Published DateTo the editor,
I haven't written a letter to the editor in awhile but I had to respond to a letter I read Saturday from Don Ewing entitled "Medicaid hikes health care usage and costs without better results". I won't argue with his mathematics or his contention that nothing in life is free, especially when it comes from the federal government. Where I have a disagreement is the statement that "Medicaid increases costs and health care usage, but patient health care results overall are no better than mixed compared to no insurance." He bases this comment on two study's, one in Oregon and the other in Virginia. I am familiar with the Oregon study published in the New England Journal of Medicine. The methodology and conclusions do not produce the slam dunk as described by Mr. Ewing. The study was not a true measure of overall health status and the changes that can occur over a long period of time. It included only a few measures, all "self reported" by participants such as blood pressure, cholesterol and blood sugar levels after only two years. In addition, according to economist Austin Frakt, the sample sizes were as much as 23 times too small. The biggest flaw was that the study didn't have enough people in bad health to measure any thing that is clinically significant.
No question that the cost of health care is too high no matter how it is accessed. Subsidized care is flawed and expensive, again no argument there. Making long term policy, though, without completely thinking through or completely understanding the problem can be catastrophic. If you do not have any health care insurance, you will in all likelihood not receive basic preventive care and will probably head to your nearest emergency room (the most expensive place to receive primary care) when you are ill. Diseases won't be detected early enough to prevent more serious and costly treatment or dire outcomes. At that point, the Medicaid debate is moot. If they can't pay, well guess what? The hospital eats the cost and we all end up paying for it. The end result is a continuing upward cost spiral that is clearly unsustainable.
So yes Mr, Ewing, subsidized care is expensive, but the alternative, which is to do nothing and live under the false assumption that no insurance will "improve medical results" is downright scary and I would argue much more expensive in the long run.