In rare form, and setting a new personal best for wrongness, Pascal-Emmanuel Gobry rails against progressives who oppose Medicaid reform:
Medicaid is a disaster. It is, by a mile, the worst health insurance scheme of any kind in the developed world. A number of studies have suggested that people on Medicaid have no better, and often worse, health outcomes than those without insurance.1
Since M. Gobry’s assertions about Medicaid are uniquely negative, I’m sure he has evidence to back them up. So let’s take a look:
If you click the first link (“studies”) M. Gobry helpfully provides, you’ll find an article from the National Center for Biotechnology Information. It summarizes findings from a study done from 2003-2007 (before any Obamacare reforms or Medicaid expansion), and this is what it concludes:
"Medicaid and Uninsured payer status confers increased risk-adjusted mortality. Medicaid was further associated with the greatest adjusted length of stay and total costs despite risk factors or operation. These differences serve as an important proxy for larger socioeconomic and health system-related issues that could be targeted to improve surgical outcomes for US Patients." 2
What that means, and what the remainder of the article makes clear, is that poor people enter the hospital in worse health than affluent people and therefore require longer surgical stays and have poorer surgical outcomes. If anything, that suggests Medicaid benefits ought to be made more generous, not less, so that recipients wouldn’t show up for surgery in such godawful physical condition.
If you click M. Gobry's second link ("suggested"), you’ll find an article in the New England Journal of Medicine concerning a highly-touted study done in Oregon in 2009-10. Here is the article’s conclusion:
"This randomized, controlled study showed that Medicaid coverage generated 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." 3
Parse it as you will, that does not sound like a “disaster”.
Gobry also waxes wroth that progressives object to imposing a “per capita” spending cap on Medicaid:
During the 2012 presidential race, the Obama campaign ludicrously described then-vice presidential nominee Paul Ryan's proposal to "block grant" Medicaid as a 30 percent cut; given that the whole concept of a block grant is to spend the same amount of money, but administer it locally, this is like claiming that 10 equals 7. As it happens, RyanCare 2.0's reform of Medicaid isn't exactly a block grant, but a per-capita allotment…But the basic idea is the same: Give the states money to run Medicaid, and let them decide how to do it locally. This is a good idea.
Since you and I are not experts on this subject, let’s see what the folks at the Kaiser Foundation tell us about the impact of a per capita limit:
"A per capita cap could control federal outlays while giving states additional flexibility and budget predictability. Implementing a per capita cap could be administratively difficult and could maintain current inequities in per enrollee costs across states. Pre-set growth rates cannot easily account for changes in costs of medical services, patient acuity or epidemics. If costs are above per enrollee amounts, costs could be shifted to states, providers and beneficiaries. States may have incentives to reduce Medicaid payment rates and restrict benefits; with changes in federal law, states could also restrict eligibility for high-cost enrollees and shift costs to beneficiaries through premiums or cost sharing." 4
Facts aside, M. Gobry insists on general principles that Medicaid would do a better job if we just “Give the states money to run Medicaid, and let them decide how to do it locally.” The problem with that suggestion is that Medicaid already works that way, as a Medicaid “fact sheet” from the Center for Budget and Policy Priorities explains:
"The federal government sets minimum standards, including the categories of people that all states must cover. Beyond that, states set their own rules, including whom they cover, what benefits they provide, and how they deliver health care services. As a result, Medicaid eligibility varies substantially from state to state. Moreover, states have taken advantage of Medicaid’s existing flexibility to improve beneficiary health outcomes while lowering costs by changing how health care is delivered." 5
I suppose that M. Gobry can be forgiven for not being conversant with the facts about Medicaid; after all, he lives in France, from which he launches his misguided rhetorical missiles across the Atlantic to our shores. It may seem harsh, but perhaps living in France should disqualify him from opining about American issues about which he knows nothing—which, come to think of it, includes pretty much all of them, Katie.