Eventually the thread became so extensive that it was decided to edit the posts to create separate articles for each school. The editor of The Royal Windsor Website is very grateful to Jane Lindsay in Australia for undertaking the substantial task of editing all the entries. Readers are welcome to add their own comments and memories on the current School Memories forum thread here. If you are not already a member you would be welcome to join us.
The claim that health insurance improves health outcomes is hardly ground breaking. Studying whether insurance affects health status is like wondering whether three meals a day lead to a higher muscle mass than total starvation.
Baicker et al found that Medicaid enrollees fared no better in terms of health outcomes than those without insurance. That is, no insurance no difference. The study is an exemplar of policy research laced with regression equations, control of known confounders and clear separation of variables.
There is only so much rigor social science can achieve compared to the physical sciences. Yet this is about as good a study as is possible.
The one thing the study did not lack was sample size. Large effects do not need a large sample size to show statistical significance. Conversely, if study with a large sample size does not show even a modest effect, it means that the effect probably does not exist.
So where is the downside? Could the downside of a government program paying physicians, on average 52 cents, and as low as 29 cents, for every dollar paid by private insurance in a multiple payer system be access?
But one I least expected was that patients on Medicaid do worse than patients with no insurance risk-adjusted, almost. I am not going to be that remorseless logician, which John Maynard Keynes warned us about, who starting with one mistake can end up in Bedlam, and argue that if you are for Medicaid that is morally equivalent to sanctioning mass murder.
Rather, I ask how it is possible that possessing Medicaid makes you worse off than no insurance whatsoever. To some extent this may artifactually appear so because poverty correlates with ill health, and studies that show Medicaid patients faring worse than uninsured, cannot totally control for social determinants of health.
However, I found a plausible explanation during a recent conversation with a physician specializing in physical medicine and rehabilitation PMR. She ran a special clinic one day a week in which she saw adolescents for free. These kids had no insurance. They were mainly from the local Hispanic and African American communities.
She did not accept Medicaid patients. This point is worth parsing out again. This doctor is happy to see patients uncompensated but not Medicaid patients, partially compensated.
Why so, I asked, bewildered and feeling that I must be in Bedlam. Plus one is exposed to unintentional billing fraud, audits, compliance and perpetual war with formularies and pharmacies.
She ran her practice as a small business and kept her support staff to a minimum; she simply could not afford the legal and coding help that this would entail.
She explained that if she saw all Medicaid patients for free she would technically be committing fraud.
Unless she made a nuanced determination to waive fees on an individual basis. At any rate it would unduly burden her, and it was a good deed that best remained unpunished. Again this is worth parsing out because this is so mind-boggling. Seeing all patients on Medicaid for free is fraud!
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