A few remarks on the Oregon Medicaid study

There is a simple quotation from Josh Barro, who by the way has supported ACA.  Josh wrote:

Despite efforts to spin it to the contrary, this is bad news for advocates of the Medicaid expansion. While Medicaid is clearly good for some things, it was supposed to be good for all of the measures tracked.

Or here is Ray Fisman:

Now that the clinical results have started to come in, it’s time for liberal media types like myself to eat some humble pie. Today’s New England Journal article presents a set of findings showing that Medicaid had no effect on a set of conditions where you would expect proper health management to make a difference. There are effective treatment protocols for hypertension, cholesterol, and diabetes, yet insurance status had no effect on blood pressure, cholesterol levels, or glycated hemoglobin (a measure of diabetic blood sugar control).

Do read the rest of those posts for a more complete picture of the results, but many commentators are overlooking these rather simple upshots.

The key question here is how we should marginally revise our beliefs, or perhaps should have revised them all along (the results of this study are not actually so surprising, given other work on the efficacy of health insurance).  For instance should we revise health care policy toward greater emphasis on catastrophic care, or how about toward public health measures, or maybe cash transfers?  (I would say all three.)  One might even use this study to revise our views on what should be included in the ACA mandate, yet I haven’t heard a peep on that topic.  I am instead seeing a lot of efforts to distract our attention toward other questions.

I am sometimes reluctant to speculate about motives, but I believe there is currently a fear of stating the actual truth, given that ACA and the Medicaid expansion are coming under increasing political fire, very often involving mistruths from the Republicans I might add.

You are seeing obfuscations of reality when you encounter two particular responses to the new Medicaid results, which I have been seeing with disturbing frequency.  The first is something like “But you still buy health insurance, don’t you?”  The second is when the debate is steered into showing that Medicaid does indeed benefit poor people (which is obviously true, and was so before and after this study).

Those are both examples of running away from the idea of thinking at the margin.  A better response would run more along the lines of “The Medicaid expansion had been oversold, we now should think more along some other lines for improving our health care system.  Let’s admit that we have more of a mess on our hands than we had realized or let on.”  You don’t have to deny that Medicaid might help with long-term care problems, for instance, or advocate the abolition of Medicaid.  The real results from the new study are most likely about health insurance and health care, not so much about Medicaid per se; see Ezra’s on-target remarks.

Compare what you have seen over the last two days with the writings on the earlier phases of the Oregon study, when it seemed to be yielding a more positive picture of Medicaid.  Those earlier writings often were preparing for a coronation of this study (please do read that link) but now we are seeing hand-wringing and all sorts of talk about the study’s limitations.

For varying and useful perspectives, here are Carroll and Frakt and Megan McArdle.

Coming on the heels of the debate over Reinhart and Rogoff, I find this all sad.  If there is any cheery lesson it is that, in relative terms, macroeconomics is in better shape than we had thought!


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