Live from the Roasterie: Alan Grayson Was Right: "Remember when people made fun of Alan Grayson for this::
Live from the South Bank of the Ohio River: Charles Gaba: Kentucky: Am I actually supposed to sympathize with Dennis Blackburn???: "Matt Bevin didn't just include generic "Obamacare suxx!!" boilerplate...
...as part of his campaign rhetoric; he made repealing Medicaid expansion (and shutting down the kynect ACA exchange) a major part of his campaign for Governor. EVERYONE in Kentucky knew this (or damned well should have known it). Yet, Mr. Blackburn voted for the guy who had explicitly promised to take away his healthcare coverage... and now he's confused and scared that Bevin might, you know, actually do what he said he was going to do...Seriously, how the hell am I supposed to respond to this guy?
Over at Equitable Growth: I have been someone who takes the long-run secular decline in prime-age male employment as a canary in the coal mine: it has seemed to me via sign that information technology which greatly reduces valuable employment of human brains as cybernetic control elements for machines poses us with significant problems that are not necessarily economic but rather in the sociology of social roles. When Case and Deaton on the decline in life expectancy among the white and middle-aged crossed my desk earlier this week, I thought that case was reinforced.
But now I find myself updating and looking at this graph: READ MOAR
Must-Read: Anne Case and Angus Deaton: Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century: "This paper documents a marked increase in the all-cause mortality of middle-aged white...
Live from KU Medical Campus: Anupam Jena: What Happens to Patients When doctors Leave Town?:
3-5 p.m., Nov. 4, Kansas University Medical School School of Nursing Auditorium. A panel comprised of KU hospital and area cardiologists including Drs. Buddhadeb Dawn, Barbara MacArthur and James Vacek will follow. View flier and RSVP."
Comment of the Day: Charles Steindel: "Well, from a slightly different but vaguely comparable position (but within the FR system)...
Eric Schlosser (2006): On Upton Sinclair: 'I Aimed For The Public's Heart, And... Hit It In The Stomach': "'The Jungle' Was A Socialist's Cry For Labor Justice....
...It Launched A Consumer Movement Instead....
Must-Read: As I have said before and will stay again, the Republican Party could be taking a serious policy victory lap right now, not just with respect to health policy--as Mitt Romney tried to do yesterday before losing his nerve and pulling back--and with respect to monetary policy. they could be pointing out right now that the most successful recovery in the North Atlantic from 2008-9 was engineered by Republican Ben Bernanke following Friedmanite countercyclical monetary policies.
Mitt Romney: [The late Staples founder Thomas Stemberg was] an extraordinarily creative and dynamic visionary.... Mr. Stemberg was one of the great business leaders...
...of our state and our nation,’ Romney said. ‘He was not only the founder, but someone who grew the company to a multi-billion dollar enterprise. He built an industry that employs thousands and thousands of people.... Without Tom pushing it, I don’t think we would have had Romneycare. Without Romneycare, I don’t think we would have Obamacare. So, without Tom a lot of people wouldn’t have health insurance...
Mind you, Romney could claim he was criticizing the late Tom Stemberg--"without Tom, a lot of people wouldn't have health insurance through RomneyCare and ObamaCare, and that would be a better world than this." But somehow I don't think Romney is going to go there.
I mean... Romney had so many opportunities over the past six years to play a constructive role... He took advantage of none of them... I... I can't even...
Come to the Medicare Part D Health Fair on Saturday, October 24!
9-Noon, Pierson Auditorium, Atterbury Student Success Center, 5000 Holmes St, Kansas City, MO 64110, 51st & Cherry
UMKC’s School of Law and School of Pharmacy [are] host[ing] a health fair aimed at making sure older adults understand their benefits and how to save money on medications.... The health fair is free and open to community members who receive, or are eligible for, Medicare Part D:
Live from UMKC: America's loonier fragments of both its left and its right agree on something that makes all of us worse off!
Ann Marie Marciarille: Important Health Message: Mumps: "What the Important Health Message doesn't say...
The remarkable thing is that the Republicans would not have had to get any concessions out of Obama in order to justly and accurately sell ObamaCare as a profoundly conservative policy initiative--as an attempt to sustain a market-oriented health-care financing system. Obama pre-conceded everything except for Medicaid-expansion block grants to the states, and there is certainly enough wiggle room in the waiver process as it has developed to claim that we effectively have that as well:
David Frum (2010): Waterloo: "Conservatives and Republicans today suffered their most crushing legislative defeat since the 1960s.
...It’s hard to exaggerate the magnitude of the disaster. Conservatives may cheer themselves that they’ll compensate for today’s expected vote with a big win in the November 2010 elections. But:
Live from Crow's Coffee: A correspondent emails:
You apparently didn't arrive at the Kansas City Medicaid expansion event last night in time to hear:
(1) Cato's Michael F. Cannon denounce ObamaCare for not eliminating employer-sponsored insurance, and thus getting people the kind of insurance that vanishes when they get sick and lose their job.
(2) Cato's Michael F. Cannon denouncing Medicaid expansion for giving insurance to people even when they are not employed, and so eliminating the necessity to find and keep a job if you want health insurance.
You see what he did there? You are right about Think Tanks staffed by those more desperate to please ideologically-rigid billionaires than to actually think about the issues.
Live from the Roasterie: as I already wrote this morning, at the state level Medicaid expansion is a total no-brainer: your citizens are already paying the taxes to pay for other states Medicaid expansion, and so the choice is either (i) pay the taxes and get none of the benefits, or (ii) pay the taxes and get your share of the benefits. Option (i) makes sense only if you can somehow convince people that Medicaid spending is evil. Since the claim that Medicaid is useless was never and is not credible, that leaves doubling-down on race and class hatred--of ghetto-dwellers, of the working poor, and of doctors and hospitals that treat Medicaid patients as part of their practice and would like to be paid something for it.
And, of course, in reality it is not big-city hospitals that treat Black people that are going to be the first to close without Medicaid expansion, it's rural hospitals that treat white people:
Jon Cohn: This GOP Governor [Sam Brownback]'s Comments About the Poor Are Incredibly Revealing: "The hospital industry has been begging lawmakers to take the federal dollars...
Over at Equitable Growth: I actually made it to the second half of the Medicaid expansion in Kansas/Missouri panel last night:
Brad DeLong: Must-See: UMKC Medicaid Panel, and Think-Tanks: "Must-See: Alas! I seem to be missing the Kathleen Sibelius panel...
...on Medicaid expansion this evening at UMKC American Public Square: Dinner at the Square A Dose of Reality: A Medicaid Status Report...
Reactions: READ MOAR
Must-Read: Harold Pollack: If you want mental health services to prevent violence, Medicaid expansion is critical: "Oregon’s mass homicide sparked the usual debate about whether guns or mental health is the best focus in preventing atrocities...
Must-See: Alas! I seem to be missing the Kathleen Sibelius panel on Medicaid expansion this evening at UMKC:
American Public Square: Dinner at the Square A Dose of Reality: A Medicaid Status Report
But I do have a question that I would like to ask panelist Michael F. Cannon of the Cato Institute. I would greatly appreciate it if somebody else would ask the question--and get an answer:
Mr. Cannon: You said that:
I have counted more than a dozen predictions you have made ever since, back in 2005, Mitt Romney set us on our current health-policy path. All of yours have gone wrong. None of yours have gone right.
How has the fact that you have been so wrong about so much over the past decade changed your thinking about how health insurance markets work, and about health policy?
What has this episode taught you about your milieu--about think-tanks controlled by billionaires with strong ideological commitments, and surrounded by flatterers who assure them they are right about everything? And what has this episode taught you about yourself and your peers who draw their paychecks from such think-tanks?
Must-Read: Nicholas Bagley, Amitabh Chandra, and Austin Frakt: Correcting Signals for Innovation in Health Care: "A combination of legal rules and institutional forces pushes health plans to cover nearly every medical innovation...
Mark Kleiman: Don’t just stand there, do something! As long as there’s something useful to do: "Eugene Volokh... [is] ridiculously and disastrously wrong... [in] assum[ing], falsely...
...that just because we’re not currently doing much to stop the violence involving guns and alcohol, it must be the case that nothing useful can be done.... Cross-national statistics offer a strong hint that there’s something very wrong with policy in the United States, since no other developed country has anything like our rate of gun deaths... three times that of Finland or Switzerland... four times that of Canada... ten times that of Australia.... We might have something to learn....
October 1, 2015
The Honorable Orrin G. Hatch Chairman
Committee on Finance
United States Senate
The Honorable Paul D. Ryan Chairman
Committee on Ways and Means
U.S. House of Representatives
The Honorable Ron Wyden Ranking Member
Committee on Finance
United States Senate
The Honorable Sander M. Levin Ranking Member
Committee on Ways and Means
U.S. House of Representatives
Dear Chairman Hatch, Senator Wyden, Chairman Ryan, and Congressman Levin:
For decades economists and health policy experts of all political persuasions have agreed that the unlimited exclusion of employer-financed health insurance from income and payroll taxes is economically inefficient and regressive. The Affordable Care Act established an excise tax on high- cost health plans (the so-called ‘Cadillac tax’) to address these issues. READ MOAR
Must-Read: I have long thought that both Forbes and the Wall Street Journal have in mind as their target audiences that small segment of the human race that actually enjoys being free-riders, rather than that much larger segment of the human race that wants to engage in win-win reciprocal gift-exchange as a mode of social interaction...
Mark Kleiman: The Moral Universe of the Corporate Killers: "Daniel Fisher... writes for Forbes... hates plaintiffs’ lawyers...
Must-Read: As I say over and over again, conservatives could be taking a huge victory lap right now with the empirical policy success of the nationwide implementation of the health-care reform pioneered in Massachusetts by the 2012 right-wing standard-bearer Mitt Romney. It is an index of their extraordinary policy, rhetorical, and ideological dysfunction that they are not doing so.
Would somebody please point them a way back to fact-based reality?
Jared Bernstein**: The Affordable Care Act Is Providing Affordable Care. That’s a Big Problem for Its Opponents: "A gov’t program that, after a troubled start...
Live from La Strada: There was a time when it seemed like Nick Gillespie was--unusually for those on the right--a relatively smart person, with respect for reality.
It looks as though those days are gone.
Jon Chait reports--and, as best as I can determine he reports the arguments of John Merline and Nick Gillespie fairly, and greatly to their discredit:
Jon Chait: Obamacare Haters Freaking Out Over New Report: "John Merline of Investor’s Business Daily and Nick Gillespie of Reason insist Obama’s promise to save money for people with employer insurance has failed...
...Why? Because the nominal cost of health insurance has gone up.... Merline and Gillespie... assume that Obama was using a baseline of existing nominal prices.... [In their view] the only way Obama’s reforms could succeed is not only if the decades of medical inflation slowed their rate, but if prices actually dropped in nominal terms. Of course, Obama never actually said anything like this. Merline does not even claim he did. Instead, he insists that it kinda ‘seems’ like Obama meant this.... Oh, it 'seems' that way, huh? That's your argument? The reason it makes sense to judge Obamacare against an alternative world in which decades of medical inflation drop to zero percent a year is that it 'seems' as if he made this insanely grandiose promise? So, yes, if you assume that Obama meant an implausibly unrealistic promise that he did not actually say, then his reforms have fallen short....
The determination of Obamacare haters to claim vindication is a testament to the power of the human spirit in the face of all factual evidence. Right-wingers have every right to ideologically oppose the concept of a government program that uses regulation, taxes, and spending to provide insurance to people who can't afford it. Their unwillingness to concede that this program is working on its own terms is delusional.
While everyone interested in reality-based health-care policy is marveling in astonishment at how much cheaper than expected ObamaCare has been to implement, Merline and Gillespie are off raving in the corner.
Must-Read: Two points: (1) Kevin Drum reveals that he writes his weblog posts not in his bathrobe but in his shorts. (2) Ever since the closing of the health-care expansion frontier opened by Medicare and Medicaid plus the industrialization of the hospital, we have seen a steady if saw-toothed decline in the pace of spending growth--your standard logistic in the share of spending devoted to health care.
The big question for me is: Are we near the asymptote? Or will there be another wave of backlash against narrow networks and bureaucratic blockages of authorizations?
Time will tell!
Kevin Drum: The Future of Health Care Costs Looks Surprisingly Rosy: "You've seen various versions of this chart from me...
I would say that Ramesh Ponnuru needs to decide whether he is going to be part of a reality-based technocratic conversation about the future of our social-insurance system, or a booster of individual politicians who evanescently catch his current fancy.
But that choice has already been made, hasn't it?
Kevin Drum: A Conversation About Scott Walker's Health Care Plan: "A Conversation About Scott Walker's Health Care PlanRamesh Ponnuru thinks I got Scott Walker's health care plan wrong...
...I complained that Walker's plan would cost a lot but he doesn't tell us how he's going to pay for it without raising taxes. Ponnuru:
Walker says he is going to reform the tax break for employer-provided plans and get savings out of Medicaid....There’s no reason to doubt that some such mix could be made to work. READ MOAR
Over at Equitable Growth: The scarily-sharp Josh Barro tweets:
Walker and Rubio plans show the dream of repealing Obamacare is dead; now we're just haggling over price. http://t.co/UJdHKi3azA— Josh Barro (@jbarro) August 19, 2015
And he sends me to an interesting, but I think largely-wrong, piece from Megan McArdle:
Apropos of Social Insurance, Harold Pollack, and His Brother-in-Law Vincent......
Harold Pollack: Veronica Pollack responds to an internet heckler: "I wrote an op-ed in Thursday’s Chicago’s Sun Times about the impact of Illinois’s budget crisis on services to people with intellectual and developmental disabilities...
...A gentleman with initials ‘J.K.’ read it, and sent me the below email:
My wife Veronica happened to see it, and composed the below response, which I am posting below.
Must-Read: Harold Pollack: Opinion: Who Will Care for My Brother-in-Law Vincent?:
Live from Bullwinkle PlazaHarry Reid: On Twitter: "Been carrying this in my wallet a long time..." http://t.co/ZoiqsoVwdk
Been carrying this in my wallet a long time. It shows you how long Republicans have been wrong about health care. pic.twitter.com/ZoiqsoVwdk— Senator Harry Reid (@SenatorReid) July 30, 2015
Must-Read: I had always thought that we had a mixed economy and the social safety net in large part to counter and correct the market's judgment as to who deserved to have resources used for their benefit. And I had always thought that this was an obvious and well-understood part of benefit-cost analysis. Have I in fact been wrong? Is this not well-understood? Do the younger economists--the kids these days!--Really think that the rights function for assessing societal well-being roughly multiplies each person's utility by their individual income?
Harold Pollack, Bill Gardner, and Timothy Jost: Valuing Medicaid: "Finkelstein and her colleagues placed a very low value...
Today's Economic History: Trevon Logan: The Transformation of Hunger Revisited: Reply: "The higher [early industrial] calorie levels reported in Gazeley, Newell, Bezabith (2015)...
...are a function of a conversion of food quantities to calories that is weighted towards contemporary, calorie-rich foods. Their conversion uses the full distribution of contemporary foods and should not be applied to historical populations. Since Gazeley, Newell, Bezabith assume that industrial workers in the past had access to contemporary foods, the revised calorie levels reflect contemporary diets rather than historical diets.
Live from Bullwinkle Plaza: Ted Miguel is 1... 2... 3... 4... 5... 6... 7... 8... 9... 10... 11... 12... 13... offices down the hall. So be warned!
My take on this is the same as the very sharp and very hard working Chris Blattman's: http://chrisblattman.com/2015/07/23/dear-journalists-and-policymakers-what-you-need-to-know-about-the-worm-wars/ http://chrisblattman.com/2015/07/24/the-10-things-i-learned-in-the-trenches-of-the-worm-wars/
"With this sentence, [Michael] Cannon is spitting out his own snake oil..."
Scott Lemieux: On Jonathan Adler and Michael Cannon: "The ACA was, in fact, passed with somewhat less haste than a turtle crawling through a tar pit...
Norm Ornstein: The Birth of Obamacare: "It is worth going back and recounting what actually happened leading up to the enactment of Obamacare...
...and reflect a little bit on what might, and what should, happen going forward.
Did Obama Leap Rashly to Consider Healthcare Instead of Focusing on Jobs or the Economy?
There is no doubt that the president made healthcare reform a top early priority. There was good reason for doing so; past experience, including that of the Clinton health-reform plan, showed that waiting to pass a major social-policy change, in the absence of a great crisis, is a fool’s errand. A president’s momentum, his public support, and the backing of his party peak early, and major social-policy change by definition shakes up the status quo, creating losers along with potential winners and an even larger number of those unsettled by change. The longer presidents wait, the greater the likelihood that their opposition will mobilize and exploit uneasy voters. And the closer midterm elections loom, the more nervousness builds among lawmakers from the president’s party. [READ MOAR]
Jonathan Chait: The Obamacare Resistance Regroups: "The 16th Amendment to the Constitution, authorizing the federal income tax...
...was ratified in 1913. Still, every once in a while, the news will report the arrest of some right-wing kook who has failed to pay his income tax on the grounds that it’s illegal. Also in 1913, the 17th Amendment, requiring the popular election of senators (who before then were often appointed by state legislatures) took effect. And yet many conservatives still want to repeal it--and not just kooks, or at least influential kooks and not just completely marginal and obscure kooks [but Antonin Scalia, Rick Perry, now-Sens. Mike Lee (R-Utah), Jeff Flake (R-Ariz.), and Ted Cruz (R-Texas). And those things happened more than a century ago. So how long will the Obamacare resistance live on? A long, long time....
Simon Maloy: “Moops” now, “Moops” forever: The sad, final yawp of the defeated King v. Burwell mastermind: "Michael Cannon argues that by losing at the Supreme Court...
...he actually won, because blah blah something whatever: If you read the Supreme Court’s 6-3 decision in King v. Burwell, you probably came away thinking that the plaintiffs and the conservative activists who dreamed up the legal challenge lost. That’s because they did. The plaintiffs argued that the Affordable Care Act was written in such a way that the government could not provide insurance subsidies to people in the majority of states. The Court disagreed and the law emerged unscathed. But according to the Cato Institute’s Michael Cannon, one the legal minds behind the King challenge, losing the case doesn’t actually mean that they ‘lost the case.’
Richard Mayhew: On Twitter:
Richard Mayhew @bjdickmayhew 4h4 hours ago @xpostfactoid1 http://www.balloon-juice.com/2015/07/06/cash-flow-of-rejecting-free-money/ … Medicaid Rejection has lower net GDP component than @Delong argued in 10/14 due to APTC and CSR $$$
Richard Mayhew @bjdickmayhew 4h4 hours ago @xpostfactoid1 @delong so for Florida, net cash missed is Medicaid Expansion for 100k... Rounding error
Richard Mayhew @bjdickmayhew 4h4 hours ago @xpostfactoid1 @delong what % 100-138℅ are of 0 to 138℅ expansion eligible... Need an intern for this
xpostfactoid @xpostfactoid1 2h2 hours ago Alabama update: perhaps 22% of those who should have been Medicaid-eligible now in QHPs. @bjdickmayhew http://bit.ly/1TaGCei
Richard Mayhew @bjdickmayhew 2h2 hours ago @xpostfactoid1 OK, that is still a big multiplier cost
xpostfactoid @xpostfactoid1 2h2 hours ago @bjdickmayhew Can be calculated state-by-state. I'll work up for FL & MS too shortly.
xpostfactoid @xpostfactoid1 2h2 hours ago @charles_gaba @bjdickmayhew I had 1.9m originally - figuring now 1.6m, w/ attrition, v. 4m in Medicaid gap, per Kaiser. That's 28.5%.
Richard Mayhew @bjdickmayhew @xpostfactoid1 @charles_gaba so net loss of about .5% GDP, not @delong initial .7% rejection state GDP...
Across the Wide Missouri: Scott Lemieux: Friday Links: The Repulsion of the Moopish Invasion: "Nice to see the conspiracy theories already heating up already...
...The reviews of Scalia’s dissent continue to come in. (Tushnet has been on this beat for a while, and his analysis looks more prescient than ever.) Lead plaintiff David King, earlier this month:
Mr. King said that he was not really worried about the outcome of the case, King v. Burwell, because as a Vietnam veteran, he has access to medical care through the Department of Veterans Affairs.
Yeah, really sorry you lost this one, buddy. Smart analysis from Brianne Gorod, Nicholas Bagley, Ian Millhiser, and Jon Cohn. Cue Nelson Muntz.
This morning, Republican-appointed Supreme Court Chief Justice John Roberts wrote and five of his colleagues -- Democrat-appointed Breyer, Ginsburg, Sotomayor, and Kagan, and Republican-appointed Kennedy -- agreed that:
Section 18031 [of the Affordable Care Act--i.e., the ObamaCare Law--] provides that “[e]ach State shall . . . establish an American Health Benefit Exchange..." [But] if [a] State chooses not to do so, Section 18041 provides that the Secretary [of Health and Human Services] “shall . . . establish and operate such Exchange..." (emphasis added [by Roberts]).... The phrase “such Exchange”... instructs the Secretary to establish and operate the same Exchange that the State was directed to establish.... Black’s Law Dictionary 1661... (defining “such” as “That or those; having just been mentioned”).... State Exchanges and Federal Exchanges are equivalent—they must meet the same requirements, perform the same functions, and serve the same purposes...A simple matter of black-letter law, no? The plain meaning of the phrase "such Exchange" means that anything legal that is true of a health-insurance exchange established by, say, the state of New York is also true of a health-insurance exchange established by the federal government for, say, the state of Florida if the state of Florida fails to establish its exchange, no?
Over at Equitable Growth: Ezra Klein has a very nice explainer on the likely consequences of the possible announcement next week of a 5-4 partisan Supreme Court vote to disrupt ObamaCare via the case King v. Burwell:
Ezra Klein: King v. Burwell Won’t Destroy Obamacare: "A ruling for the plaintiffs in King won't change anything about Obamacare...
...in California, or New York, or Massachusetts, or even Kentucky. And it won't be a long-term problem for the states using a federal exchange out of convenience rather than ideology; they'll just set up their own exchanges.... Pennsylvania, Arkansas, Delaware, and Maine are already working on backup plans. So King can't destroy Obamacare. What it can do is let Republican elected officials destroy Obamacare in states where they have a majority. That's a very different thing, and it will lead to very different political dynamics.... Resistant red states will be left with a wrecked insurance market — and a hefty tax bill.... READ MOAR
Daniel P. Tompkins: What the Ancient Greeks Can Teach Us About Human Capital: "Unsupervised, cooperative Athenians developed an economy powerful enough to escape the Malthus trap...
The Rise and Fall of Classical Greece by Josiah Ober, Princeton University Press, 464pp. "Must it not then be acknowledged by an attentive examiner of the histories of mankind, that in every age and in every State in which man has existed, or does now exist, That the increase of population is necessarily limited by the means of subsistence? That population does invariably increase when the means of subsistence increase? And, That the superior power of population it repressed, and the actual population kept equal to the means of subsistence, by misery and vice?"
Over at Equitable Growth: The trouble that is the King v. Burwell case arises because of one sub-sub-section of the law which says "established by the state" rather than "established in the state" or "established for the state". The purpose of "established by the state" in its context:
...the monthly premiums for such month for 1 or more qualified health plans offered in the individual market within a State which cover the taxpayer, the taxpayer’s spouse, or any dependent (as defined in section 152) of the taxpayer and which were enrolled in through an Exchange established by the State under 1311... READ MOAR
An excellent piece by the very sharp and thoughtful Jonathan Chait.
The remarkable thing is that Republican ideologues could, right now, be taking a huge victory lap with the apparent success of ObamaCare. All they had to say was: "this is really RomneyCare." But they didn't.
How much of what he says these days does Michael Tanner believe? My feeling is: relatively little.
...The trouble is that anti-Obamacare dogma sits so deeply at the GOP’s core that any discussion of health care must pay fealty to their belief that the law has failed utterly. The Republican Party in the Obamacare era is a doomsday cult after the world failed to end. Its entire analysis of the issue is built upon a foundation of falsehoods.
Live From the Laura Ingalls Wilder Farm: Rocky Ridge: Discussion with Senator Blunt. Subject: King v. Burwell.
Me: "A great many people here in Missouri might be unable to afford their health insurance in three months."
Ann Marie: "You need to be on the right side". Sen. Blunt: "That's really up to the judges."
Me: "But you in Congress could fix it in a sentence".
Sen. Blunt: "You are right."
Of course, "You are right" means not "we will do the one sentence fix if necessary" but "I came to Rocky Ridge on a Saturday afternoon to be avuncular, not to justify my rhetorical pose of root-and-branch opposition to something that is at bottom 'RomneyCare'".
Live from the Roasterie: Perhaps the strangest thing about hanging out on the Missouri-Kansas border is the moderate Republicans who come up to one: "Isn't the failure to expand Medicaid insane?" they say
...there was a constant stream of patients (often with multiple chronic conditions) who were seeing a doctor for the first time in years, because of the ACA coverage expansion. My question would be, who has lost care or access under the ACA? Has anyone been pushed out of care to accommodate these folks? If so, where are they? We have also been turning out more primary care doctors, especially DOs, so the proportional stats comparing today to a decade ago are somewhat misleading: they just as readily suggest we have added enough capacity to withstand all the newly covered. As well, measures of access are notoriously unreliable.... Goodman's complaint seems to boil down to: yes you expanded coverage, but coverage isn't access (we knew that thanks), and high-deductible plans aren't always great coverage (ditto). Sour grapes. And if anything, his points could support the argument the ACA didn't go far enough...
Thank you for a wonderful talk. A comment, and a question:
The comment: I have long had a bone to pick with Amy Finkelstein and company and their Oregon Medicaid study. They use “significant” in two different ways in their paper. Improvements in blood pressure and in blood sugar levels in their study were not statistically significant. Not a lot of people in the sample had high blood pressure or high blood sugar, and so the drops seen were not big enough to be confident in a statistical sense that they were not just the luck fo the draw. But the drops in blood pressure and in blood sugar levels were in line with what we expect to follow from prescribing first line lisinopril and metphormin to those who need them, and those drops are clinically significant. I’ve been trying to get them to say that the improvements in the physical health indicators they found were clinically but not statistically significant — but without conspicuous success. READ MOAR
Anybody get to this? What was said that was unexpected?
April 14, 2015 :: 9:00 AM - 12:00 PM EDT :: Brookings Institution Washington, DC
"I now know it is a rising, not a setting, sun" --Benjamin Franklin, 1787