Posted on August 29, by Scott Alexander [Content note:
The claim that health insurance improves health outcomes is hardly ground breaking. Studying whether insurance affects health status is like wondering whether three meals a day lead to a higher muscle mass than total starvation. Baicker et al found that Medicaid enrollees fared no better in terms of health outcomes than those without insurance.
That is, no insurance no difference. The study is an exemplar of policy research laced with regression equations, control of known confounders and clear separation of variables.
There is only so much rigor social science can achieve compared to the physical sciences. Yet this is about as good a study as is possible. The one thing the study did not lack was sample size. Large effects do not need a large sample size to show statistical significance.
Conversely, if study with a large sample size does not show even a modest effect, it means that the effect probably does not exist. So where is the downside? Could the downside of a government program paying physicians, on average 52 cents, and as low as 29 cents, for every dollar paid by private insurance in a multiple payer system be access?
But one I least expected was that patients on Medicaid do worse than patients with no insurance risk-adjusted, almost. I am not going to be that remorseless logician, which John Maynard Keynes warned us about, who starting with one mistake can end up in Bedlam, and argue that if you are for Medicaid that is morally equivalent to sanctioning mass murder.
Rather, I ask how it is possible that possessing Medicaid makes you worse off than no insurance whatsoever. To some extent this may artifactually appear so because poverty correlates with ill health, and studies that show Medicaid patients faring worse than uninsured, cannot totally control for social determinants of health.
However, I found a plausible explanation during a recent conversation with a physician specializing in physical medicine and rehabilitation PMR.
She ran a special clinic one day a week in which she saw adolescents for free. These kids had no insurance. They were mainly from the local Hispanic and African American communities. She did not accept Medicaid patients.
This point is worth parsing out again. This doctor is happy to see patients uncompensated but not Medicaid patients, partially compensated. Why so, I asked, bewildered and feeling that I must be in Bedlam. Plus one is exposed to unintentional billing fraud, audits, compliance and perpetual war with formularies and pharmacies.
She ran her practice as a small business and kept her support staff to a minimum; she simply could not afford the legal and coding help that this would entail. She explained that if she saw all Medicaid patients for free she would technically be committing fraud.
Unless she made a nuanced determination to waive fees on an individual basis. At any rate it would unduly burden her, and it was a good deed that best remained unpunished. Again this is worth parsing out because this is so mind-boggling.
Seeing all patients on Medicaid for free is fraud! I am a simpleton. This is plainly shooting the messenger, sometimes. The Pavlovian reaction is understandable as some on the right see in Medicaid scientific vindication of their anti-welfare stance.
But if an individual loses 30 pounds despite a complete diet inquiring about the underlying problem, whether there is a malignancy or not, does not challenge the value of eating.
How utterly incurious must one be to not wonder after the Oregon experiment and several other studies, why? How can you possibly not at the very least inquire whether Medicaid is a structurally sound program? But he accepts as do many on the right that the poor should not be thrown under the bus.
On Medicaid, the left and right are in that rare agreement. The mark of a civilized society is how it deals with the poor who are sick.By Saurabh Jha, MD “Extraordinary claims require extraordinary evidence,” said Carl Sagan. The claim that health insurance improves health outcomes is hardly ground breaking.
If the United States adapts a single-payer healthcare system, it will help Americans save money. Americans are not able to save because of the high prices of food, gas, real estate, and many more. Also, a big factor that has affected the ability to save is the high prices of healthcare insurance. The best opinions, comments and analysis from The Telegraph. Lawrence B. Lindsey was Assistant to the President for Economic Policy and Director of the National Economic Council at the White House (). From to , he was a Resident Scholar and holder of the Arthur F. Burns Chair in Economics at the American Enterprise Institute.
Schiff points out that men already die sooner than women and pay more for life insurance; men get into more accidents and pay more for auto insurance; men already pay more in terms of time and money during the courtship process as well.
In single payer system government does not own the healthcare providing facilities. In socialized medicine the government owns the hospitals and the doctors and nurses are paid by the government. Single payer health system is a socialized health insurance system not a socialized medicine.
Update 1/21/ With the Supreme Court’s decision to uphold the ACA (aka Obamacare), and President Obama’s inauguration to a second term today, the US will have universal health care in using an insurance mandate system. Single-payer health care is a system in which the government, rather than private insurers, pays for all health care costs.
Single-payer systems may contract for healthcare services from private organizations (as is the case in Canada) or own and employ healthcare resources and personnel (as was the case in England before the introduction of the Health and Social Care Act).
It is with deep sadness that we announce the passing of our friend, coworker and long time Teamster Brother, John Cousimano. RIP 12/30/ - 9/17/ John received the Bronze Star for valor in the Pacific Theater.
John's unit was cited for knocking out more .