Free Republic Needs Our Reliable Support
Donating Monthly would be Ideal.
Generous FReeper Sponsors are donating $10
for every New Monthly Donor & $1-A-Day Donor!
Posted on 05/04/2013 7:28:43 AM PDT by Kaslin
Within the White House, within the Democratic chambers in Congress and among the (overwhelmingly liberal) health policy community there was considerable anguish this week. The reason: a new study finds that (as far as physical health is concerned) there is no difference between being in Medicaid and being uninsured.
It's hard to exaggerate what a blow this is to the people who gave us the Affordable Care Act (ObamaCare). Everything about ObamaCare ? from the money we are spending to the damage being done to the labor market to the hassles the whole nation is going through ? depends on one central idea: that enrolling people in Medicaid will give them access to more health care and better health.
Beginning next year, ObamaCare is expected to newly insure about 34 million people. About half of these will enroll in Medicaid, the federal/state program for low-income families. Yet, if they won't be any healthier once they are in Medicaid than they were when they were uninsured, that implies that fully half of the entire ObamaCare program is one huge waste of money.
[Actually, the results weren't a complete disappointment. There was less depression among the Medicaid enrollees, they reported that they were a tiny bit happier and they spent about $215 less out of pocket annually on medical care, on average. But, remember, we could have simply given every one of them $215 in cash and spent far less than was actually spent on this program.]
It gets worse. The other half of the newly insured next year are supposed to get their insurance in health insurance exchanges, where most will qualify for generous premium subsidies paid for by federal taxpayers. If the Massachusetts health reform is precedent, however, these people will be in health plans that pay doctors only about 10 percent more than what Medicaid pays. Think of these plans as Medicaid Plus.
The study released this week is not the first study to find that enrollees in Medicaid do no better than the uninsured. In fact there are studies that show that Medicaid enrollees find it more difficult to get a doctor's appointment and have worse outcomes than the uninsured. Each of these studies has been subjected to a lot of nitpicking on various grounds, however, and a fair-minded person would probably have to say that how much difference Medicaid makes is an open question.
Until now. What makes this week's study so different is a special set of circumstances that originated in the state of Oregon. A few years ago the state had a limited amount of money to expand its Medicaid program and the number of qualified people greatly exceeded the state's budget. The state responded to this dilemma by conducting a lottery. This made possible an ideal experiment in which the people who remained uninsured were no different from the people who were enrolled in Medicaid, except for the luck of the draw.
Thanks to a budget crunch in Oregon, scholars had the ability to do a double-blind study (the gold standard for researchers) and it came out very, very bad for the supporters of the new health reform law.
The study doesn't speculate on the reasons why, but I will.
The uninsured in this country have access to a patch work system of free care when they are unable to pay for it out of their own pockets. In Dallas, Texas, where I live, for example, the entire county is part of a health district which makes indigent health care available to needy families. It covers people up to 250% of the poverty level, with sliding scale co-payments, based on family income. Parkland Memorial Hospital and its satellite clinics is the primary provider.
You could argue that uninsured, low-income families in Dallas are actually "insured" in this way, although they face the problems of rationing by waiting and other non-price barriers to care. Officially, they are counted as "uninsured," however. When these very same individuals enroll in Medicaid, they enter another system of patchwork care. A third of the doctors aren't taking any new Medicaid patients, for example. There is rationing by waiting in Medicaid along with its non-price barriers to care. Often, the uninsured and Medicaid enrollees are getting the same care from the same doctors and facilities ? even though one group is labeled "insured" and the other "uninsured."
A similar description applies to Massachusetts. RomneyCare cut the official "uninsurance" rate in half. But it created no new doctors or nurses or clinics. As far as I can tell, the same people are going to the same places and getting pretty much the same care that they got before the health reform. Hospital emergency room traffic is higher than it was before the reform. The traffic to the community health centers has changed very little.
But since they have expanded health insurance in Massachusetts, the demand for care has grown, even as the supply has remained unchanged. As a result, the time price of care has increased. The wait to see a new doctor in Boston is two months ? the longest waiting time in the entire country. People are getting the same care they got before, but they are paying a higher price for it.
I expect to see the Massachusetts results replicated nationwide.
Problem is that Medicaid is and was a bad idea.
Further- this system had been overwhelmingly ripped off during the time leading up to the early eighties, when it became almost bankrupt.
Now we have this, it’s a rxn to a sick system.
I think the health care companies are anxious for all those federal dollars to flow their way. Our health fund accounts are up over 18% this year so apparently all is well with the healthcare stocks. Emerging markets on the other hand, lost a little money for the year so far and it has always performed quite well. But I agree, the care for the poor and uninsured isn’t going to improve, access will be even harder, between doctors not accepting more patients and waiting months and months for new patient appointments.
How about all the doctors, many of them foreign, who are ripping off both Medicare and Medicaid to the tune of billions of our tax dollars? What does ObamaCare do to root out fraud?
In 2010, a family member of mine received $75K of free health care - not on medicaid, not insured. Another family member right now is on medicaid - she’s one of the people who legitimately should have a safety net - she hates the O. She is afraid that Obamacare will reduce her access to health care.
Bump
Obama Care is one big stinky abortion that Kermit Gosnell can’t hide away in a jar somewhere....
The best tactic for the Republicans to get control of the boondoggle is simple. Eliminate most of the federal Medicaid bureaucracy (at first) by turning it into a lump sum issued to the states, with a few general guidelines, and leaving it up to them how to spend.
Among the few rules is that all of it must be spent on health care for the poor, per capita, not based on what is done for them, and that the percent of the money spent on administration is limited to just a few percent of the total.
Fair warning that if a state tries to stiff the poor to drive them out of the state, their federal appropriation will be slashed as well.
Importantly, this is just a first step for the Republicans to get a handle on Medicaid. But by eliminating the federal bureaucracy and slashing federal control over it, will be a great first step.
Some of the Obama-voters that I work with complained that their insurance rates went up. I told them they voted for it and laughed. Just glares as a response. LOL!
That is totally unimportant. The Lefties, the very rich, and the politicians had Goodness in their hearts and MEANT WELL. The fact that they ignored European experience and that the outcome here was bad DOES NOT MATTER. /sarc
One would imagine that having Medicaid would improve health outcomes given that it removes a price barrier to obtain care. The problem—as with all government programs—is that it removes the personal incentive to seek out the benefits of such a program and to use them wisely.
As a physician, I routinely see medicaid patients who gripe and complain when something is not 100% free. There’s no co-pay for services in my state, which annoys me to no end—not so much out of lost revenue but because it disincentivizes a personal investment in care, a need to get better or any economical thinking in making healthcare decisions.
I look at the calculus of decision-making in my own family, and foremost in our line of thinking is what can most economically get the job done. This doesn’t even make a blip on the radar for Medicaid patients.
In my field we are seeing more and more physicians either moving to conglomerate community-model care or moving to private, cash-only practice. I predict that this will continue to be the trend, with the better care obviously being offered on the free market system.
Funny how the price of plastic surgery and dermatological care has actually decreased over time, whereas other fields have continued to rise.
That is a huge problem with Romneycare. We had people from Taxachusetts coming all the way down here to Florida emergency rooms trying to get help because even with potentially life threatening illness, they would not receive immediate treatment back home.
BKMK
Bump.
We were poor when I was growing up, though for most of the time my siblings and I did not know just how comparatively poor we were, compared to our peers.
As a family of ten (yes my parents had 8 kids) we were poor in spite of dad being a career warrant officer in the Air Force. Military pay was never great.
Most of us were born at mom and dad’s expense in private hospitals because we either did not live on a military base with a good private hospital, or we did not a live on a miltary base at all (not a lot of military housing available for such a large family) and a military hospital was too far from where we lived.
As for the rest, our dental care was always with private dentists and paid for “out of pocket” by mom and dad, and as for everything else there was were fewer incidents than 8 when any of my parents children had to be seen by a doctor at all; yet we all survived. To hear the Liberals tell it our survivial was impossible.
But, I think that the truth is that no matter what the statistics are about “insured” or “uninsured” we have become excessively insured and that has been a market disincentive for the healthcare industry to be more cost effective. I think our levels of coverage are excessive and have helped drive up the actual health care costs. A better deal for everyone would be less items “insured” and more of a premium cost going into a health savings account.
I’ve always wanted to ask a doctor, how is it to work on someone who is 24 years old, diabetic, smokes, is five foot nine and weighs 300 pounds? Isn’t this just an exercise in futility?
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.