One of our regulars from the early days of this blog made an appearance over the weekend in response to this observation from current regular Jeff Mobley:
“Perhaps it is unrealistic of me to absolutely foreclose the possibility that even one person’s lifetime could have been significantly lengthened by the Medicaid expansion.”
Brother (Jeff}, you can strike the “perhaps” from that sentence. I am a physician who sees patients for HopeHealth, a community health center in Florence. The majority of patients I see are uninsured and I can attest to the difference that insurance makes in their lives. Every time an uninsured patient dies suddenly, we should ask the question, did their lack of access to care contribute to their death? Sometimes the answer is no, but surely you can conceive of a patient with undiagnosed coronary artery disease ignoring it because they don’t have the funds to see a primary care physician and don’t want to run up a bill of thousands at the emergency room. If they ignore it too long, they may suffer sudden cardiac death and be found dead at home.
But helping prevent these kind of dramatic deaths is not the only attribute that Medicaid (or any insurance) provides. It provides access to expensive medications to control diabetes and hypertension to prevent coronary artery disease, stroke and kidney failure; it provides access to imaging, specialty care, and health screening services (e.g., I defy you to find me a single uninsured patient who has paid out of pocket for a screening colonoscopy); and it provides the simple peace of mind knowing that your are spared making decisions about whether to pay your rent or see the doctor.
If you are the Jeff Mobley from Columbia who ran for state senate, your profile says you work as an analyst for Blue Cross/Blue Shield. How ironic.
When you cite the Oregon study, your logic would suggest that Medicaid doesn’t change health outcomes for poor people. Then why would it change outcomes for people of means like you and I? Medicaid is good insurance, in some respects better that private insurance in its coverage (including that there is usually no significant deductible). Could Medicaid be more user-friendly and efficient? Of course. Is it subject to fraud? Certainly. But those critiques are true of BC/BS as well. See this link from 2013 https://www.fbi.gov/columbia/press-releases/2013/eight-plead-guilty-in-fraud-scheme-involving-blue-cross-blue-shield
You argument generalizes to “Insurance does not affect health outcomes.” It is interesting to me that every person I’ve ever heard make this argument has health insurance. You’ve added the caveat that “Insurance might work if the government paid private companies (coincidentally enough like the one for which I work) to do the job.”
However, private insurance offers its own set of troubles, including incentives that put profit above patients. See http://www.postandcourier.com/article/20110501/PC1602/305019922which describes the huge profits BC/BC makes and the million dollar salaries their top brass rake in.
If you are really interested in learning the practical effect of insurance on patients’ lives, I’d love for you to spend a day in my office seeing patients. I suspect that time might broaden your perspective.
Welcome back, Doc!
It would be great to have a series of posts from or about fondly-remembered commenters from years past, here in my 10th anniversary year as a blogger (first post, May 17, 2005).