Anyone who paid attention to that Oregon Medicaid Study that created such a brouhaha a few weeks back should read Ezra Klein’s column at Ten Miles Square about the rest of the Oregon Medicaid story. It involves Gov. John Kitzhaber’s determined effort to use Medicaid to change the way health care services are conceptualized and delivered in his state, with a special focus on improving the overall health of community, not just performing procedures and dispensing meds. As Ezra notes:
At the core of this shift are Oregon’s 15 “coordinated care organizations.” What makes them different from accountable care organizations or managed care is that they’re responsible for more than the health of their members, which now include 94 percent of the state’s Medicaid population. They’re also responsible for the health of the communities they’re in. They have to run regular community health assessments, and the results influence their pay.
This is a potentially transformational notion, based on a belief that the health-care system doesn’t decide or drive health, even that individuals don’t particularly drive their own health. If you live in a community where the streets are dangerous and the health of your neighbors is poor, you’re probably going to be unhealthy — and there’s little or nothing your local hospital can do about it.
Even if you don’t buy a definition of health care policy that is quite so inclusive, it helps remind us that Medicaid is essentially just a way to extend health insurance, not a distinctive philosophy of health care. If it doesn’t work immediate miracles in improving health, maybe we should look at what Medicaid does and doesn’t buy for people, instead of denying them access altogether, as conservatives gloating about the Oregon Medicaid Study—or at least a vastly oversimplified interpretation of that study—seem to be urging us to do.
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