Friday, June 26, 2015

Yeah! Obamacare is here to stay

... at least if the next President is a Democrat.

“In America health care is not a privilege for a few but a right for all,’’ Mr. Obama declared in the Rose Garden after the Supreme Court decision.

It was nice to hear the Prez make the moral case for providing health care to all, in addition to the prudential and economic cases. It would also be nice if health care were available to all -- but the ACA is step in that direction.

The health policy wonks are chattering about a study of a naturally occurring experiment: Oregon lacked the funds to extend Medicaid to an entire group that would have been eligible, so it assigned the small number of available slots by lottery. Health economists thus could study the difference in health outcomes between the winners and the much larger population of losers. Guess what? The winners were not (over a short period) any healthier now that they could see doctors. But they were happier and more financially secure. Well duh ...

Ezra Klein points out the limits of this study clearly:

... the paper can't answer whether there are gains from giving people actual Medicaid insurance rather than leaving them to whatever patchwork, uncertain system of care they're using now. That is to say, it doesn't even try to estimate how much it's worth to be able to see a doctor when you need one, as opposed to when the situation is so dire you simply rush to the ER; it doesn't know how to value the long-term health benefits of stable care or the differences in the kind of care that the insured and the uninsured get; it has no formula for weighing what it means for John to be able to get treatment without begging his brother to lend him cash.

Second, there is real cost — in anxiety and terror, as well as in money — to families scrambling to come up with the money to pay for heart medication or chemotherapy. There's real cost to parents who need to beg their local church group to help pay for their child's medicine. How do we value the relief a family gets — both emotional and financial — of knowing a child can get the medical care he or she needs? This study can't measure that.

Third, the study can't test the value we, as a society, place on everyone being able to go to the doctor when they need medical care. As an example, Social Security offsets a certain amount of support children used to provide for their parents. So a dollar in Social Security is not worth a full dollar to Social Security's beneficiaries, because it partially replaces support they would have gotten anyway. But as a society, we've decided it's really, really important for the elderly to have guaranteed income, and we are willing to pay the cost of that guarantee.

And there's another potential benefit from Obamacare's survival that I've written about here -- and about which I have not found much research. Before the ACA passed, a student of health economics who has made it his business to understand these things assured me that having health insurance was close to a complete predictor of being registered to vote. He didn't know why, but he'd seen the figures.

Well, millions more citizens now have and will have insurance. Might this not lead to increased voter registration? Certainly most people who can manage to sign up for a policy online are demonstrating the contemporary skills that might suggest they can navigate the various registration mazes set up by the states. Under the National Voter Registration Act of 1993 (NVRA), the exchanges should be pointing their users toward whatever state facilities exist for registration. Just maybe, they'll use them.

Nobody could object to that ... except possibly Republicans who can't compete if everyone is included.


Hattie said...

Great days! And I'll bet the wedding planners on Maui are going nuts right now! Who woulda thunk it?

Hattie said...

The tension between inclusion and exclusion is clear now. Really good post, Jan.

Related Posts with Thumbnails