In research, the gold standard is to do a double-blind study in which you compare the effect of some intervention on a test group with that of a perfectly matched control group. But sometimes this is not possible, say if one is doing historical research or the conditions of the research are not amenable to being controlled by the researcher. Ethics considerations limit what one can do with animal and human subjects and if the trial might result in either group being denied a valuable benefit, such studies will be disallowed. For example, it might be valuable to know what the effect of some chemical is on infant development but it would be unthinkable to try out the experiment on test groups of infants if there is the risk of harm.
In cases such as this, researchers look for ‘natural’ experiments in which the desired experimental conditions occur naturally. Natural experiments are particularly valuable when it comes to medical research where the double-blind randomized trial is the ideal.
Such a natural experiment overcame the problem of determining definitively if Medicaid produced benefits for poor people or not. It would not have been ethical to divide the population randomly into two groups and give Medicaid benefits to one and deliberately deprive the other of them, as would have been necessary to create the appropriate protocols. As a result of this restriction, no definitive studies could be done to prove the benefits of Medicaid and thus opponents of Medicaid were able to argue that Medicaid was of no use and should be eliminated.
But in Oregon, budget woes resulted in a natural experiment occurring. Since the Oregon government had money to cover only 10,000 of the 90,000 eligible Medicaid patients, it created a lottery system in which only the winners obtained benefits, thus effectively creating a database of a large pool of subjects who could be randomized and matched in terms of other variables. Researchers seized upon this opportunity to study the effects of this difference.
Health economists and other researchers said the study was historic and would be cited for years to come, shaping health care debates.
“It’s obviously a really important paper,” said James Smith, an economist at the RAND Corporation. “It is going to be a classic.”
Richard M. Suzman, director of the behavioral and social research program at the National Institute on Aging, a major source of financing for the research, said it was “one of the most important studies that our division has funded since I’ve been at the N.I.A.,” a period of more than a quarter-century.
Researchers who used the resulting data to study the issue found in the first phase that people on Medicaid had better health outcomes than those not on it.
Those with Medicaid were 35 percent more likely to go to a clinic or see a doctor, 15 percent more likely to use prescription drugs and 30 percent more likely to be admitted to a hospital. Researchers were unable to detect a change in emergency room use.
Women with insurance were 60 percent more likely to have mammograms, and those with insurance were 20 percent more likely to have their cholesterol checked. They were 70 percent more likely to have a particular clinic or office for medical care and 55 percent more likely to have a doctor whom they usually saw.
The insured also felt better: the likelihood that they said their health was good or excellent increased by 25 percent, and they were 40 percent less likely to say that their health had worsened in the past year than those without insurance.
They benefitted in non-medical ways too.
The study found that those with insurance were 25 percent less likely to have an unpaid bill sent to a collection agency and were 40 percent less likely to borrow money or fail to pay other bills because they had to pay medical bills.
Thus being on Medicaid made people’s lives a lot less stressful.
Those who seek to deny poor people benefits in order to increase the wealth of the rich will try their best to find other reasons to do so. But this research is so definitive that it should end this particular argument.
“[T]his research is so definitive that it should end this particular argument.”
Should, but won’t. Since when did objective facts mean anything in our polity?
We have hard data to prove that human activity is changing the world’s climate, yet any attempts to address the issue are crushed. We know our fiscal imbalance has been caused largely by inadequate revenues and unnecessary wars, yet we are told that entitlements are the problem. We kill innocent civilians all over the world in a “fight against terror” yet we tell ourselves that we provide justice for all.
Remember Justice Oliver Wendell Holmes’s cute idea in First Amendment jurisprudence that, in the marketplace of ideas, the truth will win out? I say “cute” because our marketplace of ideas is hopelessly, irredeemably rigged. Sadly, Holmes’s successors are the ones doing the most permanent rigging.
I think if we started spending less on war and more on looking after our own citizens then we would all be better off -- the pitiful excuses the government comes up to try and justify war would be laughable if it wasn’t so serious.
I am starting to warm towards the conspiracy theorist that promote the idea that war benefits the big bankers and therefore we will probably always have wars going on.
Cut the spending on war and spend it on health.
Did we really need to waste time and/or money to prove that having health care increases the number of healthy people? Are we really shocked that people who had access to doctors when they were sick actually feel better and healthier? How cruel and elitist to think that medicaid doesn’t make a difference in people’s health. We take our dogs to the vet when they are ill. Don’t human beings have more value than a pet?