Wonky Wankers

Oh, no! A randomized controlled trial reveals that when poor people get medical insurance because they won a lottery, they don't instantaneously shed their ravaged, neglected bodies and become pictures of robust good health overnight. The wonkosphere is going nuts. Pseudoliberals worry that the "bombshell" results of an Oregon study on insured and uninsured poor people could put a damper on Obamacare's Medicaid expansion. Republican nihilists are crowing "we told you so" -- you give a bunch of takers gummint health care and they still get sick, so why waste money on them?

No matter that 10,000 lucky ducky Medicaid sweepstakes winners reported feeling a whole hell of a lot better mentally, just knowing they no longer had to pick between going to a doctor and eating. They may feel better, but they still have diabetes, hypertension and high cholesterol. The punditocracy is shocked, shocked that after lifetimes of living on the edge of mortality, the Medicaid study group did not immediately regain its health when accessing health care. These policy experts are not taking into account the continuing poor diets of the poor, that often the only food affordable to them is laden with sugar, salt, fat and chemicals. They're not taking into account the irreversible effects of environmental pollution on people. They're not taking into account the lingering, unaddressed scourge of income disparity. They are of the exceptional American mindset that a pill and a doctor visit should cure everything, overnight.

Zeke Emanuel, former health care advisor to the Obama Administration, calls the study results, published in the New England Journal of Medicine, "disappointing" -- not inconclusive, mind you! --which means they'll have to tinker with "the system." (code, probably, for privatizing it.) This is what happens to physicians when they turn into deficit-obsessed technocratic policy wonks, controlled by numbers instead of focusing on real people.

Slate's Ray Fisman writes:

Now that the clinical results have started to come in, it’s time for liberal media types like myself to eat some humble pie. Today’s New England Journal article presents a set of findings showing that Medicaid had no effect on a set of conditions where you would expect proper health management to make a difference. There are effective treatment protocols for hypertension, cholesterol, and diabetes, yet insurance status had no effect on blood pressure, cholesterol levels, or glycated hemoglobin (a measure of diabetic blood sugar control).

(Liberal media types like Fisman obviously buy into the insta-cure messages spewed over cable by Big Pharma snake oil salesmen.)

Conservatives, of course, are gleefully twisting the study results into their own toxic pretzels. They argue that since expanded Medicaid coverage means more people will finally be diagnosed with disease, it naturally follows that Medicaid actually makes people sick! The Cato Institute's Michael Cannon writes that the Oregon study should throw a huge stop-sign in front of Medicaid expansion:

There is no way to spin these results as anything but a rebuke to those who are pushing states to expand Medicaid. The Obama administration has been trying to convince states to throw more than a trillion additional taxpayer dollars at Medicaid by participating in the expansion, when the best-designed research available cannot find any evidence that it improves the physical health of enrollees.
 

The study itself is unfortunately behind a paywall. But the lead author does caution about reading too much into it, suggesting we need to take the long view, that other studies show that people's health improves over time when given adequate medical care.

Tell it to the politicians. One side of the duopoly panics and caves, the other side smirks, and the private insurance predators controlling both parties laugh all the way to the bank.