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L'Esprit de l'Escalier: May 3, 2013

Josh Barro: What to Make of the Oregon Health Study

I would say that we already knew that the Medicaid model is not a terribly productive way to create chronic conditions like high blood pressure and diabetes, and that we need to find better condition-management models pronto. But I would also say that the depression and financial security findings are better news than I expected. About what I would have expected (but worse than I might have hoped) on some welfare indicators, better than expected (and as good as I might have hoped) on others--net-net, goods news for the efficacy of Medicaid expansion.

And people who say otherwise aren't reading the study…

Austin Frakt sends us to Josh Barro, who makes a lot of good points:

What to Make of the Oregon Health Study: While Medicaid is clearly good for some things, it was supposed to be good for all of the measures tracked. It might be: The study did find that subjects on Medicaid did better on measures related to hypertension and diabetes than those without insurance, just not at levels anywhere close to statistical significance… even if Medicaid does improve physical health outcomes, this study suggests the effects may not be large.

Still, the “I knew Obamacare was a waste of money” reactions are misplaced. The financial effect is a big deal…. The government should be taking steps to support people who are being left behind by the increasingly asymmetrical economy, and this is one of them. The depression finding is important too… financial strain can be a cause of depression.

I think it makes more sense to read the study as an indictment of medical insurance broadly, rather than just one of Medicaid. If Medicaid is spending lots of money without clear improvements in physical health to show for it, isn’t it likely that much more expensive private insurance -- which we can’t do a random-assignment study of -- is doing the same? The study is yet another argument for “some health care for all, but not too much.”…

The discovery mechanism that’s used now is unacceptable: We’re forcing people to ask themselves the question, “Is this medical treatment so important that it’s worth going bankrupt over?” But maybe we can come up with other structures that divine the same information in a less punitive way. All of this makes me wish even more that conservatives had been productive partners in health reform rather than trolls…. They didn’t, partly because Republicans care more about not spending money on poor people and not changing programs that old people like than they do about making the health-care system more efficient….

I’d love to see this study shift the conversation on health reform toward how to use government and market mechanisms to ensure that money goes toward care that is actually useful. Obamacare includes a number of policies toward this end that could surely be improved, including by increased consumer direction. But given the right’s consistent non-constructive approach toward health policy, I’m not holding my breath.