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As I've stated before, there's plenty of bad journalism out there.  Which is why it's not exactly surprising to be doing another post on the hacks over at the National Review.  I mean sure it's Uncle Rukus' favorite tabloid but it's barely been a week since I've chronicled their reality- and context-free diatribe regarding Republicans and immigration reform.  But after reading what amounted to a hit piece conservative superstar John Kasich, my hand was forced.  What was the horrible crime that put the Governor of Ohio on the National Review naughty list?  Why, accepting the expansion of Medicaid under Obamacare of course.

The hackery begins early here.

Ohio governor John Kasich has joined the dishonor roll of Republican leaders backing an expansion of Medicaid under the Affordable Care Act. Our earlier criticism of Arizona governor Jan Brewer applies equally to the case of Ohio: The governor has allowed himself to be bought off by the false promise of “free money” from the federal government.
First of all, for the first three years of the program, the money is free not "free."  The federal government will pay 100% of the cost of the program's expansion.  Following the initial outlay by the federal government, the costs do shift but only ever so slightly.  Eventually, the states will have to pay an egregious gasp 10% of the program's costs.  Keep in mind that the state of Ohio wouldn't even be paying that paltry 10% until the year 2022.  And for that paltry cost, an additional 275,000 citizens of the Buckeye state would now have access to medial care.  But don't let me bog you down with actual facts about the program.  Let's hear how the National Review describes the expansion:
Like a street-corner drug dealer, Washington offers the first taste of Medicaid expansion for free, picking up 100 cents on the dollar of the costs. Afterward, the states will be expected to pick up at most 10 percent of the cost, again creating the illusion of something for nothing.
Classy.  Let's take a moment to highlight the imagery used here.  Now why would this publication want to paint the Obama administration as "street corner drug dealer?"  It's like they're driving at some subtle thing that I can't quite put my finger on.  If only I could decode this language.  But besides the basic offensiveness of the image, it also fails the logic test.  I've never purchased drugs from a street-corner drug dealer but I'm pretty sure they don't wait ten years to collect their money, much less waiting ten years to collect 90% of their money.  Speaking of something for nothing, at present Ohio doesn't even pay 50% of the cost for Medicaid like many states.  They only pay about 25%.

They continue:

Medicaid is a fiscally disastrous program that provides questionable benefits; studies routinely indicate that patients on Medicaid have health outcomes inferior to those who have no coverage at all. As it stands, Medicaid already costs nearly twice as much annually as the Iraq War did in its most expensive year ($258 billion vs. $140 billion), and the program is rife with fraud. It is in fact precisely the sort of wasteful and counterproductive program that intelligent governors of both parties should be seeking to reduce rather than to expand.
deep cleansing breath  Did they seriously just used the terms "rife with abuse" and "questionable benefits" to contrast the Medicaid program with the Iraq War?  Wow.  Just fucking wow.  OK, let's go there.  Medicaid is by no means a perfect program but the author's analogies leave a lot to be desired.  It's curious that he chose to use the fact that Medicaid costs more than the Iraq War and that it's the Medicaid program that's  "rife with abuse."  For one thing, Medicaid serves an actual purpose.  What was the purpose of invading Iraq again? Originally we went looking for Weapons of Mass Destruction that Saddam Hussein totally had and was hellbent on using.  When those fictions were exposed, there were a few more permutations of why we simply had to invade.  We just now started drawing down forces in Iraq but we won't be out until 2014.  So we spent more than a decade fighting in a country for no reason in particular and with little to show for it . "Questionable benefit" is the term we'd use for the war if one were drunk and trying to be exceedingly kind. Any year of Medicaid is vastly superior to the entirety of the Iraq War because it provides a tangible benefit to actual people.

Now as for the rife with abuse accusation, Iraq is again a hilariously poor example to use for contrast with Medicaid.  The most recent Congressional report back in 2011 showed that there was 60 billion of fraud done by contractors.  To say nothing of the 6630 members of the armed forced who've died as a result of the Bush Administration's fraudulent war.  But if fraud is a reason to denounce a program in its entirety that means everything from banks, police departments and educational institutions should likewise be razed to the ground.  Then again, let's not give these fools any ideas.

Now as to the fact that numerous studies conclude that Medicaid has no benefit at all, again I call bullshit.  The studies they are referring to were originally referenced in a Wall Street Journal article.  Generally speaking, what all four of the studies actually say is uninsured patients and Medicaid patients have worse health outcomes as compared to patients with private insurance.  For the first two studies the results of the uninsured and Medicaid recipients were combined.  And for the last two studies that actually do delineate Medicaid patients doing worse than uninsured patients in certain instances, it’s not quite that simple. I'll explain after this excerpt from the study:

Lung transplants: A 2011 study of 11,385 patients undergoing lung transplants for pulmonary diseases, published in the Journal of Heart and Lung Transplantation, found that Medicaid patients were 8.1% less likely to survive 10 years after the surgery than their privately insured and uninsured counterparts.
If you're purposefully trying to mislead people into thinking that Medicaid has no value, this is the quote that you would use.  I mean wow, Medicaid patients are more likely to die than their uninsured counterparts.  But what does that mean exactly?  The first thing that's important to understand is there are almost as many types of uninsured as there are flavors of Medicaid.  The qualifications for Medicaid are very strict, so you could simply make more money than is allowed and be uninsured.  Or you could be independently wealthy and chosen to not have purchased any private insurance.  This part of the study is comparing patients on Medicaid receiving lung transplants with uninsured people receiving lung transplants.  Uninsured people don't just get medical care.  Not outside of the Emergency room anyway.  I've worked in health care for a while so I can tell you that a lung transplant conservatively costs between $400,000-$550,000 depending on the operation.  So this study is actually comparing your typical Medicaid patient, which for a family of four in New York means making less than $18,070per year, to one that can come up with more than half a million dollars out of pocket.  Totally fair comparison, no?

All that particular study shows is that if you have outrageous sums of money and are willing to spend it, you can overcome not having health insurance.  You can even do 8% better than poor people with health insurance.  What a scandal!  Except that numerous studies have already shown that health is directly correlated to income.  And the poorer you are the worse your health.  That’s for a variety of reasons including environmental factors, diet, and lack of preventive care.  Reasons that were cited in some of the very studies the National Review is using to try to say that Medicaid is basically useless.  Lack of preventive care is an issue with the entire U.S health system not just Medicaid.   And it’s easy to see why a lack of preventive care might be more pronounced in a population of poor people.  Wage slaves aren’t typically the kind of people who have paid sick time for example.   Or a person from the Medicaid family cited above could get a raise of a quarter an hour.  Now a quarter raise doesn’t sound like much but in this example it would make him ineligible for Medicaid.  So he could have access to care and based on his getting a tiny raise or working too much over-time, lose all coverage.  Those are more of a health system/societal problems rather than a Medicaid problem.  But that's the kind of context that readers of the National Review frequently go without.

Speaking of context, the Kaiser Family Foundation did some real analysis of the expansion of the Medicaid Program under Obamacare and what that would mean to states.

The analysis also points out that Medicaid enrollment and spending is expected to rise even in states that elect not to expand coverage… For states that do adopt the expansion, they will see significant increases in coverage with limited incremental state costs and will see large increases in additional federal funds.

If coverage is expanded, states can expect to see declines in uncompensated care costs tied to spending on hospital care for people without insurance.

So states like Ohio which, according to a 2009 report by the American Hospital Association provided more than 2.1 billion dollars in uncompensated care.  Only a tiny fraction of that cost is picked up by the federal government.  By expanding the program hospitals will make more money for no other reason than being paid for more of the services they already provide.  So the expansion of Medicaid is a big plus for the medical system overall.  That’s why numerous hospitals and medical centers have been lobbying for the expansion.  If you don’t like the moral argument for expanding coverage to more people, there are plenty of financial ones.

Let's sum this all up.  There are reasons both moral and financial to expand Medicaid coverage under Obamacare.  Reasons the National Review is willfully ignoring to serve their own partisan hackery.  Worse than willfully ignoring the facts, they've actually gone our of their way to lie about the actual results of studies to denigrate a program that helps millions of Americans get access to health care.   And let's not forget images of "street-corner drug dealers" tied directly to the Obama administration because it wouldn't be the National Review without them being overtly racist at least once per cover article. At least.

Once you pick apart their shallow rationales based on cherry-picked elements from studies, their argument seems to be: Come one Kasich, who cares if hospitals in your state performs billions of dollars in uncompensated care every year, medical bills are one of the leading causes of bankruptcy and you can fix some of that with the stroke of a pen.  Instead of doing what's right for the patients, doctors and hospitals of your state, can't you just simply ignore overwhelming evidence just to stick it to the administration.  That what real leaders do!

National Review, please go and eat an entire bag of dicks.

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Comment Preferences

  •  Worse Outcomes Than No Coverage at All? (4+ / 0-)
    Recommended by:
    a2nite, Linda1961, Ticorules, NancyWH

    That would seem to warrant a diary of its own.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Sat Feb 09, 2013 at 09:45:45 AM PST

  •  Where is the Disagreement? (2+ / 0-)
    Recommended by:
    nextstep, Dogs are fuzzy

    You write

    First of all, for the first three years of the program, the money is free not "free."  The federal government will pay 100% of the cost of the program's expansion.  Following the initial outlay by the federal government, the costs do shift but only ever so slightly.  Eventually, the states will have to pay an egregious gasp 10% of the program's costs.
    National Review writes:
    Like a street-corner drug dealer, Washington offers the first taste of Medicaid expansion for free, picking up 100 cents on the dollar of the costs. Afterward, the states will be expected to pick up at most 10 percent of the cost, again creating the illusion of something for nothing.
    The numerics appear to be the same.  There is no disagreement here between you and National Review, except in where you each put invidious adjectives.

    With respect to "free", most conservatives appear to have grasped, like the blind nuts who have found their squirrel, a very fundamental point:  There is no free money.  The Treasury does not print money.  Instead, that money came out of the wallets and pocketbooks of taxpayers (and, contrary to Mitt Romney, essentially all working Americans pay a fair amount in taxes; it's called Social Security) or out of the incomes of future generations, paying interest on federal bonds.

    Now, you may reasonably claim that the money is well spent -- you did -- but the money is assuredly not 'free'. It came from someplace.

    We can have change for the better.

    by phillies on Sat Feb 09, 2013 at 10:26:25 AM PST

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