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.