May 4th, 2013

Megan McArdle deserves some sort of prize for this one

Please please do yourself a favor and read Megan McArdle’s comprehensive and penetrating analysis of that Medicaid outcome study.

And afterward, please send it to some other people whom you think might actually be inclined to read it.

11 Responses to “Megan McArdle deserves some sort of prize for this one”

  1. Mr. Frank Says:

    It’s just like the studies of Head Start. We know that Head Start makes no difference in academic performance by third grade, but we want to continue it because we want it to work. We believe it must help because we care so much.

  2. Paul in Boston Says:

    The purpose of ObamaCare, as directly stated by Barney Frank and Obama himself, is single payer national health insurance, i.e., socialized medicine. It has nothing to do with improving anyone’s health, it’s all about increasing the size and power of government, fundamentally changing America.

    We know that socialized medicine doesn’t provide any kind of improvement over what we have now, which is quite socialized already through Medicare and Medicaid. One example is the VA system in the US for ex-military. It’s notorius for its low quality and only serves the poorest vets. The rest get their own. In Great Britain the results are awful as exemplified by the recent scandal in which thousands of elderly died in National Health hospitals through lack of attention and shear negligence. Sweden had to pass a law limiting delays for doctor appointments to six months. But it’s FREE!

  3. Geoffrey Britain Says:

    Paul in Boston,

    Yes, single payer, government health insurance is the goal. ObamaCare was always meant to be a transitional step in that direction. Better health is a disingenuous justification. I would add to your analysis the primary justification; simple fairness and an appeal to humanity. The argument being that it is a social injustice that, in the richest nation on earth, any American would be without health insurance.

    It is of course a disingenuous argument. No one in America is denied emergency treatment. As for chronic illness, a far greater expense, the purported greediness of the rich is advanced as justification for making them pay for it. Yet, regardless of how greedy the rich may be, they cannot pay for the level of entitlement demanded. Which shall result in the middle class being taxed to pay for the poor, which of course results in serial rounds of taxation, until all you have is the vast proletariat and the elite. Attempts to eliminate life’s essential unfairness always result in greater suffering.

    Ironically and tragically, the West is busily rejecting the sole method ever developed for progressively better healthcare for all; Capitalism.

    That it takes decades and even generations to do so isn’t a bug but a feature.

  4. Don Carlos Says:

    See also this: http://online.wsj.com/article/SB10001424127887323628004578457453194365088.html?mod=djemEditorialPage_h

  5. Geoffrey Britain Says:

    Don,

    Have to be a subscriber. Perhaps you could give us a synopsis?

  6. Don Carlos Says:

    Here’s the wsj article, in full:
    ‘A familiar critique of liberal governance is that the results always matter less than its grand social ambitions. The latest evidence of this truth comes in the reaction to disappointing new findings from one of the most important public-policy experiments since the 1970s.

    A team of varsity health economists, mostly at Harvard and MIT, is studying the relationship between health outcomes and health insurance delivered by Medicaid. In 2008, Oregon’s Medicaid program conducted a lottery to enroll a limited number of low-income adults, and the economists are comparing over time the winners who gained coverage with those who applied but remain on a waiting list. Such experiments with large randomized trials are rare.

    On Wednesday the New England Journal published the results from year two of the Oregon project, which “showed that Medicaid coverage generated no significant improvements in measured physical health outcomes” versus being uninsured. If Medicaid were a new drug, in other words, the FDA would reject it.

    The Medicaid group used about 35% more health services, but they showed no clinical differences from the identical uninsured group across basic health measures like blood pressure, blood sugar and cholesterol levels that can be improved with the right treatment. The same was true comparing subgroups such as people with chronic diseases like diabetes. Health spending was higher among the Medicaid group, despite claims that using more preventative care and less emergency room will lower costs.

    Yet liberals are proclaiming the results a great success and a reason to expand Medicaid under ObamaCare. They point to a side finding that Medicaid increased economic security and led to “a reduction in financial strain,” the share of personal income going to care. “Here Medicaid shined. It hugely reduced out of pocket spending,” noted Aaron Carroll of Indiana University and Austin Frakt of Boston University.

    Richard Kronick and Andrew Bindman of the Health and Human Services Department praise Medicaid for providing “a low-income population with considerable financial protection” and increasing access to care, even if it is “less clear how well Medicaid accomplished the third goal—improving health.”

    So when liberals are confronted with robust empirical evidence that Medicaid offers little benefit for the money, they emerge to rationalize the program’s failures as, well, at least they spread the wealth.

    Medicaid in Oregon did nearly eliminate catastrophic medical expenses, compared to 5.5% of the uninsured control group that experienced a ruinous illness or injury. But that sure sounds like an argument for reforming Medicaid to extend basic catastrophic coverage to more poor people, instead of holding Medicaid lotteries.

    Sorry. Federal Medicaid rules require states to offer all-you-can-eat benefits to everyone rather than targeting public assistance to those most in need. These mandates often force states to squeeze provider payments to pennies on the private dollar, further harming quality and access for the poor.

    These counterproductive priorities will be familiar to students of the forced equality of government-run health care. But what the progressive response to the Oregon experiment shows is that ObamaCare has never been about the quality of care. It is an ideological project to redistribute income in the name of social justice. As Montana Senator Max Baucus put it not long after his law passed, it is a correction to the “maldistribution of income in America,” adding that “The wealthy are getting way, way too wealthy, and the middle-income class is being left behind.”

    No single study is conclusive, and more health care does not always mean better health. Yet such caveats were absent in the health-care debate: “Everyone in this room knows what will happen if we do nothing,” Mr. Obama told a joint session of Congress in 2009. “More Americans will lose their coverage when they are sick and need it the most. And more will die as a result. We know these things to be true.”

    Now we learn that the truth is closer to the opposite and that at best Medicaid does no active harm. But then that may count as an achievement by government standards, especially given the “glitches and bumps” that Mr. Obama predicted for his new entitlement the other day “even if we do everything perfectly.”

    He continued: “Oh, look, this thing’s, you know, not working the way it’s supposed to, and this happened and that happened. And that’s pretty much true of every government program that’s ever been set up.” But who cares when your egalitarian intensions are good.’

  7. blert Says:

    The Signal to Noise Ratio pulled in by medical statistical analysis is so exceedingly poor that it is unproductive in multi-variate complexity.

    Simply put: as the variables increase, ANY signal drowns.

    It took Megan f o r e v e r to stretch that out in her obtuse way.

    ========

    As pointed out above ^^^^^^ the partisan politics is based upon the sacred cow: feeding even more resources into the medical complex.

    What wealth five-thousand years ago went into funerary complexes now goes into ‘medical pyramids.’

    The expenses are running away BECAUSE the guild is structured at this time on a COST-PLUS basis.

    This was the same scheme that gave us WWII victory via unlimited war spending — and insanely overpriced military goods — the very same goods that the Left was baulking about for the next forty-plus years.

    Inspection of the Federal budget indicates that Leftists have entirely inverted the perversion: America is being destroyed by the medical-industrial-compassion complex.

    The military-industrial complex has been reduced to garrison status.

  8. n.n Says:

    Why does the Left care about distinguishing between cause and effect now? The reason unearned insurance effects a counterintuitive outcome is dissociation of risk. It’s the same reason that welfare is also an unproductive policy to rehabilitate people. It actually provides an incentive for development and persistence of dysfunctional behaviors, both of the provider and beneficiary.

    Why does the Left have a selective interest in the consequences of their efforts to normalize dysfunctional behaviors?

    blert:

    You’re right. There are more lives lost (e.g. elective abortion) and destroyed (e.g. welfare) by “good intentions” without accountability. The military cannot compete in absolute numbers with the people who claim to have “good intentions.” “Good intentions” are essentially the most effective WMD. The ill effects are broadcast through its sponsorship of corruption — a progressive corruption.

  9. Mike Says:

    The woman has a brain but no conscience.

    On a Wednesday she will tell you how horrible everything Obama has done is.

    By Thursday she’ll be voting for him again.

    The woman has a brain, but neither soul nor conscience nor care about anything good and decent.

    She is like a robot compelled to write the truth, even if she is personally against it and doesn’t live by it.

  10. Don Carlos Says:

    blert:
    Delete military. industrial and medical from your complex. Compassion Complex by itself serves nicely. Or Crony Capitalism-Compassion Complex.

  11. blert Says:

    Don…

    You’re right.

    Brevity is the soul of blog posts.

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