It must be tough these days to be a pro-Obamacare journalist. Every day brings more bad news that must be explained away. Thus, the implementation train wreck becomes the result of Republican parsimony, and skyrocketing health coverage premiums have to be blamed on insurance company greed. Likewise, any statistical analysis that suggests “reform” will accomplish little or nothing toward improving the health of those on whose behalf it was purportedly passed must be presented as evidence of progress. This type of fantasy literature is not easy to write.
Consequently, there must have been widespread consternation among the “reporters” tasked with writing such tales when the New England Journal of Medicine published a study last week showing that uninsured patients who go on Medicaid enjoy “no significant improvements in measured physical health outcomes.” This is a problem for the supporters of Obamacare because 10 to 15 million of the uninsured patients for whom the law will now provide coverage will get it via Medicaid. The obvious question that comes to mind is: What’s the point?
Moreover, this was no ordinary study. As Cato’s Michael Cannon describes it, “The Oregon Health Insurance Experiment, or OHIE, may be the most important study ever conducted on health insurance.” The state took a large number of low-income patients and used a lottery to randomly select which patients would receive Medicaid as well as which patients would not. Thus, as Cannon goes on to say, “The OHIE is the only randomized, controlled study ever conducted on the effects of having health insurance versus no health insurance.”
And its findings were devastating for the pro-Obamacare point of view. So, the PPACA pimps had to produce more bad fiction. The resultant fables were not, however, wholly devoid of value. Many were genuinely funny. The desperate effusions of Ezra Klein, for example, contained several howlers. In a blog post titled, “Here’s what the Oregon Medicaid study really said,” Klein provides this subtle analysis: “Here’s what we can say with certainty: Medicaid works as health insurance.… The people who got Medicaid used more health care …”
Klein admits that “the health care itself didn’t work as well as we hoped,” but attributes this to conjectural flaws in the study, including the claim that the sample size was too small. This has become the standard progressive excuse regarding this particular study. Kevin Drum also deploys it: “Unfortunately, the experiment was too small to be definitive.” Jonathan Cohn uses it as well: “It’s always possible that the limited sample size makes it hard to detect health effects that, by their nature, will affect a small group of people.”
And Klein, Cohn, and Drum are by no means alone in trotting out this talking point. In reality, however, there was no problem at all with the sample size. Avik Roy responds to the “too small” meme using one of my favorite words: “Balderdash.… In trials of drugs for high cholesterol, high blood pressure, and diabetes, such sample sizes are nearly always adequate for demonstrating whether or not the treatment is beneficial. If Medicaid were a new medicine applying for approval from the Food and Drug Administration, it would be summarily rejected.”
Not that this reality will prevent this ridiculous talking point from being endlessly repeated by Obamacare supporters. They really have no choice in the end. The facts are piling up and threatening to bury every assumption upon which Obamacare is based. And this study provides a particularly deadly set of data because Medicaid will play such an important role in whether the law succeeds or fails. As Cannon phrases it, “There is no way to spin these results as anything but a rebuke to those who are pushing states to expand Medicaid.”
But it’s possible that Cannon underestimates the ability of Obamacare’s supporters to introduce fiction and red herrings into the debate. Cohn, for example, makes much of the fact that “the people on Medicaid were about half as likely to experience other forms of financial strain — like borrowing money or delaying payments on other bills because of medical expenses.” Well, it’s pretty obvious that low-income people with free health coverage endure fewer financial difficulties than might otherwise be the case, but this study was about health outcomes.
Likewise, Drum complains that “the study says nothing at all about some more fundamental questions. Is Medicaid well run? Does it deliver better performance per dollar than some other programs?” Again, this was a study about medical outcomes! Thus, it also fails to draw conclusions concerning whether the Empress of Blandings deserved the prizes she won in the "Fat Pigs" class of the Shropshire Agricultural Show. For readers unfamiliar with the Empress, she was a huge sow who frequently figured in the novels of P.G. Wodehouse.
What has the Empress to do with this Medicaid study? Absolutely nothing, of course. And that’s the point. It’s safe to say, however, that if she were trotted out as a provision of Obamacare, people like Klein, Cohn, Drum and others of their ilk would earnestly promote her as an essential addition to American health care. They would get out their journalistic lipstick and tart her up in their columns and blog posts. And let’s face it, that would involve less work than spinning the Oregon Health Insurance Experiment to Obamacare’s advantage.