[I]t turns out there were improvements in blood pressure, glycated hemoglobin, and cholesterol, but the size of the study was fairly small, so the results weren’t statistically significant. Specifically, as Sam Richardson tweets, “#Oregon point estimates: Reductions of 30% in depression, 18% in high HbA1c, 17% in high chol, 8% in high BP. Big effects, little power.”
“Proving no positive health outcomes” (even if you ignore the very positive finding about the impact of Medicaid on depression) is a very different thing from finding improved health outcomes in a sample so small that you can’t deem them as “statistically significant.”
But here’s the bigger issue Kevin raises:
The truth is that if you take a narrow view of “outcomes,” it’s hard to find a significant effect from most of our healthcare efforts. Nonetheless, improved access to Medicaid produces plenty of improvement in acute problems; better use of preventive care; and far better financial outcomes. This is all worthwhile stuff even if controlling chronic conditions remains a challenge.
Overall, I’m a little unclear about what the conservatives who are crowing over this study really think. They obviously believe that access to healthcare is a good thing for themselves. (At least, I haven’t heard any of them swearing off doctor visits.) But you can’t have it both ways. If it’s a good thing for us middle-class types, it’s a good thing for poor people too. Conversely, if it’s useless for poor people, then it’s useless for the rest of us too. So which is it?
If something about Medicaid itself is the problem here, then what’s the alternative? Insurance poor people can’t afford for crappy coverage in high-risk pools? Reliance on hospital emergency rooms for expensive acute care the rest of us pay for? Most of those who are using a cartoon version of this study to provide a talking point for screwing up the implementation of Obamacare probably aren’t thinking about alternatives at all.