And about that Medicaid expansion…
The blogosphere is chattering about a study that purports to show that covering more people under Medicaid hasn’t resulted in any significant health benefits after all, or certainly only minor ones.
There was a small reduction in the incidence of depression among the new and randomly-selected Medicare recipients in the study, but that effect apparently occurred before the benefits were ever received. Apparently the mere news that they would be getting Medicaid brightened people’s lives—which makes sense if you think about it. Other measures such as blood pressure and cholesterol didn’t seem to change in a manner that was statistically significant.
Some people who seem eager to prove that expanding Medicaid benefits is a highly desirable thing are arguing that although the study’s results were indeed not as strong as they would have liked, they were still in the right direction. Well, that’s true, but it doesn’t mean a whole lot. After all, isn’t that what testing for statistical significance is about—to make sure we don’t come to unjustified conclusions based on figures that don’t necessarily indicate what they seem to?
And isn’t the real question whether the improved outcomes (that is, if there are any) are enough to justify the costs? That may sound harsh to liberal ears, and it can often be a very difficult and complex question to answer. But if we are going to make taxes more onerous for everyone, we better have a pretty good reason to do so in the form of results. Otherwise, we’re just making a show of the fact that we “care” without really helping anyone.
But maybe that’s what most Americans want these days.
Yes, yes, this is all about moral aesthetics, just like gun control and so many other issues of the left. You take the proper outward stance that feels good, that demonstrates you are the sort of caring type that matters.
The study is so damning to nationalized health insurance, and the way we know that is because the major media outlets had to distort the findings. They had to protect the Adherents of the Faith from some very unplusgood bad information leading to doubleplusungood thoughts. It’s almost comical if it weren’t so sad.
And I find it odd that the presumption is that spending money on ineffective programs that are intended to help is not the real uncaring thing. There are opportunity costs. By spending trillions on an ineffective program, we are diverting resources that we could otherwise spend on actually helping people. Whether that’s in the form of government programs are merely going back into private hands, who would likely spend it more generously and wisely anyway. (That’s the other part of the More Caring presumption- if it’s done by the government, it’s inherently virtuous.)
A big problem with liberalism is that the facts don’t matter. One would like to think that if a major rationale behind spending trillions on Medicaid is shown to be invalid (or largely overblown), then even liberals would agree this is not a worthy expenditure. But they won’t respond that way at all. They will dig in, disparage the research, and demonize those who would try to cut back on — or simply oppose expansion of — this program.
When you reach your 60s you become keenly aware of your own mortality because your body stops working as efficiently as it did when you were younger. Some people –probably many people– believe on some level that modern medicine will fix that, or at least help. Maybe it does to some extent, but the fact remains, Medicare or no Medicare, our bodies all continue to deteriorate, will eventually give out, and we all sooner or later get sick and die. There is no fix for that right now. Is it any more complicated than that?
The study increased health care costs, and “reduce(d) financial strain” on the freeloaders.
It also showed that the so-often praised preventive care yielded precious few benes, costwise or heathwise. Figure that into the increased healthcare costs.
As to modestly reducing depression, I have my doubts as to the value of that; next we’ll hear that Medicaid ‘increases happiness’, so we should make the Medicaid people happier, but the taxpayers more grumpy and depressed, all OK with that?
Conrad said, “A big problem with liberalism is that the facts don’t matter. One would like to think that if a major rationale behind spending trillions on Medicaid is shown to be invalid (or largely overblown), then even liberals would agree this is not a worthy expenditure.”
It’s the same way with Head Start. Though shown to be essentially an expensive baby sitting program, they are now trying to extend it to every child.
Medicaid sounds so compassionate, but if it doesn’t yield better outcomes, it becomes an expensive, probably inefficient way of getting health care for low income people. The old way (prior to Medicare/Medicaid and EMTALA) was much better. People got treated and paid what they could afford. Under that system doctors were still among the best paid professionals in the country.
Don Carlos said, “It also showed that the so-often praised preventive care yielded precious few benes, costwise or heathwise. Figure that into the increased healthcare costs.”
I have tried my best to live a healthy life. Exercised, kept my weight under control, ate healthily, got regular physicals, followed doctor’s orders, etc. Well, I’m 80 now and have several medical conditions I never thought I might get. All slow moving, the question now is which one will actually bring me down. So much for preventative medicine. Entropy will have its way.
The plan seems to be you dumb down the population through miseducation and then create an immense govt industry to care for the miseducated. With the added benefit that the miseducated can actually man important positions in the industry and are by far the best qualified to miseducate future citizens not even born yet.
J.J.
The Headstart info came out–slowly–starting about four years ago.
Mentioned it to a lib relation. Panic and anger. At me.
If you’re doing Good Things to/for the lower orders, what could possibly go wrong? That’s a rhetorical question, btw.
Neo said:
“And isn’t the real question whether the improved outcomes (that is, if there are any) are enough to justify the costs? That may sound harsh to liberal ears, and it can often be a very difficult and complex question to answer.”
Neo, you are giving the so called liberals too much credit. They have been talking about cost to benefit analysis for many years. That is the reason Obama care has the “death panels”. Their idea is to use the cost to benefit analysis to deny service to groups who they believe are not worthy of their largess ie white men so they will have more money to spend elsewhere. There is already a recommendation to abolish the PSA test which is the best test to detect early prostate cancer.
My take on the study you are discussing is a little different. If the study had continued longer there might have been a difference since they seemed to be able to detect diabetes earlier. That could be easily accomplished at much less expense by providing free diabetes screening for everyone at pubic health facilities.
Neo, to avoid misunderstanding, I do wish to point out that black males have a high rate of prostate cancer. Since females are the preferred gender, removing the PSA test makes sense even thogh it will impact black males as well as the targeted group white males.
Neo, to avoid misunderstanding, I do wish to point out that black males have a high rate of prostate cancer. Since females are the preferred gender, removing the PSA test makes sense even thogh it will impact black males as well as the evil white males.
This is the paragraph of conclusions from the New England Journal of Medicine article:
“We found no significant effect of Medicaid coverage on the prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for these conditions. Medicaid coverage significantly increased the probability of a diagnosis of diabetes and the use of diabetes medication, but we observed no significant effect on average glycated hemoglobin levels or on the percentage of participants with levels of 6.5% or higher. Medicaid coverage decreased the probability of a positive screening for depression (−9.15 percentage points; 95% confidence interval, −16.70 to −1.60; P=0.02), increased the use of many preventive services, and nearly eliminated catastrophic out-of-pocket medical expenditures.”
Appearing in NEJM is important. Long regarded as the best general medical journal, I subscribed from medical school through retirement. But it is owned by the Mass. Medical Society, and its editorial controls have gradually been seized by the elitist best and brightest, all academics, from Harvard et al, who will dictate-yes, dictate- what all docs should do based on “evidence-based medicine” policies which they formulate after government grants, which they receive. As if the rest of us are ignorant clucks incognizant of scientific reason.
And the Leftist slant on its “opinions” articles, such as health care finance, universal coverage, etc., became so unreasoned and propagandistic that I quit taking it several yrs ago.
You need to read the Megan McArdle desconstruction of all of this.
JJ-
Forget entropy. Try apoptosis.
Hey that’s a word I’ve just encountered. apoptosis
I’ve been studying lower back pain, having been beset with some episodes.
It is absolutely amazing how many myths are out there about the spine. I’ve been reading Bogduk and Stuart McGill and the medical journal “Spine.”
And the term “degenerative disc disease” which is, in some ways is an “alike” mechanism of apoptosis. Degenerative disc disease is a catch all term to describe age related changes, some worse than others. But the “some worse” reasons is the most intersting part of the study. You’d think years of hard work would pre-dispose one to more degeneration. But it appears that depression and smoking and “social economic” status is a better predictor. MRIs show that people with identical degenerative conditions (herniated discs, facet hypertrophy, spondylosis, otheoartritis . . . ) will have differing experiences of pain. Some will have no pain, some have some, and a few will be disabled.
People with PTSD have a high incidence of lower back pain. It’s interesting stuff and the growth of lower back pain in the last 20 years is astounding. Is it mostly mental. Is the increased suicide rate, increased lower back pain, increased this and that, all in our heads, or maybe more appropriately, in our hearts.
Aptotosis:
: a genetically determined process of cell self-destruction that is marked by the fragmentation of nuclear DNA, is activated either by the presence of a stimulus or by the removal of a stimulus or suppressing agent, is a normal physiological process eliminating DNA-damaged, superfluous, or unwanted cells (as immune cells targeted against the self in the development of self-tolerance or larval cells in amphibians undergoing metamorphosis), and when halted (as by genetic mutation) may result in uncontrolled cell growth and tumor formation–called also programmed cell death
Don Carlos, apoptosis is a better word for it than entropy. Thanks!
sharpie, try reading this:
http://www.cure-back-pain.org/Dr-Sarno-back-pain-cure.html
Good luck!
sharpie:
As to apoptosis, do not overlook ‘programmed cell death”. That is why skin gets frail with age, one gets ‘senile purpura’, wounds heal more slowly, etc, etc.
It is programmed, and one’s capacity to regenerate cells, in whatever organ, each with its X cell generations, attenuates with age. Until you run out.
Hey that’s a great site, JJ.
Thanks.
I’ve recently changed my diet, started exercising a little more, and watch that I don’t sit too long, especially with bad posture. Seems to have done the trick.
I’m not one to go all out and decry the “medical” establishment or big Pharma! My mom (80) was greatly helped with a disectomy and the new technologies haven’t even hit yet. But there’s something as well to the mind/body connection. Ironic thing is that usually the one you try first isn’t the one that works.
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