Commentary Magazine


Topic: Medicaid

The Medicaid Scam and ObamaCare Lies

Yesterday’s congressional oversight hearing on ObamaCare was, to those interested enough to watch, mostly about Jonathan Gruber, the ObamaCare architect who was caught on video repeatedly bragging to audiences about the level of dishonesty required to pass ObamaCare. Yet the hearing was also called for another reason: the Obama administration had been caught falsifying more enrollment numbers.

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Yesterday’s congressional oversight hearing on ObamaCare was, to those interested enough to watch, mostly about Jonathan Gruber, the ObamaCare architect who was caught on video repeatedly bragging to audiences about the level of dishonesty required to pass ObamaCare. Yet the hearing was also called for another reason: the Obama administration had been caught falsifying more enrollment numbers.

To that end Marilyn Tavenner, the administrator of the Centers for Medicare and Medicaid Services, was also at the hearing to be questioned by the committee. When the enrollment numbers were not meeting their benchmark, the government simply fudged the stats by counting dental plans, thus boosting the numbers by hundreds of thousands of enrollees. There won’t be any real consequences for the government repeatedly lying to the people, and so it won’t stop: central planners cannot keep honest records and still convince the people they are on the right track. Never have, never will.

But Tavenner’s appearance coincided with another revelation that will give her heartburn. The New York Times reports that the Department of Health and Human Services inspector general has concluded his investigation into the availability of doctors for those covered under Medicaid–a major source of insurance coverage expansion under ObamaCare. What he found won’t shock you: enrollees are being lied to, again. The Times explains:

Large numbers of doctors who are listed as serving Medicaid patients are not available to treat them, federal investigators said in a new report.

“Half of providers could not offer appointments to enrollees,” the investigators said in the report, which will be issued on Tuesday.

Many of the doctors were not accepting new Medicaid patients or could not be found at their last known addresses, according to the report from the inspector general of the Department of Health and Human Services. The study raises questions about access to care for people gaining Medicaid coverage under the Affordable Care Act.

The health law is fueling rapid growth in Medicaid, with enrollment up by nine million people, or 16 percent, in the last year, the department said. Most of the new beneficiaries are enrolled in private health plans that use a network of doctors to manage their care.

Patients select doctors from a list of providers affiliated with each Medicaid health plan. The investigators, led by the inspector general, Daniel R. Levinson, called doctors’ offices and found that in many cases the doctors were unavailable or unable to make appointments.

It’s worth reading the whole story, because it’s just filled with such tidbits. Some are absurd, like the fact that “More than one-third of providers could not be found at the location listed by a Medicaid managed-care plan.” One-third of providers can’t even be found! The rest of the details, though, evince mostly outrage.

What is the result of the fact that Medicaid only pretends to offer health care? Well, the report, summarized by the Times and scheduled for release on Tuesday, offers the kind of brilliant insight we all have come to expect from a federal bureaucracy whose management would have to improve greatly just to be considered mediocre:

“When providers listed as participating in a plan cannot offer appointments, it may create a significant obstacle for an enrollee seeking care,” Mr. Levinson said. “Moreover, it raises questions about the adequacy of provider networks. It suggests that the actual size of provider networks may be considerably smaller than what is presented by Medicaid managed-care plans.”

Yes, when you can’t see your doctor, it “may”–may!–be an obstacle for you. The government apparently believes that Medicaid enrollees consider medical appointments roughly on par with social calls. It “may” be an obstacle to seeking care because, perhaps, the appointment with your doctor was to watch the game together, or some such. If you are actually seeking medical attention, however, the government’s disappearing doctor is always an obstacle.

And I’m not sure it “raises questions about the adequacy of provider networks” so much as it makes declaratory statements about the provider networks, such as: The networks are terrible.

Here’s another one: “a number of obstetricians had wait times of more than one month, and one had wait times of more than two months for an enrollee who was eight weeks pregnant. Such lengthy wait times could result in a pregnant enrollee receiving no prenatal care in the first trimester of pregnancy.” Completely unacceptable.

The Times, of course, gets a quote from Tavenner in response. Behold: “Inaccurate provider directory data may unnecessarily delay an enrollee from selecting a provider.” Tavenner is, just as a reminder, the administrator of the Centers for Medicare and Medicaid Services. So enrollees are in great hands.

Medicaid is rife with such problems. The government is failing those who come to it for health care. So of course, under Obama, the government decided to put itself in charge of far more of the health sector. It is a general problem that the administration doesn’t know what it’s doing. When that incompetence is applied to health care, it becomes exponentially more dangerous for the citizens the government is supposed to be protecting. Heads should roll. They won’t, but they should.

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ObamaCare: Yesterday’s Failures Today

The ObamaCare rollout has been such a mess that explaining its manifold failures has become somewhat complex. But basic news coverage of the law is still studded with quotes that, while describing individual weaknesses of the law, would serve as succinct summations of the government’s incompetence. Today’s New York Times story offers a couple of good candidates.

The back story, briefly, is that last month more results from the Oregon Medicaid study were released, further undercutting the central claims of ObamaCare. Part of the recriminations that followed had to do with the fact that the government had not been utilizing randomized studies, which are considered the “gold standard” in medical research, when planning out ObamaCare. Today the Times carries a story on how ObamaCare is funneling taxpayer money into new research facilities–and you won’t be surprised to hear that the government’s new facilities are not using the most reliable methodology:

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The ObamaCare rollout has been such a mess that explaining its manifold failures has become somewhat complex. But basic news coverage of the law is still studded with quotes that, while describing individual weaknesses of the law, would serve as succinct summations of the government’s incompetence. Today’s New York Times story offers a couple of good candidates.

The back story, briefly, is that last month more results from the Oregon Medicaid study were released, further undercutting the central claims of ObamaCare. Part of the recriminations that followed had to do with the fact that the government had not been utilizing randomized studies, which are considered the “gold standard” in medical research, when planning out ObamaCare. Today the Times carries a story on how ObamaCare is funneling taxpayer money into new research facilities–and you won’t be surprised to hear that the government’s new facilities are not using the most reliable methodology:

The idea seemed transformative. The Affordable Care Act would fund a new research outfit evocatively named the Innovation Center to discover how to most effectively deliver health care, with $10 billion to spend over a decade.

But now that the center has gotten started, many researchers and economists are disturbed that it is not using randomized clinical trials, the rigorous method that is widely considered the gold standard in medical and social science research. Such trials have long been required to prove the efficacy of medicines, and similarly designed studies have guided efforts to reform welfare-to-work, education and criminal justice programs.

The story then quotes health experts complaining about the missed opportunities. And what is the government using instead of the “gold standard”? The Times explains:

Instead, the Innovation Center has so far mostly undertaken demonstration projects; about 40 of them are now underway. Those projects test an idea, like a new payment system that might encourage better medical care — with all of a study’s participants, and then rely on mathematical modeling to judge the results.

Dr. Patrick Conway, the director of the center, defended its reliance on demonstration projects, saying they allowed researchers to evaluate programs in the real world and regularly adapt them. “Does it look like it is working?” he asked. “If it does not look like it is working, we can stop.”

That is the first of two classic quotes from the story underlining the government’s failures: “If it does not look like it is working, we can stop.” That’s not, apparently, the case with ObamaCare. It doesn’t appear to be working but the government’s natural tendency when watching bad money float away is to toss good money in after it.

But the better candidate for “ObamaCare in a nutshell” comes from the Times’s description of the activities of two health experts, one of whom was involved in the Oregon study. The Times notes the fact that the U.S. has been slow to use randomized studies despite their accuracy, and then adds:

The situation is different in the developing world. There, randomized trials have become common in health care and other areas, sponsored by a variety of groups like J-PAL, a global network of researchers that was organized by M.I.T. and Harvard economists.

So far, J-PAL has conducted over 440 randomized trials in 55 countries, according to Amy Finkelstein, an M.I.T. economist.

Dr. Finkelstein and Lawrence Katz, a Harvard economist, have now started J-PAL North America to spur randomized trials in, among other areas, health care.

So there you have it: in order to fix one of ObamaCare’s weaknesses, experts are importing methods from the developing world.

Now, in fairness to the administration, the lack of randomized trials is an issue across the board–it’s not a problem invented for or by ObamaCare. But it’s still quite telling that with a blank slate (and a practically blank check of taxpayer money) the government founded an Innovation Center to take us into the future of government health-care services with the past’s outdated and maligned systems and practices.

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Study: “Basic Economic Principle” Debunks ObamaCare Claim

“If you’ve got insurance, then … preventive care is going to be covered, and that should make a difference,” President Obama said in 2010, describing ways his unpopular health-care reform law “should save us all a lot of money. I mean, one of the toughest things about this health care debate was—and sometimes I fault myself for not having been able to make the case more clearly to the country—we spend—each of us who have health insurance spend about a thousand dollars of our premiums on somebody else’s care.”

How were we all spending that money on other patients’ care? “What happens is, you don’t have health insurance, you go to the emergency room,” and the costs for those expensive ER visits get passed along. “And that’s why,” Obama boldly declared, “we feel pretty confident that over the long term, as a consequence of the Affordable Care Act, premiums are going to be lower than they would be otherwise; health care costs overall are going to be lower than they would be otherwise. And that means, by the way, that the deficit is going to be lower than it would be otherwise.”

That sounded great, but as we’ve come to understand with ObamaCare’s selling points, that means it’s probably false. And indeed we are getting more evidence on that score. The New York Times reports on the latest data from Oregon’s Medicaid study:

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“If you’ve got insurance, then … preventive care is going to be covered, and that should make a difference,” President Obama said in 2010, describing ways his unpopular health-care reform law “should save us all a lot of money. I mean, one of the toughest things about this health care debate was—and sometimes I fault myself for not having been able to make the case more clearly to the country—we spend—each of us who have health insurance spend about a thousand dollars of our premiums on somebody else’s care.”

How were we all spending that money on other patients’ care? “What happens is, you don’t have health insurance, you go to the emergency room,” and the costs for those expensive ER visits get passed along. “And that’s why,” Obama boldly declared, “we feel pretty confident that over the long term, as a consequence of the Affordable Care Act, premiums are going to be lower than they would be otherwise; health care costs overall are going to be lower than they would be otherwise. And that means, by the way, that the deficit is going to be lower than it would be otherwise.”

That sounded great, but as we’ve come to understand with ObamaCare’s selling points, that means it’s probably false. And indeed we are getting more evidence on that score. The New York Times reports on the latest data from Oregon’s Medicaid study:

Supporters of President Obama’s health care law had predicted that expanding insurance coverage for the poor would reduce costly emergency room visits because people would go to primary care doctors instead. But a rigorous new experiment in Oregon has raised questions about that assumption, finding that newly insured people actually went to the emergency room a good deal more often.

The study, published in the journal Science, compared thousands of low-income people in the Portland area who were randomly selected in a 2008 lottery to get Medicaid coverage with people who entered the lottery but remained uninsured. Those who gained coverage made 40 percent more visits to the emergency room than their uninsured counterparts during their first 18 months with insurance.

The pattern was so strong that it held true across most demographic groups, times of day and types of visits, including those for conditions that were treatable in primary care settings.

The findings, the Times correctly notes, “go against one of the central arguments of the law’s supporters”—a phrase we’re getting used to hearing by now. It’s another casualty not just of the dishonesty that marked the efforts to mislead the public enough to get the law through Congress but also of the degree of intellectual isolation so typical of ObamaCare’s supporters, who closed themselves off from the evidence that would have helped them make more informed decisions, as the Times adds:

“I suspect that the finding will be surprising to many in the policy debate,” said Katherine Baicker, an economist at Harvard University’s School of Public Health and one of the authors of the study.

Sure—when the government passes a major reform law first and asks questions about its bedrock assumptions later, don’t be surprised to be surprised as the facts reveal themselves. But is that intellectual isolation even an excuse? The Times piece not so subtly suggests that a combination of basic economics and common sense could have solved this puzzle for the administration’s pseudo-wonks:

Dr. Baicker and Amy Finkelstein, an economist at the Massachusetts Institute of Technology, another author, said the increased use of emergency rooms is driven by a basic economic principle: When services get less expensive, people use them more. Previous studies have found that uninsured people face substantial out-of-pocket costs that can put them in debt when they go to the emergency room. Medicaid reduces those costs.

No kidding. And that preempts a line in the story that might have put the administration’s ignorance in a better light—but is a blistering, if unintentional, condemnation of government in general. Readers are told that this Medicaid study is the “gold standard” in terms of being able to accurately analyze the effects of the policies under consideration, but that such experiments “are rarely used for domestic health care policy.”

The article is full of such now they tell us revelations, including doctors telling the Times that (contra President Obama) preventive care is quite limited in preventing ER visits, and policy experts saying that the cost savings would have been modest even if Obama had been right about such care—though he wasn’t.

But it’s actually worse for ObamaCare than it sounds, because the new health law risks exacerbating the situation—turning a minor increase in costs into a potentially more consequential expense. As CNN reported in October, “Obamacare is expected to increase patient demand for medical services. Combine that with a worsening shortage of doctors, and next year you may have to wait a little longer to get a doctor’s appointment.”

That wait time increase, according to one of the authors of the study, is a major factor, as might be expected, in the increase in ER visits:

Heidi Allen, an assistant professor at Columbia University and an author of the study, said much of the non-urgent emergency department use among patients she interviewed happened because those patients could not get same-day appointments with their primary care doctors.

Again, much of this is common sense, the rest basic economics. That neither seems to have been utilized in reforming America’s health-care system is both appalling and, by now, all too apparent.

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The Cruelty of ObamaCare

When ObamaCare’s individual mandate went before the Supreme Court, both sides argued over whether it was severable from the rest of the law–could one stand without the other? Severability also weighs on the law, in a more figurative sense, in its defense: now that we know the law isn’t working and won’t do what was promised, can the moral arguments used to bludgeon its opponents still be employed with any credibility?

That is, since ObamaCare’s defenders can no longer argue in favor of the law’s technical merits, can they still argue in favor of the law’s moral merits? The answer is no: as Frank Sinatra sang, you can’t have one without the other. The moral imperative of passing ObamaCare was always specious, since the administration wasn’t telling the truth when selling the law–and they knew it, having briefly debated whether or not the president should start telling the truth about the law and deciding to keep on misleading the public.

But ObamaCare’s defenders don’t have much left at this point, so they’re going to try loud, self-righteous hectoring to drown out the truth. The latest example is from the Washington Post’s Colbert King, who visited a church in Washington D.C. that seemed to spend its weekend politicking for the president’s agenda. King writes that this is because the people of this church are good people, and their attitude toward ObamaCare was in stark contrast with ObamaCare’s opponents, who are bad people. Yes, it’s really that simple according to King:

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When ObamaCare’s individual mandate went before the Supreme Court, both sides argued over whether it was severable from the rest of the law–could one stand without the other? Severability also weighs on the law, in a more figurative sense, in its defense: now that we know the law isn’t working and won’t do what was promised, can the moral arguments used to bludgeon its opponents still be employed with any credibility?

That is, since ObamaCare’s defenders can no longer argue in favor of the law’s technical merits, can they still argue in favor of the law’s moral merits? The answer is no: as Frank Sinatra sang, you can’t have one without the other. The moral imperative of passing ObamaCare was always specious, since the administration wasn’t telling the truth when selling the law–and they knew it, having briefly debated whether or not the president should start telling the truth about the law and deciding to keep on misleading the public.

But ObamaCare’s defenders don’t have much left at this point, so they’re going to try loud, self-righteous hectoring to drown out the truth. The latest example is from the Washington Post’s Colbert King, who visited a church in Washington D.C. that seemed to spend its weekend politicking for the president’s agenda. King writes that this is because the people of this church are good people, and their attitude toward ObamaCare was in stark contrast with ObamaCare’s opponents, who are bad people. Yes, it’s really that simple according to King:

The talk-show criticism and the pulpit defense crystallized the Obamacare debate. Drawn into sharp relief is the struggle taking place in this country between doing what is right and good and an unashamed indulgence in the immorality of indifference.

The issue couldn’t be put more simply.

Because ObamaCare is broadly unpopular, King is basically telling his readers they are bad people. Some of them may be “right and good,” but given the poll numbers, it’s clear King thinks a great many of them are indulging in “immorality.” This is a variation on a column by King’s Post colleague Matt Miller, who had earlier used the deaths of thousands in Typhoon Haiyan to tell his readers that they are bad people:

Disasters like Haiyan bring into sharp relief our moral instincts when faced with the paramount role that luck plays in life. When human beings are left vulnerable and desperate by events beyond their control, we want to help. Empathy for human frailty and powerlessness in such a tragedy evokes compassion. We say such victims “deserve” help because they are suffering through no fault of their own.

So of course we’re sending money and Marines to Manila.

A typhoon is obviously beyond anyone’s control. But so is a preexisting condition.

Now, Post readers could easily point out that King and Miller are arguing in favor of getting insurance to those who don’t have it, and since ObamaCare is kicking millions off their insurance plans while also preventing them from finding new (more expensive, of course) plans, perhaps it is King and Miller practicing “an unashamed indulgence in the immorality of indifference.”

But it should also be noted that a key element of greatly expanding coverage for poor and older Americans under ObamaCare is Medicaid, a program studies show serves people no better–and sometimes worse–than those without any insurance at all. This is when ObamaCare’s defenders finally get somewhat honest and admit that ObamaCare is not a health program but a wealth transfer. Medicaid, they say, is about preventing unaffordable health-care bills from piling up on those who can’t pay them.

ObamaCare opponents, who understand the health-care issue significantly better than big-government leftists, have tried to warn that expanding Medicaid will exacerbate the lack of doctors available to see Medicaid patients. Now that the media is playing catch-up, they can read the same analysis in the New York Times:

Medicaid for years has struggled with a shortage of doctors willing to accept its low reimbursement rates and red tape, forcing many patients to wait for care, particularly from specialists like Dr. Mazer.

Yet in just five weeks, millions of additional Americans will be covered by the program, many of them older people with an array of health problems. The Congressional Budget Office predicts that nine million people will gain coverage through Medicaid next year alone. In many of the 26 states expanding the program, the newly eligible have been flocking to sign up. …

In California, with the nation’s largest Medicaid population, many doctors say they are already overwhelmed and are unable to take on more low-income patients. Dr. Hector Flores, a primary care doctor in East Los Angeles whose practice has 26,000 patients, more than a third of whom are on Medicaid, said he could accommodate an additional 1,000 Medicaid patients at most.

“There could easily be 10,000 patients looking for us, and we’re just not going to be able to serve them,” said Dr. Flores, who is also the chairman of the family medicine department at White Memorial Medical Center in Los Angeles.

What happens if you give people coverage but they can’t be seen by a doctor? Or they have to wait so long to get an appointment, if they can get one at all, that what should have been an easily treatable condition worsens significantly? The health outcomes will often be terrible, and the bills will pile up anyway. Their other choice is, of course, to pay out of pocket for a doctor who doesn’t take Medicaid. Which they could have done anyway, before waiting months for an appointment and now living in agony.

All this aggravation would come as the government promised them those days were over and they could now get health coverage. This process, which underpins ObamaCare’s major expansion of coverage, is cruel. And the moralizers in the liberal commentariat passing judgment on those who oppose this malicious process might want to take that into consideration.

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More Trouble for ObamaCare

In March 2011, Avik Roy wrote about something that constituted, in his opinion, “simply put, the greatest scandal in America. Bigger than Madoff, bigger than the Wall Street bailout, bigger even than the plight of the uninsured.” The scandal was a study demonstrating that “despite the fact that we will soon spend more than $500 billion a year on Medicaid, Medicaid beneficiaries, on average, fared worse than those with no insurance at all.” (Emphasis in the original.)

Indeed, Medicaid does not tend to fare well when tested. But yesterday’s news was among the worst that proponents of expanded Medicaid and its larger ObamaCare policy disaster could have received. The New England Journal of Medicine reported the results of a study conducted by major health-policy scholars–including ObamaCare advisor Jonathan Gruber–further showing that Medicaid is an expensive bust. The conclusion from the study authors:

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In March 2011, Avik Roy wrote about something that constituted, in his opinion, “simply put, the greatest scandal in America. Bigger than Madoff, bigger than the Wall Street bailout, bigger even than the plight of the uninsured.” The scandal was a study demonstrating that “despite the fact that we will soon spend more than $500 billion a year on Medicaid, Medicaid beneficiaries, on average, fared worse than those with no insurance at all.” (Emphasis in the original.)

Indeed, Medicaid does not tend to fare well when tested. But yesterday’s news was among the worst that proponents of expanded Medicaid and its larger ObamaCare policy disaster could have received. The New England Journal of Medicine reported the results of a study conducted by major health-policy scholars–including ObamaCare advisor Jonathan Gruber–further showing that Medicaid is an expensive bust. The conclusion from the study authors:

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.

In other words, it’s a middle class-financed bailout of Medicaid beneficiaries, not a health care program. But it’s expensive, and it’s a major component of increased insurance coverage under ObamaCare. None of this is too surprising to conservative health policy analysts, who have been pointing this out for years. But it may come as a surprise to liberal supporters of ObamaCare who, as their reaction to opening arguments at the Supreme Court last year demonstrated, were shielded from the data by their furious commitment to epistemic closure.

It was difficult to argue that Medicaid expansion was the right way to go, since the data don’t support such a claim. And it was patently absurd to claim–though ObamaCare boosters tried anyway–that if you liked your insurance, you could keep it (ObamaCare was specifically designed to undercut such a claim, and the government knew it). So without the data or, in many cases, simple logic on their side, ObamaCare proponents resorted to the accusation that opposing ObamaCare was akin to attempted mass murder.

But liberals also resorted to all manner of claims about the current American health-care sector that would be fixed by passing their favored legislation. Megan McArdle, at the time writing for the Atlantic, noted:

Judging by the statistics that have been used to sell this thing, over and over, liberals are expecting big things.

1) Ezra Klein is confidently predicting that it will save hundreds of thousands of lives.

2) Nick Kristoff (sic) expects miraculous improvement in our national life expectancy.

3) Michael Moore thinks this will stop people from getting thrown out of their homes in a Medical bankruptcy.

4) At least one of you must be willing to claim massive improvements in infant mortality, after you’ve cited those statistics to me over and over.

McArdle proposed simply that we hold liberals to their predictions, allowing them some leeway for overstatement in the heat of the moment. In a follow-up post, McArdle responded to ObamaCare’s proponents who had objected to the suggestion that they be held accountable for their claims.

McArdle, now with the Daily Beast, reacts to the new Medicaid study, as do Avik Roy and Phil Klein. This is big news, McArdle concludes:

And it’s actually bigger, and more important than Obamacare.  We should all be revising our priors about how much health insurance–or at least Medicaid–really promotes health.  What this really tells us is how little we know about health care, and making people healthy–and how often data can confound even our most powerful intuitions.

McArdle is right that ObamaCare was supposed to bend the cost curve down and save lives, and this sort of thing should have us rethinking the issue. The big question is: will the introduction of important new facts change the opinions of ObamaCare supporters on the left? It’s difficult to imagine that happening, because the ObamaCare fight was never about data or empirical scholarship; for the left, it was about ideology.

I don’t say this to suggest that liberals didn’t really think ObamaCare would save the lives of poor Americans. I’m sure they did. It’s just that this belief was taken on faith and ideological assumptions, not evidence. And for that reason, they won’t be looking at the new Medicaid study the way policy experts might expect.

A perfect example of this sort of thinking came last month, when a New America Foundation study advocated adding almost $1 trillion to Social Security payments with no mechanism to pay for it, and the study received cheers from the left. I wrote at the time that the study “should really just be one sentence: People would have more money if we gave them more money.”

The reaction to this Medicaid study may very well be similar. Although people on Medicaid didn’t get better health care, they didn’t have to pay for the subpar health care the government provided for them by transferring wealth from other struggling, but less poor, Americans. All that happened was that the government gave people money, and they liked receiving that money. That’s good enough for a leftist movement that believes, against all evidence, that increased government control is a worthy policy goal–and justification for massive reform projects–all by itself.

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It’s Not About the Price of Pizza

Yesterday, Jonathan wrote about the increased price of pizza for customers of Papa John’s in light of the Affordable Care Act, showcasing a very real-world and imminent example of how the healthcare law will increase costs not just for taxpayers, but also for consumers. Many of our respondents held this view:

It is shocking that the CEO of Papa John’s and this magazine commentator would begrduge the near-poor workers of that company health insurance — and better healthcare for a few cents per pie!! Our country is based on the premise that we all pay a little more to help those less fortunate — the key here is “a little more.” Does anyone really object to that??

What this person and other liberals have wrong is this: It’s not about the price of pizza. If it were actually possible to improve healthcare for millions of Americans and insure millions more, conservatives would be on board. The basis of conservative opposition to ObamaCare is this: We do not think it will help the majority of Americans. The bill is titled the “Affordable Care Act,” but does nothing to make healthcare more affordable, nor will it improve health care. In reality, it provides a worse standard of care at a higher cost.

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Yesterday, Jonathan wrote about the increased price of pizza for customers of Papa John’s in light of the Affordable Care Act, showcasing a very real-world and imminent example of how the healthcare law will increase costs not just for taxpayers, but also for consumers. Many of our respondents held this view:

It is shocking that the CEO of Papa John’s and this magazine commentator would begrduge the near-poor workers of that company health insurance — and better healthcare for a few cents per pie!! Our country is based on the premise that we all pay a little more to help those less fortunate — the key here is “a little more.” Does anyone really object to that??

What this person and other liberals have wrong is this: It’s not about the price of pizza. If it were actually possible to improve healthcare for millions of Americans and insure millions more, conservatives would be on board. The basis of conservative opposition to ObamaCare is this: We do not think it will help the majority of Americans. The bill is titled the “Affordable Care Act,” but does nothing to make healthcare more affordable, nor will it improve health care. In reality, it provides a worse standard of care at a higher cost.

Under ObamaCare, 17 million Americans will be added to Medicaid’s rolls in order to move some Americans from the uninsured to the insured column. Are they actually better off? In National Review, Avik Roy demonstrates why they are not. He explains:

In July 2010, at National Review Online’s Critical Condition blog, I wrote about a University of Virginia study, published in Annals of Surgery, finding that surgical patients on Medicaid endured a 97 percent higher likelihood of in-hospital death than patients with private insurance, and a 13 percent greater chance of death than those with no insurance at all. I noted several other clinical studies that showed similar results.

Roy is an expert on the perils of Medicaid and recently published a heartbreaking story about a young boy on Medicaid who died from a simple tooth abscess. This story is heartbreaking not only because it was entirely preventable, but also because this is the broken system that millions of vulnerable Americans are subjected to and millions more are about to experience. Two years ago, before I was with COMMENTARY, and before I even worked in the conservative movement, I wrote a post on my personal blog about growing up on Medicaid. This young boy’s story about dying from a tooth abscess could have been my own; it almost was. I could not find a reputable dentist that would accept my insurance and when I was finally able to get an appointment with a dentist that accepted Medicaid I experienced nothing but fraud and incompetence. I also could not find a reliable oral surgeon for a simple wisdom tooth extraction. The one I ended up with charged Medicaid for general anesthesia which he did not administer — I was wide awake for my entire surgery. My experience was far from unique, and this is the system that we’re now set to expand under ObamaCare.

There are many more costly provisions on deck for ObamaCare before we see the full effect of the healthcare law. Jonathan’s post about the increased cost of pizza was just the tip of the iceberg. Not only will we see more costs ahead (in the form of increased goods and services, taxes and healthcare premiums), but we will also see a marked decline in the quality of our healthcare with fewer doctors to administer it.

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