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This article challenges the originally widely praised concept of the famous Oregon experiment; a study conducted in 2011 claiming that having Medicaid was significantly better than being uninsured, which directly refuted various studies claiming that individuals are no better or worse off with Medicaid than without it. The public response to its’ preliminary, flimsy, and uncertain results in 2011 was driven by media hype and premature over eagerness—headlines such as “A new, rigorous study from Oregon confirms that Medicaid does, indeed, save lives,” (Roy) and “What we found in a nutshell is that having Medicaid makes a big difference in peoples’ lives” (Roy) flooded front pages; the Oregon experiment had ignited national, growing faith in Obamacare that was previously unseen. The day prior to publishing of this article, May 1st 2013, the authors of the original Oregon study released their updated two year results— “Medicaid generated no significant improvement in measured physical health outcomes.” This article analyzes the staggering results, critiques the experimental methods used, and questions the $450 billion/year spent on a seemingly futile program.
The structure of the Oregon study was centered around the comparison between the health outcomes of individuals enrolled in Medicaid, versus the health outcomes of the uninsured. The outcomes examined for comparison were levels of elevated blood pressure, high cholesterol, elevated HbA1c levels, and long-term cardiovascular risk (measured by Framingham scores). The main question the authors wanted to answer: Did Medicaid improve the health of its enrollees?
Before analyzing the statistical data of the experiment, it is crucial to understand the flawed structural setup that introduced massive bias and even possibly skewed the results. The Medicaid population was partially self selected, making it an inaccurate representative sample of the common population. The Medicaid users were consciously and knowingly aware that they were receiving the benefits of Medicaid, and the uninsured were well aware that they were uninsured—this concept could potentially favor the Medicaid population due to prevalent bias. In much more accurate clinical trials, both the doctor and patient should be unaware whether the patient has received the placebo or the test drug in order to achieve an unbiased, accurate answer. The Oregon authors also only measured the baseline health status of the uninsured group, not the baselines of the Medicaid group. This massive flaw doesn’t allow for accurate results within the Medicaid group by offering no definitive method of comparison when analyzing the data. The process of creating the Medicaid group was also driven by massive bias. Of the 35,169 residents who “won” the lottery to gain Medicaid enrollment, only about 30% actually enrolled, and 60% of those selected out of the 30% physically filled out the forms to receive benefits. The 60% who signed up are clearly more likely to need the treatment and benefits compared to the other 40%, who didn’t bother to fill out paperwork. (Roy) Those who chose to enroll were therefore sicker and more in need of treatment; making them more likely to benefit from treatment than the control group, or the uninsured. The final element of bias introduced, and perhaps most significant, is how the state of Oregon individually manages their Medicaid program compared to the national average. In Oregon, Medicaid pays primary care physicians approximately 62% of what private insurers pay. Our national average pays 52%, and many blue states pay well under 40%. (Roy) Because the state of Oregon pays their health care professionals more, their beneficiaries have better access to doctors; better access to doctors should lead to better health outcomes for beneficiaries than we’d likely see in other states, making the state of Oregon an unsuitable host for this experiment.
As for the data, the authors found no statistically significant differences in elevated blood pressure, HbA1c levels, high cholesterol, or long-term cardiovascular risks between the insured and the uninsured. The sole, significant difference between the two groups in this study was the amount spent and the utilization of services. Medicaid patients spent an average of $1,172 more than the uninsured, with zero statistically supported data leading to better health outcomes. (Roy)
These findings are extremely significant; the flaws within the setup of the experiment introduce extreme bias and inevitably lead to inaccurate data. I am convinced of the validity of this article due to the meticulous research, critique, and analyzation on the flaws of the Oregon experiment as a whole as conducted by the author. He raises a notable point that should be seriously considered by American citizens, government officials, and policy makers alike. With the heavy reliance on Medicaid expansion under Obamacare, this experiment questions the major flaws within the system in its entirety, making us ask ourselves: Is it worth it?
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