Newsflash!! Sick Oregonians Getting Healthcare They Don't Deserve!!

Recent coverage of the outcome of a two-year study into the impact of an expansion of Medicaid in Oregon had me laughing out loud. Apparently, despite the expansion of Medicaid there was - get this - an increase in ER visits and the usage of healthcare services. I had to nearly pull over the car when I heard that one on the radio.

Those sick bastards! Being sick and going to use healthcare services to which they are entitled!! Next thing you know hungry children will be going to food banks and getting fed!! It's practically communism!!

Seriously though, the coverage of the 'Oregon Experiment' as it is termed puzzled me a little. This healthcare expert writing in Forbes, Avik Roy, breaks down the data in the study for Forbes readers. He concludes that the central premise of Obamacare - that expanding healthcare coverage will reduce overall costs and decrease the use of expensive ER services - to be a myth, as demonstrated by the outcomes in the Oregon Experiment. 

Yet if you read the actual results of the study in the abstract of the paper, it notes that while ER visits did not decline, patient health outcomes were improved and there was a lesser chance of a diagnosis of depression for patients with Medicaid as well as a higher chance of being diagnosed and treated for diabetes. That sounds like a good outcome to me. Roy overlooks these outcomes in his analysis. 

There is an ongoing strand in the US debate on healthcare that sick people who can't afford insurance are freeloaders. It's as if healthcare is a scarce commodity like say, diamonds, and poor people who get access to it without paying their fair share are like jewel thieves. 

The mindset here is flawed. Healthcare is not a commodity. It is (kind of) a public good. Some of us get more cancer than others and so we consume more than our 'fair share' of healthcare but that's hardly a privilege worth envying. Illness is not evenly distributed throughout the population and if your neighbor gets cancer and has his healthcare paid for by your taxes, you are not 'benefiting' in the way that we all benefit from street lights or national defense but we all benefit from living in a humane society where we don't leave sick people to die by the side of the road because they are poor. Healthcare options for the poor is the cost of living in a civilized society. 

So back to Oregon. Does it matter that ER visits increased once these awful dreaded sick poor people got access to Medicaid? Ideally they would be accessing their healthcare through primary care rather than the ER, yes. Ultimately, however, the study shows that:

"[there were] no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain."

The overall outcome of the Oregon Experiment was therefore either neutral or positive. Yes, more people accessed healthcare but if they needed it, then surely that's a good thing? Costs were not significantly lowered to the overall healthcare system in Oregon but surely they were reduced individually for the needy people who finally could get the care they required? I think that counts as a success and I'm flummoxed by the mindset of people who would think otherwise and still claim to live in a civilized society. 

In Praise of Daycare

When you say you have your child in daycare around here you often get a little sniffy reaction. Daycare? Really? Wouldn't a nanny be preferable? Daycare damages children's brains.

Before I moved to the US and gave up my right to work, I had my life as a working parent all planned out. I would work three days per week while my spouse worked four days a week and our child would then only have to go to daycare for one day per week when he was young. This was in librul commie pinko Europe of course where I would have had a year off on maternity leave, in theory, although only about four months of that would have been paid.

Daycare did not appeal to me. I worried that my child couldn't possibly thrive in such an environment. I assumed that the ideal situation for a working mother would be to hire a nanny rather than subject her child to group care. How could group care be good for a young child with so many intense needs and an inability to verbalize them? Surely one-on-one care in the home would be best?

Now that I am a parent, however, and a stay-at-home parent at that, I see the benefits of daycare more than I did before. Firstly, being at home full-time has made me realize what atomized lives we all live these days. Traditionally a woman raising children had extended family nearby and would have lived as part of an established, traditional community.

She would have known and trusted her neighbors. She would most likely have had many more than just one child. My grandmothers had five and eight children each. Children typically grew up in a group setting with cousins, neighbors and siblings providing their social context, not solitary interaction with one caregiver. Many people still are fortunate enough to be able to raise their children in such tight-knit families and communities but I, and many other mothers I know, don't have that option.

So who takes the place of grandparents and siblings and cousins in the small nuclear families we now have? I think daycare is a good substitute. If it is a good daycare facility, your child can bond with his caregivers and make friends among the other children. Even if he is too young to have 'friends' as such, these children will be familiar faces for him.

In his new preschool my son interacts with children his own age and learns how to sit quietly at circle time, how to share toys and how to wait his turn. In his life to come these will be important skills and if we do have another child, he will hopefully be able to transition better to the idea of sharing.

As individuals we all exist within the context of society. Group interactions are the norm in society, whether at work, school or in sports or science. Despite our obsession with lone geniuses like Einstein or Steve Jobs, even 'lone wolf' high achievers like this will sometimes have to work alongside others.

Negotiating group situations and managing other people are very valuable skills that my son will need in today's competitive world. I'm very happy that we can afford to send him to a good daycare  for a couple of mornings a week to help him develop socially. Parents who send their children to a daycare facility full-time shouldn't be made to feel that they are making an inferior choice. In the context of our past, children being raised in a group environment like daycare are closer to the traditional style of child-rearing than anything else in our modern, atomized society.