May 5, 2013

DID HE EVEN READ WHAT HE WROTE?:

Obamacare and the Mystery of Medical Science (Jonathan Chait, 5/03/13, New York)

Okay: The case for Medicaid expansion is not as strong as I had thought. [...]

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.

Mr. Chait has--even if accidentally--made a pretty good case that rather than wasting money on universal medical care, which makes little difference to people's health, we ought to use the money to supplement wealth and make social welfare more generous.  Of course, that's exactly what HSAs do and Medicaid does not do.  It's an essay at war with itself.



Posted by at May 5, 2013 12:20 PM
  

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