Oregon Medicaid Study

The Oregon Medicaid Study came out in the May 2013 edition of the New England Journal of Medicine.  I recently listened to two podcasts talking about the results of this study.  The first one was with Aaron Frakt and the second was with Jim Manzi. Both of these discussion were with Russ Roberts who puts together a weekly podcast called EconTalk. This study will be used for many years in the healthcare debate. I’d recommend reading it, and looking at the author’s conclusions for yourself. Basically the study found that “Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase the use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.” The study has its critics and supporters. Critics will argue that the study didn’t have enough power, the sample size wasn’t large enough, or the time period wasn’t large enough. Supporters will be happy to jump on the bandwagon to proclaim that having health insurance doesn’t improve health outcomes even though people use health services more.

As I read the study, the thought I had come to my mind was that they proved health insurance has some of the same benefits of other types of insurance. It lowers financial strain! It found the following areas of financial strain were statistically significant for the control group: amount of out-of-pocket expenses, catastrophic expenditures, any medical debt, and borrowing money to pay bills or skipping payments. Isn’t this the point of insurance. I have homeowners’ insurance incase my house burns down. I have car insurance incase I have an automobile accident. We have insurance (life, homeowners, renters, car, etc) to protect against catastrophic risks. Why don’t we treat health insurance the same way, as a risk mitigating tool? Just because I have car insurance doesn’t mean my car will run better. Why should my health be better just because I have health insurance? In my opinion, one way to lower health care related costs is to use health insurance like we use other types of insurance. Imagine the expense of an oil change if we used auto insurance like we use health insurance. Blum found that only 10% of a person’s health is related to the healthcare they received. The majority comes from lifestyle. To really improve health, we have to change individual’s lifestyles.


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