“Never ascribe to malice that which can adequately be explained by incompetence.”
- Napoleon Bonaparte
A recent study from Oregon made headlines by demonstrating a decreased death rate for Medicaid patients compared to the uninsured. However, those who actually read the study were more impressed by the relatively small impact such insurance made. The perplexing fact is that having health coverage of any kind makes very little difference in mortality. Although people with some sort of insurance feel better about their health, more concrete measures of improvement are lacking. Megan McArdle discusses the issue at great length, and emphasizes that the political biases of the writer seem to be the most important factor in how the data is interpreted.
The most important finding these studies demonstrate is that reporters have no clue about how medical care is actually provided. People without insurance get healthcare, and the quality is often little different from the rich and famous. The uninsured go to emergency rooms, and are treated, without regard for their ability to pay. Patients lacking coverage get their gallbladders removed, their pneumonia treated, and their cardiac stents placed. Hospitals in this country do not turn away acutely ill individuals, and the services provided are performed by the same physicians that treat the insured patients. The poor may not get immediate hip replacements, twenty injections for back pain, or 50 episodes of psychotherapy for their depression, but they are not dying in the streets. Furthermore, they are not over-treated or subjected to marginally effective or dangerous therapies for equivocal complaints. Even those with chronic medical problems, such as cancer or AIDS, eventually obtain Medicaid coverage, and receive care.
Furthermore, I have said previously, much “preventive” medicine is overrated. The number of lives saved by cancer screening is relatively small. Even untreated high blood pressure and cholesterol don’t kill many people before Medicare eligibility. Most serious medical problems soon become manifest, which brings patients into the healthcare system, usually through emergency rooms.
This safety net for the uninsured is either not understood or ignored by the authors of the study, the press, and our politicians. The care is erratic, inconsistent, and sometimes substandard, but the sick are not barred from emergency rooms. These services are rendered for free by those very physicians who are universally castigated for their greed and avarice.(up to 20 percent of the care I gave was not compensated). The present system subsidizes this care, through higher fees for people with actual insurance or Medicare, and by additional capacity in the healthcare system.
Thus, the claims about the uninsured being completely unable to obtain medical care are simply not true. The press, politicians, and reformers who rail about these may not be malicious or incompetent, but they certainly are clueless.