Robert Samuelson reports on study of Medicaid patients who started getting health insurance versus those who didn't. While they got more health care, though not dramatically (Uninsured people already receive health care.), they health didn't necessarily improve.
Oregon's expansion of Medicaid -- the federal-state insurance for the poor -- unwittingly solved this problem. In 2008, the state decided to increase enrollment by 10,000. But there were 90,000 people on the waiting list, so the state adopted a lottery to decide who would receive coverage. The result was two similar groups of poor, one with insurance (Medicaid) and one without, that could be compared. The New England Journal of Medicine recently published the study.This is supported by a previous 2007 study of Medicare.
The most overlooked finding is that the uninsured already receive considerable health care. On average, the uninsured had 5.5 office visits annually, used 1.8 prescription drugs and visited the emergency room once. Almost half (46 percent) said they "had a usual place of care" and 61 percent said they "received all needed care" in the past year. About three-quarters (78 percent) who received care judged it "of high quality." Health spending for them averaged $3,257.
True, when people were covered by Medicaid, many of these figures rose. The number of office visits went to 8.2; the number of drugs, 2.5; the share of patients with a usual place of care, 70 percent; the proportion receiving all needed care, 72 percent. Preventive care also increased. The share of patients receiving screening for cholesterol moved from 27 percent for the uninsured to 42 percent; the share of women over 50 having mammograms jumped from 29 percent to 59 percent; the share of men over 50 getting PSA tests for prostate cancer doubled from 21 percent to 41 percent. Spending rose to $4,429.
Unfortunately, the added care and cost didn't much improve people's physical health. The study screened for high blood pressure, high cholesterol, diabetes and the risk of a future heart attack or stroke. There were no major detected differences between the uninsured and Medicaid recipients. There was more treatment for diabetes, though no difference between the two groups on a key indicator of the disease.
The Congressional Budget Office reported that the uninsured typically received 50 percent to 70 percent of the care of the insured. A study in 2007 of the 1965 creation of Medicare -- insurance for the elderly -- concluded that it had "no discernible impact on elderly mortality" in the first 10 years but improved recipients' financial security by limiting out-of-pocket expenses.And the end result is likely wasting billions upon billions of dollars to implement another big government boondoggle.
Samuelson takes Obamacare advocates to task: "They were too busy flaunting their own moral superiority. Universal health insurance is a legitimate goal, but 2009 -- in the midst of a major economic crisis -- was the wrong time to pursue it. Predictably, it polarized public opinion and subverted confidence for what seem, based on the available evidence, modest likely public health improvements. The crusade for universal coverage has been as much about advocates' sense of self-worth as about benefits for the uninsured."