Oregon Medicaid Results: Half Full or Missing the Point?
Much as been written this past week about the second year results of the Oregon Medicaid lottery experiment. (See Avik Roy’s post at Forbes for a clear and full background.)
I believe the results from this study will drive many future decisions about Medicaid and how it is structured given the methodological uniqueness of the program.
While the results have largely been spun in the direction of how one views the ACA, the real debate in the Medicaid program should be how to best use public dollars in order to assist low-income families and the disabled.
From my perspective, it is not a matter solely of the amount of money being spent, I (along with Avik) would be happy to continue spending if we knew we were getting good results. However, Oregon has questioned that basic argument for Medicaid.
Even Jon Gruber seems to have reframed his opinion based on this experiment:
I would view this study as somewhat weakening the argument for universal coverage based on health improvements and greatly strengthening the argument based on financial security and mental well being.
This is like referencing a study that finds kids going to school results in
very little learning, but improves socialization and increases the diagnosis of
ADHD. Don’t get me wrong, both positive outcomes, but not the primary rationale
for schooling, and reason enough to question some of the underpinnings of the
If the goal of Medicaid is improved financial security and better mental health
assessment, then we should provide a catastrophic insurance plan and improve
screening and treatment services for mental health. This program would be
significantly cheaper than the status quo, and free up additional funds to address
some of the flaws in the current system. For example, we could guarantee better
access to doctors for those on Medicaid by paying more like a “concierge medicine service,” which would better coordinate care.
This is the debate that should be happening, not reframing the results to focus on the half-full glass, while the vulnerable linger in a $450 billion a year mixed results program. Don’t they deserve better?