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.
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.