Attentive readers are probably aware of a new Oregon-based study indicating that getting access to health insurance via Medicaid increased rather than decreased use of emergency room services. At Ten Miles Square, my esteemed friend Harold Pollack does not regret the loss of the “it’ll cut expensive trips to the ER” talking point a lot of liberals made for universal health coverage:
The effect size was pretty small—about one extra ED [emergency department] visit per recipient, every 3.5 years or so. In dollar terms, this amounts to an estimated annual expenditure increase of something like $120 per recipient. We can’t say from this paper whether the extra ED visits were valuable or cost-effective. We can say that these results will embarrass some liberal advocates who argued that expanded coverage would reduce overall rates of ED use.
It should. This talking point was never properly evidence-based or even particularly plausible given prior research. It’s not obvious that reducing the rate of ED use is even a sensible policy goal. Advocates across the political spectrum should stop using the ED for cheap talking points about the mythical savings associated with universal coverage or about the misbehavior of Medicaid recipients who supposedly waste huge amounts of money through overuse.
Quite rightly, Harold urges progressives to keep focused on the big picture instead of trying to make every imaginable claim for universal coverage (the mistake the president clearly made in his “you can keep your insurance/doctor” rap.
We might, instead, take some satisfaction that we have created a system, open 24 hours per day, 365 days per year, which people turn to when they need help. Our challenge is to make this system work.
That ought to be enough of an accomplishment, and enough of a challenge.
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