that the law's expansion of Medicaid was justified. The second-year results significantly complicate that argument. 

But there was always good reason to be skeptical that the study would not reveal that Medicaid coverage improves health on the health markers measured. As I noted when the first results from the study were published, even though it is true that self-reported health status rose amongst the population assigned Medicaid, the bulk of the improvement in self-reporting occurred prior to the provision of any care. Just because the Medicaid recipients said they felt better, in other words, did not necessarily suggest that they were measurably healthier. And now, it turns out, they weren't, at least not by any measure the study examined. 

I'll have more to say about this in the next day or so. In the meantime, however, make sure to read Cato's Michael Cannon on what this means for governors still considering Obamacare's Medicaid expansion, and Slate's Ray Fisman, an Obamacare booster who had high hopes for the program after the initial results were published, but now cautions that "the findings should give pause to even those who are most committed to universal health insurance."

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  1. Obviously this study was commissioned by rethuglican teabaggers who hate poor people and free healthcare. /progtard

  2. “Those with Medicaid did see some reduction in out of pocket health expenses.”

    Uh, ya think?

  3. HA-haw!

  4. What kind of study measures health by self-reporting? When objective criteria are available, why ask some doofus how he fucking feels?

    Another big blow for obamacare huh? What I thought when I read that is probably not what Peter had in mind when he wrote it.

    1. That’s the best part of this study — self-reported health went up after they were chosen for th program, before eligibility kicked in, and before they saw a doctor.

    2. Maybe they got some Medicaid-paid LEGAL oxycodone and dexedrine. You’d feel better too!

      1. Does Medicaid get you a mobility scooter or is that just Medicare?

        1. Why shouldn’t everyone get a mobility scooter?

          1. Oh shit you’re right! It can be like Wall-E up in here.

  5. Those with Medicaid did see some reduction in out of pocket health expenses. They were also less likely to be diagnosed with depression.

    If it didn’t make people any healthier, but it made them happier, then that means it’s basically nothing but a cost redistributing placebo, right? So we’re just blowing up the budget and passing costs onto future generations for no purpose other than making poor people think they’re healthier than they are.

    1. Obviously, a modest reduction in depression is worth every trillion.

      1. If it makes even one person think he’s healthier, it’s worth it.

    2. “a cost redistributing placebo”

      You win the comment of the day.

      1. Concur. Near genius level phrasing.

  6. Proletariat Radio’s one sometimes tolerable program (marketplace) had a story on this study this evening. Great stuff hearing them go around trying to say it’s great, when really, no real impact.

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    1. Heroic Mulatto –

      What is the native language of this awful bot that plagues us with horribly mangled english?

      1. Let me try:

        Darmok and Jalad at Tanagra. Darmok and Jalad his arms wide.

        1. Shaka, and the walls fell.

          1. Sokath, his eyes uncovered

            1. That episode makes no sense. Clearly the aliens have the same concepts, the same words, and all the parts of speech. Why would they talk all retarded then?

              1. “You talk like a fag and your shit’s all retarded.”

      2. And the Reason servers routinely reject legitimate links as spam but seem incapable of stopping the bots.

        1. ^This^

      3. Hmmm…that’s a hard one. The bot definitely knows modal verbs and it doesn’t make mistakes in tense, so that rules out most East Asian languages….it uses articles correctly, so it’s probably not Russian.

        I’m going for Alpha Centaurian.

        1. Based on some of its exotic and luxury car choices I’m going with a time traveler from the past.

          1. no, it’s John Titor.

            1. I remember that shit when it happened.

              It was awesome.

    2. Let me try:

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  8. Oh for God’s sake Peter. I make one wise crack about ‘Another big blow’ and you change it to ‘More bad news’?

    I liked it better before.

  9. Is there a single entitlement program besides social security, which actually did lower poverty among old people, that has ever produced a measurable positive effect? If there is, I don’t know of one.

      1. That’s more of employment compensation than an entitlement program anyway.

    1. I don’t know, was RIF a net positive? I know entitling small children to free books might not seem like much, but it helped my reading level when I was in Kindergarden.

  10. resajcnsdlka

  11. “found that those who got Medicaid did not on average have healthier blood pressure, cholesterol levels, or diabetic blood pressure control than those who did not get Medicaid.”

    Uh, so? Wow, Medicare doesn’t make poor people live any healthier, quite the newsflash.

    What about the stuff that its advocates are probably thinking of to justify their support, like treating infectious disease, injury, pregnancy, cancer, and that sort of thing?

    1. Medicaid == poor, state partnership
      Medicare == old, federal

      1. D for deadbeats

        E for elderly

      2. I just wrote the wrong thing, but I did read it correctly. I don’t actually think old fucks have to worry about pregnancy much.

        1. Most of the problems affecting the health of lower income individuals are lifestyle related. Even though access to (read: heavily subsidized) health insurance has been sold as improving their health outcomes, the study shows this is not the case.

      3. OK so infectious disease. Something that might be an actual medical problem. Not lifestyle problems like blood pressure.

  12. The study considered only adults, so Medicaid *might* be helping children.

    More research grants, please.

  13. it has huge implications for public policy

    Clearly we aren’t spending enough money.

  14. Today’s NDP:

    The province is ramping up its powers during a state of emergency, by allowing police to arrest those who obstruct flood control structures or ignore evacuations.

    Steve Ashton, the minister responsible for Manitoba’s Emergency Measures Organization, said changes were initially sought after emergency responders were forced to rescue Manitobans from rooftops in Breezy Point and the Rural Municipality of St. Clements during the flood of 2009. Those residents had refused an order to evacuate.

    “That put our emergency responders at risk and those individuals at risk. So we’ve brought in legislation to ensure that doesn’t happen. In some cases, we’ll be able to take people into custody, again, primarily for their own protection,” said Ashton.

    Those who ignore evacuation orders could also be forced to pay the government costs of their apprehension.

    1. Help us Mercans out. Ndp — are they the equivalent of the US dems?

      1. but more Left

      2. oh yeah.
        They also raised the Provincial Sales Tax from 7% to 8%. They promised in the last election that raising the PST was out of the question. There is a law from 1995(!) that requires a referendum on raising the PST. So they also passed a law that negated the need for a referendum in this case.

  15. Suck it Knick fans. LOLOLOL

  16. Suck it Leafs fans.

  17. I’m curious. How does the medicaid results compare to results from private insurance, for example?

  18. The solution is obvious: expand Medicaid’s scope of coverage and eligibility so that we can see an effect.

  19. OT:
    CA AG finds microgram amounts of lead in everything, sues everybody:
    “Under Proposition 65, a product that contains even small amounts of lead or other chemicals identified by the state as harmful to human health must carry a label warning consumers.”

    Read more: http://www.sfgate.com/news/us/…..z2S67dlQKk

    1. Tell him the lead in pencils isn’t actually lead?

    2. As a onetime frequent visitor to California the Prop 65 signs everywhere were a source of constant amusement. As a person who is going to live in California soon I’m sure I’ll just start to not even notice them, negating any possible effect.

      1. “As a person who is going to live in California soon I’m sure I’ll just start to not even notice them, negating any possible effect.”

        You’re right about the P65 warning signs. They could say ‘enter here and die’ and people would. Some old Greek guy commented on crying wolf.
        But it doesn’t matter. Kamala Harris is the AG; she found politics screwing Willy Brown, and she learned well. She’s a pro at getting ink and air time, and worthless at accomplishing anything for the citizens of CA.

        1. Kamala Harris?

          Is that the HOT AG Obama has been telling us about?

        2. Crying wolf, indeed. No one pays any attention to those signs because if you did you wouldn’t be able to live your life. Everyone knows they are, by and large, bullshit anyway.

      2. My cousin in NY commented that all of his carpet cleaning supplies say “known to the state of CA to cause cancer” and wondered why CA knew but nobody else gave a shit.

          1. A little disappointed. I was expecting the

            You know I heard starlight gives you cancer, but then what doesn’t these days?

            quote from Family Guy.

            1. I don’t know enough Family Guy to post shit from it.

              1. Oh, it’s part of the “Road to Rhode Island” episode, which was one of my favorites from the original run of the show. I haven’t sat down to watch an episode of Family Guy in years.

                1. The new episodes of Family Guy were/are so bad that even the old ones are ruined for me.

    3. The primary sources for lead exposure to children in the U.S. are old paint, contaminated drinking water and soil tainted by old leaded gasoline, the CDC reported.

      So clearly the thing to do is sue over trace amounts of lead in candy.

      1. “So clearly the thing to do is sue over trace amounts of lead in candy.”

        If you’re looking for coverage on the evening news, that’s exactly what you’d do.
        This is Harris the hypocrite.

    4. And it doesn’t seem like they are trying to get the candy taken off the shelves, just get them a label no one will read.

      But this is all about safety not shaking down business for protection money.

      1. …”shaking down business for protection money.”

        Side benefit.

  20. “This study is perhaps the best and most important study of Medicaid’s health effects ever conducted, and it has huge implications for public policy”

    Therefore it will summarily ignored.

    1. I have a hard time getting as pissed about this as some other issues:
      1) It’s government ed; presumed to be shitty from the get-go.
      2) OK, some kids bleeve ‘god did it’. Well, a whole lot of kids think there was this junior god named Hesus, too.
      So, as pathetic as it is, I’m far more concerned that “FDR ended the depression and saved us from Nazis!” is taught.

      1. “Abraham Lincoln only did it for the slaves” is a good one for concern too.

        I can’t wait to see what the history books say about 9/11, the Iraq war and the Patriot Act 50 years from now.

    2. I try to get angry over that. But is it really any worse than the AGW cult that they teach? Belief in creationism doesn’t cause one to think that electricity comes from the light socket or that we don’t need to use fossil fuels to have an economy.

      1. Anecdotes:
        I have a WBIL (that’s woo brother-in-law; most everyone has one) who really bleeves people lived to 400 years during ‘biblical times’. He taught government schools (in CA) for X years.
        I have a woo wife-of-cousin who home-schools her two kids and teaches them that Hesus is king!
        Who caused more harm?

        1. It looks like neither caused any. The public school teacher probably didn’t teach that information in school. and the woman teaching her kids is just teaching the religion.

          1. I would say educating children that people lived to be 400 years old or creationism (if he did so) is harm but it is such a low level of harm that I have a hard time giving a shit. Keep that shit out of public schools but really the problem is public schools not creationism.

        2. have a WBIL (that’s woo brother-in-law; most everyone has one) who really bleeves people lived to 400 years during ‘biblical times’. He taught government schools (in CA) for X years.

          A non-sequitur. What he believes may be irrelevant to what he taught or was required to teach in the government school.

          I have a woo wife-of-cousin who home-schools her two kids and teaches them that Hesus is king!

          King of what?

          Who caused more harm?

          You should take a mulligan on that question.

          1. “A non-sequitur. What he believes may be irrelevant to what he taught or was required to teach in the government school.”

            It may be, but this is a guy who casually mentioned at a Thanksgiving dinner that people lived to 400 years at one time. Somehow, regardless of the syllabus, I have a hard time accepting the guy didn’t work this into the instruction.
            —————–
            “King of what?”

            EVERYTHING! Hesus is LORD!

            1. It may be, but this is a guy who casually mentioned at a Thanksgiving dinner that people lived to 400 years at one time. Somehow, regardless of the syllabus, I have a hard time accepting the guy didn’t work this into the instruction.

              The absence of evidence is the evidence of absence?

              EVERYTHING! Hesus is LORD!

              Indeed. That why Hesus saves but you roll for damage.

            2. Everything lived much longer, not just people. Dinos are just lizards that kept growing because of their much longer lifespans. It’s because there was an extra sphere of water “the firmament” which protected everyone from extra cosmic rays and the extra pressure was energizing. (I can’t find a good citation for this, it was just in a tape we listened to on the drive to school)

              Aww I miss the constant barrage of Biblical literalism I grew up with.

              I particularly liked this story of a conference of paleontologists going to the Creation Museum, and it making at least one of them cry.

              1. Reading the comments there is frightening.

                How about this gem:

                “Of course we should continue to tolerate religion.
                But we must not tolerate its intolerance of the truth. We are failing to address the real damage that the ignorant, irresponsible side of religion is doing to our collective wisdom. We must legislate controls that forbid ‘education of falsehoods’. It is doing real damage, and desperateley needs real action.”

                I dont think tolerance is what he thinks it is.

            3. The Scriptures are about man’s relationship with God and restoring it. It has nothing to do with the age of the earth and such.

    3. I cant tell you how difficult it was to keep my head from exploding while going through the public school system here. 12 years of pure hell.

  21. I’d play this game
    Lego: Breaking Bad

  22. Is Dunphy on the case?

  23. Did they leave out mental health? I realize not all of us believe in mental, but I do.

    I’m sorry to admit to my fellow libertarians that I did use Medicaid to receive mental health treatment. I felt at the time I had no other choice, except death. It was a net net positive to society- if you care about the “cost-benefit” aspect of that. I understand pure rights libertarians might have some way to explain how I am evil and deserved to die, but I’m cool with that. I also notice a lot more non-libertarian conservatives posting here these day, and I’m cool with you, too.

    The short story is I found myself in the top 1% in many measures, but in the bottom 1% in income, with no realistic or unrealistic conservative-fantasy prospects for doing anything about that. I leeched a few hundred dollars a month in services for a few years, which enabled me to raise my income by around 1500%. I realize this is anecdotal and not statistically representative of anything. But I do think it’s absurd to deny that some people can’t afford services that would allow them to be more productive and in turn benefit taxpayers. Or to just say that mental health is a myth or doesn’t matter. I’m sure depression and anxiety burden the economy more than just about any other health issue, and I’m not talking about apathy but actual disorders.

    1. I don’t support medicaid for that and “net net positive society” and “benefit to taxpayers” is utilitarian collectivist bullshit but I don’t think you are evil for taking what was available.

      1. I follow along Penn Jillette’s line of thinking on this one:

        It’s amazing to me how many people think that voting to have the government give poor people money is compassion. Helping poor and suffering people is compassion. Voting for our government to use guns to give money to help poor and suffering people is immoral self-righteous bullying laziness.

        People need to be fed, medicated, educated, clothed, and sheltered, and if we’re compassionate we’ll help them, but you get no moral credit for forcing other people to do what you think is right. There is great joy in helping people, but no joy in doing it at gunpoint.

    2. I understand pure rights libertarians might have some way to explain how I am evil and deserved to die,

      Now give that strawman a jab-hook while he’s on the ropes!

      The short story is I found myself in the top 1% in many measures, but in the bottom 1% in income,

      Fuck does that even mean?

      I leeched a few hundred dollars a month in services for a few years, which enabled me to raise my income by around 1500%.

      Golf clap for you.

      that would allow them to be more productive and in turn benefit taxpayers.

      And who says that you or I am here to benefit the taxpayers?

      I’m sure depression and anxiety burden the economy

      For a guy who claims to be libertarian, you make a lot of collectivist noises.

    3. I’m glad you got the help you needed. If the argument is that medicaid crowds out charitable spending on healthcare and doctors doing charitable or pro-bono work, I don’t think you’re in the wrong for seeking help through available means. One hopes that in a reformed system this could be handled through private funding, but you were working with what you had available.

      1. I’m guessing this is a sockpuppet as AC sussed out. No libertarian could spout some of that collectivism he spouted.

        1. Eh, he could be a sockpuppet or a fellow traveler who needs considerable polishing. My response doesn’t hang on the veracity of his story.

          Besides EDG and Irish have both admitted to liking deep dish pizza. I’m pretty sure that’s a bigger Reason sin than having gone (even fictionally) to get medical treatment under Medicaid.

          1. Maybe libertarians would do a better job reaching people if their pizza taste wasn’t self evidently terrible.

            1. I dunno, last night I made a delicious cis-crusted pizza with goat cheese, red onions and spicy italian sausage. If that’s terrible, I don’t want to be right.

              1. Assuming “cis-crusted” means pizza and not some deep dish crap that sounds delicious. I love all kinds of pizza including white pizza. Yeah, I love a traditional NY style pepperoni or cheese pizza but no need to restrict yourself. When I lived in Austin I quite enjoyed every specialty pizza on this menu especially 5, 7 & 8.

            2. As has been pointed at Reason multiple times and in other places, Medicaid is a system of transfer payments by which one group of citizens is robbed under color of law to pay for another. If Johnny had come in with the “I needed help and I’m not ready to be a martyr for libertarianism” fine, I’ve got no problem with that. Hell, I know I don’t want to die for the cause if I don’t have to.

              But the whole “you evil fuckin’ natural rights, republi-tarians want me dead, and by the way, you’re anti-science and don’t believe in mental illness!” is a bunch of flamebait bullshit.

    4. When strawmen are burning, they cast the most wonderful light.

    5. I am glad you got help though. My first reaction is always to be glib and sarcastic, but good for you.

      Not enough people with mental problems actually seek out help.

  24. Shocking.

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      1. I’m thinking the spam filter is there to filter out those posts which are not spam.

  26. Over the river and thru the woods lol.

    http://www.GoGetAnon.tk

  27. A subtle but important research methodology fact: As I posted on Shikha Dalmia’s May 2 entry, statistical significance testing cannot be used to prove Medicaid’s alleged ineffectiveness. By design, this testing can only present evidence suggesting the falseness of the opposite hypothesis, Medicaid’s alleged effectiveness. Your headline, and the NE Journal of Medicine’s synopsis, are wrong. The study did not prove ineffectiveness, it failed to (borrowing from your article) “reveal” effectiveness. Two very different things.

  28. “Those with Medicaid did see some reduction in out of pocket health expenses.”

    It would be cheaper just to give them money for out of pocket expenses. That is, give them money, indistinguishable from any other money that they’re given, but tell them that this money is coated with a special pixy dust that makes the money only able to be spent on out of pocket expenses. That should help improve their depression.

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