How Much Should We Value a Health Care Program that Doesn't Provide Significant, Measurable Physical Health Benefits?


Noah Strycker | Dreamstime.com

If you're so inclined, you can read the second-round results of the Oregon Health Insurance Experiment as justifying Medicaid on the simple basis that it helps people, somehow, even though it doesn't appear to improve objective physical health measures in a statistically significant way. The study showed pretty clearly that Medicaid insulates beneficiaries from financial shocks associated with large health expenses. It also showed that Medicaid beneficiaries screen positive for depression far less than those who aren't enrolled.

But is that really enough to justify the program's existence—or planned expansion under Obamacare?

Medicaid is supposed to be a health care program. It's supposed to make people healthier, physically. And it ought to do so in ways that are clear after careful, rigorous scrutiny. That's the rationale for spending roughly $7 trillion on it over the next decade. But the OHIE results suggest that Medicaid may not do that. 

If that's the case, then you have to ask: What, exactly, is the point of a health program that doesn't obviously provide significant measurable physical health benefits to those who are enrolled? You certainly wouldn't design it from the ground up that way. If what we really want is a program that helps the poor screen positive for depression less often and cushions low-income individuals from health-related financial shocks, then what we probably ought to be doing is developing a program or programs that are primarily intended to do that. We could probably build a program that accomplishes those goals for a lot less than we spend, or are projected to spend, on Medicaid.

On the other hand, if what we actually want is a program that helps achieve statistically significant, measurably better physical health outcomes amongst the poor, then we probably ought to be trying to design a program that does that, and can be shown to do that in a high-quality examination. Instead, the folks who continue to back Obamacare's Medicaid expansion are fighting to expand a program that, in the single best study of Medicaid's effects ever conducted, doesn't meet that standard.