Posted: May 06, 2013 7:11 am
John Chait has the best way with words:
Tyler Cowen asks, “Who is now willing to write?: 'The case for Medicaid expansion is not as strong as I had thought,' data caveats can follow after that.”
Okay: The case for Medicaid expansion is not as strong as I had thought. Now for the caveats: The case for Medicaid expansion is overwhelmingly strong. If a study found that puppies survive steep falls at a higher rate than expected, then you could say the case for throwing puppies out of skyscraper windows has marginally weakened, but would remain extremely strong. Indeed, data notwithstanding, either throwing puppies out of skyscrapers or throwing people off Medicaid are both acts of sadism.
The United States has very high levels of income inequality, a very stingy welfare state, and is the only advanced economy that does not guarantee access to medical care. The Oregon study does not raise particular questions about the efficacy of Medicaid; it raises questions about the efficacy of medical care in general. Measuring the impact of medicine is just really hard to do, yet almost nobody would volunteer to follow this frustrating fact to its logical conclusion and forgo the benefits of modern medicine.
And the Oregon study is not pushing the political debate toward a rethinking of the benefits of medicine writ large. It is only strengthening the hand of those who want to deny it to people who can’t afford health insurance. The Oregon study results from an unusual circumstance: The state had the budget to add 10,000 people to Medicaid, but far more who wanted to join, so it conducted a lottery. It is only the poor who can be subjected to Hunger Games–style experimentation with their health. In any other advanced country, in which medical care is a basic right, such an experiment would be wildly unethical.
We know that Medicaid makes people happier and less poor. We have trouble proving its impact on their physical well-being because proof of the benefits of medicine remain elusive. Unless we want to stop thinking of basic medical care as a life necessity, and we don’t, the case for Medicaid remains unimpeachable.
Tyler Cowen asks, “Who is now willing to write?: 'The case for Medicaid expansion is not as strong as I had thought,' data caveats can follow after that.”
Okay: The case for Medicaid expansion is not as strong as I had thought. Now for the caveats: The case for Medicaid expansion is overwhelmingly strong. If a study found that puppies survive steep falls at a higher rate than expected, then you could say the case for throwing puppies out of skyscraper windows has marginally weakened, but would remain extremely strong. Indeed, data notwithstanding, either throwing puppies out of skyscrapers or throwing people off Medicaid are both acts of sadism.
The United States has very high levels of income inequality, a very stingy welfare state, and is the only advanced economy that does not guarantee access to medical care. The Oregon study does not raise particular questions about the efficacy of Medicaid; it raises questions about the efficacy of medical care in general. Measuring the impact of medicine is just really hard to do, yet almost nobody would volunteer to follow this frustrating fact to its logical conclusion and forgo the benefits of modern medicine.
And the Oregon study is not pushing the political debate toward a rethinking of the benefits of medicine writ large. It is only strengthening the hand of those who want to deny it to people who can’t afford health insurance. The Oregon study results from an unusual circumstance: The state had the budget to add 10,000 people to Medicaid, but far more who wanted to join, so it conducted a lottery. It is only the poor who can be subjected to Hunger Games–style experimentation with their health. In any other advanced country, in which medical care is a basic right, such an experiment would be wildly unethical.
We know that Medicaid makes people happier and less poor. We have trouble proving its impact on their physical well-being because proof of the benefits of medicine remain elusive. Unless we want to stop thinking of basic medical care as a life necessity, and we don’t, the case for Medicaid remains unimpeachable.