THCB

Laughing at the Chutzpah of the Right on Medicaid

There’s no one that pisses off the right in this country as much as Paul Krugman, and there’s nothing that pisses off the right as much as welfare for the poor. So when Krugman wrote recently in the NY Times supporting a program that is welfare for the poor, and describing how Romney/Ryan would decimate it, well you can expect an explosion from the GRWC. Yes the topic of today’s right-eous indignation is Medicaid.

The place to go to see that explosion is the comments section of John Goodman’s blog. That’s the halcyon world where the poor are oppressed by government programs and would much rather be set free to swim in the happy waters of the free market. Goodman proves to himself that studies showing that people without health insurance on average die prematurely must be wrong because they’re not seen in any “credible, peer-reviewed social science journal” — just in biased rubbish like the American Journal of Public Health and reports from the crack-smoking wackos at the Institute of Medicine.

Having read the comments on Goodman’s article I’m very surprised that Heartland’s Peter Ferrera hasn’t gone on welfare to show how it’s now a guaranteed path to unlimited riches (as opposed to say the tough job of taking payola from a convicted felon) and that Goodman himself hasn’t rejected his health insurance and gone naked on the income of the single mom & waitress in Dallas that Uwe teased him about a few years back. After all it would give him so much buying power to impact the market!

Back in the real world, everyone on the left knows that Medicaid is a dog-meat last ditch program. But over the past seven decades the intense efforts of assorted whack-jobs, lie-factories and mean spirited Republicans–and many right wing DINOs– mean that there is no national comprehensive health plan. Medicaid is all the poor have, and all that keeps granny in the nursing home rather than living in the front room or on the street. It’s the politics of the right that prevented folding it into Medicare in 1965 and into a comprehensive plan in 1994, and made it impossible to do anything other than build on Medicaid in 2010. That’s why Daschle championed it as the least bad route to quasi-universal insurance.

To really suggest that Ryan/Romney won’t cut Medicaid means that the fools at the AP must have been very confused when they penned this article suggesting that block grants would reduce Medicaid by $800 billion. They must have meant that instead states like Texas, Florida and Mississippi would of course massively increase their Medicaid spending and cover more people because of the “flexibility” block grants would give them. Of course those states have been falling over each other to take the Federal dollars now on offer for Medicaid.

Oh and none of the right-wingers mention the facts that for the non-elderly & disabled Medicaid is already 65% run through private health plans (see p13 here)–much closer to that free market nirvana that the right aspire to than Medicare with its 25% rate.

But that’s all fine. Medicaid does relatively well with the pittance it gets, but if the right’s boy Romney wins we’re going to see just how huge the clout of the poor is when they get those Medicaid cards taken away from them and thrown off the rolls. And I’m sure Goodman and his buddies will all be lining up to explain to them how their new reality of being broke, sick and uninsured is so much better!

I’ll wait expectantly (no, not really!) for Obama et al to pick up this thread that Clinton left them at the Convention in the next week…

Matthew is the founder of THCB and is guilt-stricken about how rarely he gets to write on it!

Livongo’s Post Ad Banner 728*90

27
Leave a Reply

18 Comment threads
9 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
14 Comment authors
David DranoveDeterminedMDSteveHTlrAshley Doran Recent comment authors
newest oldest most voted
Bob Hertz
Guest
Bob Hertz

David and I may disagree on some issues, but as far as death rates go I am totally on his side. Mortality is a very bad way to measure the performance of a health insurance system. One reason is that people die from violence and genetic factors and bad habits, which no health insurance system can cure. Yes, there are poor women who lose a child due to a lack of pre-natal care. But I do not think this a large statistic in America, or has been since 1960 or was ever a big statistic outside the rural south. Using… Read more »

David Dranove
Guest
David Dranove

I should have added, if uninsured and insured individuals do not live in exactly the same locations (e.g., perhaps the uninsured are more likely to live in densely populated areas), then yes, their chances of getting hit by cars may differ. I am in no way suggesting that being uninsured has no consequences (and my recent Health Affairs study documents how falling seriously ill while being uninsured has catastrophic consequences for one’s savings). I am merely pointing out that academics should take research methods seriously. There is no excuse in academia for sloppy econometrics even in pursuit of a worthy… Read more »

Peter1
Guest
Peter1

Well I haven’t read the study, so maybe it should have stated that being poor brings you closer to death.

Needing a study to understand if everyone needs equitable healthcare or trying to find flaws in a study advocating we all need healthcare seems genuinely American, and, if I might say, “Romneyesk”.

I’ll leave you PHDs to argue the finer points of Studies 101.

David Dranove
Guest
David Dranove

The authors of that study make a specific claim about the number of deaths caused by a lack of insurance. Due to the underlying failure to properly identify a causal effect, their claim lacks validity. Perhaps fewer deaths are caused by the lack of insurance. Perhaps more. Due to the poor research methods, there is no way to know. If you will humor me and promise not to cuss again, I will offer a statistics primer. The authors show there is a correlation between mortality and insurance status and assume they know the direction and magnitude of causality. But there… Read more »

David Dranove
Guest
David Dranove

The study purporting to show that being uninsured causes premature death has methodological shortcomings. The authors fail to sort out causality (in econometric parlance, the statistical model is not identified.) As a result, one cannot state with any confidence that the authors have demonstrated causality. I am the editor of a social science journal and I am reasonably confident that this paper would have been desk rejected. It is not unusual for social science studies to be published in medical journals. They should be treated with the same caution as one would treat medical studies published in social science journals.… Read more »

Peter1
Guest
Peter1

“The study purporting to show that being uninsured causes premature death has methodological shortcomings. The authors fail to sort out causality”

I don’t know David, do uninsured people get hit by cars more than the insured.

Exactly how do people die if not by accident, would it be by disease? If you have good access to good care (eliminating poor nutrition and dangerous neighborhood) wouldn’t that prolong your life, unless of course, a frigging tree fell on you?

bob hertz
Guest

America has been divided for quite some time between states and businesses that are generous when it comes to health care (i.e.Minnesota, General Motors), versus states and businesses that are stingy about health care (Texas, the entire restaurant industry) The PPACA law, when you pull out the details, has many clauses which if enforced will require the stingy players to be more generous. This is not an intrinsically bad thing to do. We forced Southern states to be at least somewhat decent to black voters from the 1940 to 1970 and it didn’t kill them. No, the test of forced… Read more »

DeterminedMD
Guest
DeterminedMD

Michael Gerson wrote a great piece as to what could play a sizeable factor to Obama losing the election next week, which I link below. I want interested readers to read it all, but pay attention at the bottom 1/4 to what Gerson lists as a major reason why Obama has shown non partisan cronies and choir shriekers why he is not only lame, but why Democrats, in my opinion, have shown even more callous and ruthless qualities than what I have believed to be the ugliness of Republicans for decades now. You read and decide: http://dyn.realclearpolitics.com/printpage/?url=http://www.realclearpolitics.com/articles/2012/10/30/obamas_discrediting_victory_115971.html I have absolutely… Read more »

DeterminedMD
Guest
DeterminedMD

If it is fair to sum up this election with one premise, it would be this: You are either voting for abandonment, per the republican dogma as is, or, enslavement, per the Democrat dogma as is. Wow, what a choice, in the end it is not about freedom, independence,and choice, but what will amount to brutal survival conditions, and isn’t it ironic, as well as cruel, that nature is giving us a preview now in the East. Frankly, we are stuck with a one party system of Republocrats, and as long as entrenched incumbents keep their seats, it is irrelevant… Read more »

SteveH
Guest
SteveH

I was at a meeting in Texas this year when one of the speakers told the audience that a single, childless adult has to have an income below 26% of the Federal Poverty Level to qualify for Medicaid. The panelists, all from out of state, repeatedly asked him to clarify that figure. It was incomprehensible to them that someone making $4,000/year was too wealthy to qualify for Medicaid. Health care is too valuable to allow just anyone to access it.

Tlr
Guest
Tlr

But how do you really feel Matthew? Nice piece. I think we all know where we are headed. (a single payer system with a thriving supplemental care private market sitting on top of it). Unfortunately things probably need to hit rock bottom before politicians find the political will to go there. Adding an additional 20M people to a broken system (financially broken not clinically) will just make it fail faster and get us to the end game faster. 2-3 years after it is implemented we will all be wondering how we wasted 60 years debating it whether it was communism/fascism/socialism/pure… Read more »

Ashley Doran
Guest
Ashley Doran

Having just returned from the Medicaid Health Plans of America Annual Meeting last week (and I’m still recovering from the depression that ensued…talk about dinosaur energy) let me suggest two basic foundational problems that rarely get addressed in discussion of Medicaid. 1) Medicaid programs are designed by the State – which is to say, state employees (with the occasional assist from consultants). Many, if not most of these folks, RARELY get any fresh air. There is no money in their budgets to attend conferences. No incentive to stretch. And the heads of these state agencies are typically decided by whomever… Read more »

Bob Hertz
Guest
Bob Hertz

In 1962, Bobby and Jack Kennedy had to send 1,000 armed troops into Oxford Mississippi, to let James Meredith register for classes at Ole Miss. In the ACA law, the federal government had to promise 95% funding for 5 years to get Southern and Western states to cover more of the working poor — and the states are still resisting. As Jeff Goldsmith has pointed out, there is a block of persons about 10 million strong who could be on Medicaid right now, ignoring the ACA expansion, but are discouraged from doing so by paperwork and their own confused lives.… Read more »

Brian Klepper
Guest

Who is this new writer on THCB?

Matthew Holt
Guest

Yes, they let any whackjob with a keyboard on here now…

Bob Hertz
Guest
Bob Hertz

One of the common right-wing slams against Medicaid is that the persons who receive it have ‘poor mortality and morbidity.’ Let’s be charitable and assume that this criticism exempts the aged and disabled persons who make up about 2/3 of Medicaid spending. Their poorer mortality is rather obvious and cannot be caused by their getting Medicaid. Based on what nursing homes and polio wards were like in the 1950’s, it is likely that Medicaid has improved the health of this group. Now move over to the women and children now on Medicaid. Their mortality and morbidity is said to be… Read more »

Matthew Holt
Guest

RNMPH is actually right in that a little known secret is that within Medicaid and the safety net providers, we’ve seen quite a lot of innovation–same is true with the VA. Having said that I’m reminded of the time in the 1990s when my colleague at Harris Poll Bob Leitman did a study of Arizona Medicaid which was already 100% in managed care programs way before any other state tried it in Medicaid. His one liner to the group of health care executives was–“this study shows that relative to other Medicaid recipients, the ones in Arizona managed care plans are… Read more »

RNMPH
Guest
RNMPH

If you think Medicaid is “dog-meat, last ditch”, come to North Carolina, where the program is serving 1.5 million and saving the state more money each year from using medical homes and care management. Pt satisfaction is pretty high too.