Study: Giving People Government Health Insurance May Not Make them Any Healthier

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    May 04, 2013 1:48 AM GMT
    Oops...

    http://www.thedailybeast.com/articles/2013/05/01/shocker-oregon-health-study-shows-no-significant-health-impacts-from-joining-medicaid.html

    Bombshell news out of Oregon today: a large-scale randomized controlled trial (RCT) of what happens to people when they gain Medicaid eligibility shows no impact on objective measures of health. Utilization went up, out-of-pocket expenditure went down, and the freqency of depression diagnoses was lower. But on the three important health measures they checked that we can measure objectively--glycated hemoglobin, a measure of blood sugar levels; blood pressure; and cholesterol levels--there was no significant improvement.
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    May 04, 2013 11:29 AM GMT
    I don't ever recall people making the argument that universal healthcare coverage makes people healthier. That's an asinine argument. Having insurance in of itself isn't going to make you healthier.

    However, not having it will mean that you are screwed if you need those services. It is a fact that mortality rates are linked to rates of being insured. The segment of the population that has access to healthcare has a lower mortality rate than those that don't.

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    May 04, 2013 11:59 AM GMT
    If you look at the outcomes they measured they were all metabolic disease oriented (blood pressure, cholesterol, sugar, ect). The healthcare system doesnt do a great job of controlling these in the private insurance patients (which pays much more than medicaid does) so why should we expect it to be any different? The fundamental flaw with all of these "reforms" is that they dont address the primary underlying reason behind bad health in America, poor diet and physical inactivity. Simply giving people more insurance wont fix this.
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    May 04, 2013 12:15 PM GMT
    From the article:

    This study is a big, big deal. Let me explain why.


    The Health Wonk's Conundrum: It's Damned Hard to Stuy the Effects of Being Uninsured


    We think we know that giving people more access to doctors at lower cost makes them healthier--it's only intuitive, right? Otherwise, why are we spending so much time agonizing over whether to pay extra every month for the PPO?

    But finding something intuitively plausible isn't actually the same as knowing it.

    Until 2011, there had been only one RCT of health insurance. Most of the studies of health insurance are panel studies. You take years worth of data from the same people, like census surveys, or the National Health and Nutrition Examination Survey. You start with year one and divide people into groups: those who have insurance, and those who don't. And then you look at what happens to them over time. There are some problems with this, of course. For one thing, those people didn't necessarily stay uninsured; most people who are uninsured lose insurance for only a few months. And the surveys don't necessarily have all the data you'd ideally like to look at to see the effect of insurance on health. So these studies have tended to focus on mortality, because it's a piece of data that virtually every survey collects, and it's fairly unambiguous. We all agree on what it means to be "dead". And also, that being dead is definitely very bad.

    Most of you probably have probably heard the statistic that being uninsured kills 18,000 people a year. Or maybe it's 27,000. Those figures come from an Institute of Medicine report (later updated by the Urban Institute) that was drawn from these sorts of studies.

    The biggest problem these studies have is that people who have health insurance are different from people who don't--and not just because they don't have a pretty white card from Aetna.

    Some of the differences we know about: the uninsured are poorer, more likely to be unemployed or marginally employed, and to be single, and to be immigrants, and so forth. And being poor, and unemployed, and from another country, are all themselves correlated with dying sooner.

    Then there are the differences that we don't know about--that don't show up in any of the big panel surveys. For example, say you have very poor impulse control. You are probably more likely than the average citizen to end up uninsured, because you are probably more likely than the average citizen to end up divorced, fired, and with a prison record. You are probably also more likely than the average citizen to drive without your seatbelt, ride your motorcycle helmetless while sipping a beer, or subsist on nothing but pork rinds and Mountain Dew for weeks at a time. When you finally drive that Harley into a tree, your death will raise the mortality rate for the uninsured, even though it would have taken something much stronger than an insurance policy to keep you alive. This is a problem that social scientists call "omitted variable bias", and it plagues the hell out of most studies of health insurance.

    To give you a taste of what I mean: panel studies not infrequently show that putting people on Medicare or Medicaid kills them. No, I'm not kidding. According to some of the studies (the same ones that show being uninsured kills), people on Medicare and Medicaid have higher mortality rates than people with no insurance at all, even after you control for things like age, and smoking.

    Okay, you can tell a story where Medicaid is actually killing people: maybe only bad doctors take Medicaid, and going to a bad doctor is worse than going to no doctor at all. (In health-wonk jargon, this is known as "iatrogenic mortality"). But really, how likely is this? The authors of the studies have explained--convincingly!--that people on Medicaid are more likely to be poor, and have substance abuse problems, and all manner of other issues that make them die sooner, so that what you were seeing was not actually the effect of being on Medicaid, but the effect of being the kind of person who goes on Medicaid.

    The problem is, the same sort of problems plague the data about the uninsured. Ultimately, there's a danger that we're doing an intuition gut check: it doesn't make sense that Medicaid would kill you, while it makes perfect sense that being uninsured would, so we look for reasons that Medicaid patients are different . . . and then stop before we get to the uninsured. Oh, there are some observational studies to support those beliefs, but there's always the risk that a heavy dose of "that just doesn't make any sense" is creeping into our analysis.

    Meanwhile, some of the observational studies don't even show any benefit from insurance. For example, one study that looked at old people before and immediately after the establishment of Medicare showed that putting the entire over-65 population on health insurance produced zero detectable improvement in their mortality rates. And the biggest observational study of all, with over 600,000 people in it, showed no mortality benefit from insurance. This was not done by some conservative crank: the author was Richard Kronick, a UC San Diego professor who was an advisor to the Clinton Administration.
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    May 04, 2013 12:54 PM GMT
    Guess which one of these countries does not provide universal government health insurance?

    060511krugman1-blog480.jpg
    http://www.commonwealthfund.org/News/News-Releases/2010/Jun/US-Ranks-Last-Among-Seven-Countries.aspx
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    May 04, 2013 1:05 PM GMT
    Ex_Mil8 saidGuess which one of these countries does not provide universal government health insurance?

    060511krugman1-blog480.jpg
    http://www.commonwealthfund.org/News/News-Releases/2010/Jun/US-Ranks-Last-Among-Seven-Countries.aspx


    Given that what these two studies on the effect of health insurance point out that they have little effect on health outcomes, your link becomes irrelevant.
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    May 04, 2013 1:18 PM GMT
    riddler78 said

    Given that what these two studies on the effect of health insurance point out that they have little effect on health outcomes, your link becomes irrelevant.


    Inconvenient perhaps, but hardly irrelevant.

    How is 'Long, Healthy, Productive Lives' not a health outcome?
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    May 04, 2013 1:27 PM GMT
    Ex_Mil8 said
    riddler78 said

    Given that what these two studies on the effect of health insurance point out that they have little effect on health outcomes, your link becomes irrelevant.


    Inconvenient perhaps, but hardly irrelevant.

    How is 'Long, Healthy, Productive Lives' not a health outcome?


    Hardly inconvenient, irrelevant. What are you saying "long healthy productive lives" is an outcome of? The two studies suggest that this isn't health insurance - and your survey doesn't do anything to show causation.
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    May 04, 2013 1:49 PM GMT
    riddler78 said
    What are you saying "long healthy productive lives" is an outcome of? The two studies suggest that this isn't health insurance - and your survey doesn't do anything to show causation.


    From the same report:

    "LONG, HEALTHY, AND PRODUCTIVE LIVES
    The goal of a well-functioning health care system is to ensure that people lead long, healthy, and productive lives. To measure this dimension, the Commission’s National Scorecard report includes outcome indicators such as mortality amenable to health care—that is, deaths that could have been prevented with timely and effective care; infant mortality; and healthy life expectancy."
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    May 04, 2013 1:56 PM GMT
    Ex_Mil8 said
    riddler78 said
    What are you saying "long healthy productive lives" is an outcome of? The two studies suggest that this isn't health insurance - and your survey doesn't do anything to show causation.


    From the same report:

    "LONG, HEALTHY, AND PRODUCTIVE LIVES
    The goal of a well-functioning health care system is to ensure that people lead long, healthy, and productive lives. To measure this dimension, the Commission’s National Scorecard report includes outcome indicators such as mortality amenable to health care—that is, deaths that could have been prevented with timely and effective care; infant mortality; and healthy life expectancy."


    Again, your study fails. It doesn't show causation. The other studies took a randomized group within the US to put on medicare to compare them with those who didn't get on showing that the benefits - insofar as healthcare outcomes are next to non existent.

    So to put it in context, even with health insurance, there's nothing your study shows to suggest that the problems wouldn't still exist except that there would be a checkbox ticked for health insurance and the number insured.
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    May 04, 2013 2:06 PM GMT
    riddler78 said
    So to put it in context, even with health insurance, there's nothing your study shows to suggest that the problems wouldn't still exist except that there would be a checkbox ticked for health insurance and the number insured.


    The tenet of your thread title is that 'Giving People Government Health Insurance May Not Make them Any Healthier'.

    The Commonwealth Fund report tends to indicate that, in those industrialized countries where government does 'give people health insurance', people are generally healthier (and for half the price).
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    May 04, 2013 2:26 PM GMT
    Ex_Mil8 said
    riddler78 said
    So to put it in context, even with health insurance, there's nothing your study shows to suggest that the problems wouldn't still exist except that there would be a checkbox ticked for health insurance and the number insured.


    The tenet of your thread title is that 'Giving People Government Health Insurance May Not Make them Any Healthier'.

    The Commonwealth Fund report tends to indicate that, in those industrialized countries where government does 'give people health insurance', people are generally healthier (and for half the price).


    Take a step back. The argument that the Commonwealth Fund makes is that because you have health insurance in these other countries, "people are generally healthier"

    The problem with this argument is that it doesn't show causation. They argue that the cause is health insurance, but really it could be anything. In fact, if you look at the recent latest study - which did the randomized comparison between those with insurance and those without, it showed in fact the difference wasn't health insurance. So again, all your study shows is that there's a difference in healthcare outcomes - it doesn't show why and it certainly doesn't show that it's because of health insurance.
  • GQjock

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    May 04, 2013 5:20 PM GMT
    Healthier????

    How about checking out with you little biased browser how many people DIE every year because they can't afford health insurance
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    May 04, 2013 5:26 PM GMT
    GQjock saidHealthier????

    How about checking out with you little biased browser how many people DIE every year because they can't afford health insurance


    Voila, what some Doctors have to say:

    http://www.reuters.com/article/2009/09/17/us-usa-healthcare-deaths-idUSTRE58G6W520090917


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    May 04, 2013 10:43 PM GMT
    meninlove said
    GQjock saidHealthier????

    How about checking out with you little biased browser how many people DIE every year because they can't afford health insurance


    Voila, what some Doctors have to say:

    http://www.reuters.com/article/2009/09/17/us-usa-healthcare-deaths-idUSTRE58G6W520090917




    Except their study was done post facto - they looked at mortality given they had or didn't have health insurance - which may or may not be causal (eg the people have higher mortality because they were poor and associated lifestyle choices versus rich. The other study in the OP was based on similar population group and randomization of participants that they tracked over several years.
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    May 04, 2013 10:45 PM GMT
    Meanwhile - reinforcing fact that not all government enforced healthcare systems are the same:
    http://reason.com/blog/2013/05/01/democrats-in-congress-are-increasingly-w

    Last week The New York Times noted that Democrats on Capitol Hill were increasingly concerned about the rollout of Obamacare. The Hill follows up with a report today noting that “anxious Democrats fear a botched implementation of ObamaCare could dash their hopes of controlling the House and Senate for President Obama’s last two years in office.”
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    May 05, 2013 12:00 AM GMT

    Meanwhile the rest of us have google which we use to get real info rather than spin doctored opinions.
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    May 05, 2013 12:48 AM GMT
    meninlove said
    Meanwhile the rest of us have google which we use to get real info rather than spin doctored opinions.


    That's right - because you have this inability to read and interpret. Again, did you bother to read either of the studies or did you just choose from the study that you thought best represented your views?

    There's an empirical answer here as to which study is in fact stronger evidence - and in your case, not really evidence of what you thought at all - and on top of that, from an advocacy group. But yes, I do think others should google or (gasp!) bother reading each.
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    May 05, 2013 6:53 AM GMT
    Whenever you read an article about "a study' the FIRST thing you need to do is find the study and read it for yourself.

    http://www.nejm.org/doi/full/10.1056/NEJMsa1212321


    RESULTS
    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.

    CONCLUSIONS
    This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.

    -----------

    In short it did EXACTLY what health insurance is supposed to do, give you access to health care and an ability to manage your health. Secondarily, prevent the chance of you being unable to cover the costs of catastrophic injury (i.e. car accidents, brain aneurysm etc.,)

    What would have happened to these people if they weren't diagnosed with diabetes and given medication management? They would have become progressively worse, and could develop serious life threatening conditions. They were spared that.

    So, anyone trying to spin this as a failure of the affordable care act... is being ridiculous.

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    May 05, 2013 1:10 PM GMT
    Adam228 saidWhenever you read an article about "a study' the FIRST thing you need to do is find the study and read it for yourself.

    http://www.nejm.org/doi/full/10.1056/NEJMsa1212321


    RESULTS
    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.

    CONCLUSIONS
    This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.

    -----------

    In short it did EXACTLY what health insurance is supposed to do, give you access to health care and an ability to manage your health. Secondarily, prevent the chance of you being unable to cover the costs of catastrophic injury (i.e. car accidents, brain aneurysm etc.,)

    What would have happened to these people if they weren't diagnosed with diabetes and given medication management? They would have become progressively worse, and could develop serious life threatening conditions. They were spared that.

    So, anyone trying to spin this as a failure of the affordable care act... is being ridiculous.



    Exactly what health insurance is supposed to do? You would ALSO expect health coverage to impact "physical health outcomes". Did you forget or deliberately ignore that this was measured against a control group of whom there would be a number that would have undiagnosed "serious life threatening conditions?

    What are you claiming would be the success of the affordable care act? This study looks at *Medicare*. This study puts directly into question as to the numbers that have been claimed through extrapolation that "44,000 people a year die from lack of health insurance".

    Given that the ACA hasn't been completely implemented yet, the failures are yet to come - in cost overruns, exclusions and outright failures in coverage. And that's the outcome of a poorly written bill - but that's not what this study aims to or claims to address.
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    May 05, 2013 8:26 PM GMT
    More on why and how this study is important:
    http://www.forbes.com/sites/aroy/2013/05/02/oregon-study-medicaid-had-no-significant-effect-on-health-outcomes-vs-being-uninsured/

    For three years, an incredibly nerdy—but consequential—debate has raged among health policy researchers regarding Medicaid, America’s government-run health-care program for the poor. Piles of studies have shown that people on Medicaid have health outcomes that are no better, and often worse, than those with no insurance at all. But supporters of Obamacare were cheered in 2011 when a lone study, out of Oregon, purported to show that Medicaid was better than being uninsured. Yesterday, however, the authors of the Oregon study published their updated, two-year results, finding that Medicaid “generated no significant improvement in measured physical health outcomes.” The result calls into question the $450 billion a year we spend on Medicaid, and the fact that Obamacare throws 11 million more Americans into this broken program.
  • TroyAthlete

    Posts: 4269

    May 06, 2013 12:10 AM GMT
    Adam228 said
    In short it did EXACTLY what health insurance is supposed to do, give you access to health care and an ability to manage your health. Secondarily, prevent the chance of you being unable to cover the costs of catastrophic injury (i.e. car accidents, brain aneurysm etc.,)

    What would have happened to these people if they weren't diagnosed with diabetes and given medication management? They would have become progressively worse, and could develop serious life threatening conditions. They were spared that.

    So, anyone trying to spin this as a failure of the affordable care act... is being ridiculous.



    Facts don't matter to riddler78, also known as RealJock's Daily Fail Guy. Whenever he posts, you have to keep in mind this is someone who believed Romney was going to win in a landslide. That tells you all you need to know about his ability to interpret information.
  • GQjock

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    May 06, 2013 12:33 AM GMT
    riddler78 said
    meninlove said
    GQjock saidHealthier????

    How about checking out with you little biased browser how many people DIE every year because they can't afford health insurance


    Voila, what some Doctors have to say:

    http://www.reuters.com/article/2009/09/17/us-usa-healthcare-deaths-idUSTRE58G6W520090917




    Except their study was done post facto - they looked at mortality given they had or didn't have health insurance - which may or may not be causal (eg the people have higher mortality because they were poor and associated lifestyle choices versus rich. The other study in the OP was based on similar population group and randomization of participants that they tracked over several years.


    Do you hear yourself?????
    The people have higher mortality rates because they WERE POOR and had ASSOCIATED LIFESTYLE CHOICES?
    Rid you cannot be that dense ... IC that you at least are able to type and gather information ... however ill-conceived that may be
    But the ENTIRE argument over healthcare IS that only SOME people can get it and the people with "IT" have the MONEY for "IT"
  • Apparition

    Posts: 3525

    May 06, 2013 7:17 AM GMT
    here is a better study riddler. If you were suddenly unemployed, and you say, cut off a few fingers accidentally, would you rather have them sewn back on using your universal insurance, or pay 80 grand to get them sewn back on.

    THAT is the only study required.

    ALL people with universal health care are willing to pay a little more in taxes so that nobody every goes bankrupt due to health. To live without it is INSANE to them, they would NEVER give it up EVER.

    Everyone with universal healthcare thinks that anyone campaigning against it, is INSANE.
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    May 06, 2013 10:24 AM GMT
    GQjock said
    riddler78 said
    meninlove said
    GQjock saidHealthier????

    How about checking out with you little biased browser how many people DIE every year because they can't afford health insurance


    Voila, what some Doctors have to say:

    http://www.reuters.com/article/2009/09/17/us-usa-healthcare-deaths-idUSTRE58G6W520090917




    Except their study was done post facto - they looked at mortality given they had or didn't have health insurance - which may or may not be causal (eg the people have higher mortality because they were poor and associated lifestyle choices versus rich. The other study in the OP was based on similar population group and randomization of participants that they tracked over several years.


    Do you hear yourself?????
    The people have higher mortality rates because they WERE POOR and had ASSOCIATED LIFESTYLE CHOICES?
    Rid you cannot be that dense ... IC that you at least are able to type and gather information ... however ill-conceived that may be
    But the ENTIRE argument over healthcare IS that only SOME people can get it and the people with "IT" have the MONEY for "IT"


    The poorer tend to be more overweight and have other health conditions versus the rich - there are many reasons for this - but yes, there are *choices*. Or do you deny this?