One of the truisms I observed a long time ago was that people may have good intentions with their policy ideas, but they are quick to ignore whether those policies are likely to promote any good outcome. Health care is full of all kinds of government initiatives that haven’t done a thing to improve health, and typically government sticks to the program even after it has been shown to be a complete waste of money. We have been told for decades that we have to expand Medicaid or poor (although you no longer need be poor to get Medicaid) people will die. For those who don’t know anything about Medicaid, it is gold-plated health care, everything is covered with basically no cost-sharing. It is far better than the employer or group coverage most Americans have, even better than Medicare. It has always mystified me why those who have no desire to work should be given Medicaid, but they are, which only increases their incentive not to work. And it would be much cheaper to just subsidize the cost of employer-sponsored insurance for the working poor. So I think Medicaid is actually a fundamentally unfair program.
And it has been shown a number of times that Medicaid does little to improve the health or health care of the recipients, many of whom have zero interest in or incentive to engage in good health behaviors, like not smoking, drinking or using drugs, eating healthy and losing weight, or getting good exercise. This new paper finds that those oh-so important and very expensive Medicaid expansions didn’t do anything to lessen mortality among recipients. The authors examined all-cause deaths, deaths that might have been prevented with good health care, deaths that weren’t amenable to better health care, and those related to HIV. To a large extent this paper is designed to rebut earlier poorly designed study that claimed the expansions did reduce mortality. They found no evidence of any impact on deaths in any state included in the study, in any category of death or in all states and all categories considered together. (NBER Paper)
My lesson from the paper is applicable generally to “equity” efforts in health care. If people have poor behaviors, giving them things like free health care won’t do squat to change the behaviors or the consequences of the behavior, so it isn’t going to change outcomes or make everyone “equal”, which is what equity means to whacked progressives. All you are doing is wasting money, which you took in part from hard-working taxpayers who have worse health care coverage. The country is headed toward a fiscal and debt disaster within five years. Medicaid will be drastically cut, and it won’t make a bit of difference, other than to perhaps encourage a few people to be more responsible in regard to their health and to get a job or work harder.