Like many other liberal health-policy wonks, I’ve written a lot about the value of health reform in improving access to preventive care, protecting people against crippling medical debt and improving people’s physical and mental health.Alexander Hertel-Fernandez:
I haven’t written much about how better access to health care can actually save lives. The argument for the Affordable Care Act, President Obama’s signature health-care-law, doesn’t ride on this. Moreover, the connection between health insurance and mortality is really hard to pin down, even if insurance truly has strong protective effects. The uninsured in America are mainly non-elderly adults. Deaths are really rare in this population, on the order of 0.4 percent per year. according to an Urban Institute study. Real-world randomized clinical trials—even those with thousands of patients—are just too small and too brief to reliably determine how much we might reduce mortality by extending coverage to the uninsured.
On Monday, though, a beautiful study was published in Annals of Internal Medicine that provides some of the best data we have connecting health coverage to saved lives. It’s changed my thinking, too. I’m more confident than I was last week that the ACA will save many thousands of lives every year.
Although the states largely split on partisan lines, some states with GOP governors or Republican legislative majorities have agreed to expand Medicaid – and more such states may yet do so. The new politics of health care are creating divisions in forces in and around the GOP.More politics and policy below the fold.
Consider America’s best-known business association, the Chamber of Commerce. In many states, Chambers have lent their considerable clout to forces pushing for Medicaid expansion. As my data show, although Chambers of Commerce in 24 states have stayed on the sidelines, Chambers in another 24 states have publicly come out in support of Medicaid expansion. Ironically, in several states, such as Arizona and Missouri, Chambers have actually waged high-profile campaigns to lobby GOP-led legislatures for Medicaid expansion even while continuing to decry the Affordable Care Act overall.
Given that neither the national Chamber nor its state affiliates are known for supporting President Obama or boosting Democratic initiatives, why is this happening? I am still looking into the factors at work, but three stand out so far.
Sen. Marco Rubio did not sugarcoat his feelings for Charlie Crist in a Fox News interview this afternoon.Rubio is, of course, a subject matter expert on phonies.
Neil Cavuto asked about Crist's comments yesterday in which he asserted he left the GOP over racism.
"I think it's ridiculous and silly,” Rubio said. “I'm even cautious to dignifty that with a serious response. My prediction is that by the end of this election, even Democrats will be embarrassed that Charlie Crist became a Democrat. If this is in fact how he felt at the time, whey didn’t he say it?
Cavuto: "You think he's a phony?"
Many point to research conducted on Oregon's expansion of Medicaid in 2008. That study found people who gained coverage made little progress controlling their cholesterol and blood pressure compared with low-income Oregonians without Medicaid. The researchers scrutinizing Massachusetts' experience looked at a longer-term — and arguably more consequential — measure of health: mortality.Philip Klein:
That is important, said Katherine Baicker, a health economist at Harvard and former Bush administration official who has been studying Oregon and co-wrote the Massachusetts study. "Studies like this one can take advantage of both longer time frames and larger sample sizes," she said.
There is more uncertainty as to whether the results of the study can be applied more broadly to Obamacare. The authors note that the study does provide “suggestive evidence” that the national health care law will have an impact on mortality. “However,” the authors add, “it is critical to note the many dimensions in which Massachusetts differs from the rest of the nation, including lower mortality, higher income and baseline insurance coverage rates, fewer minorities, and the most per capita physicians in the country. The extent to which our results generalize to the United States as a whole is therefore unclear, which underscores the need to monitor closely the Affordable Care Act’s effect on coverage, access, and population health across all states.”Especially interesting, given that Klein is a conservative and this is the Washington Examiner.
Thus, it will take many future studies of the implementation of Obamacare to determine whether the nation as a whole can achieve the type of reduction in mortality that the authors detected in Massachusetts. But, no doubt, the Massachusetts study offers the most compelling evidence to date that increasing health insurance coverage translates into fewer deaths.
So is Avik Roy:
Their findings are compelling. Among non-elderly adults, the authors found a statistically significant reduction in all-cause mortality of 2.9 percent. The finding had a p-value of 0.003, which means that it had a 0.3 percent chance of being the result of statistical noise. They also found a meaningful reduction in health care-amenable mortality—4.5 percent—with a p value of less than 0.001 (less than a 0.1 percent chance of being statistical noise).Roy makes the argument that it's private insurance that's the reason, not Medicaid, but Ocare is half Medicaid, therefore don't assume anything. But as someone who treats Medicaid and private insurance the same and side by side in my office, I don't get the assumption other than private is inherently better because it is.
If you look under the hood of the data, it’s even more convincing. People living in counties with below-average incomes, and high uninsured rates, showed a significant reduction in mortality, whereas higher-income and low-uninsured counties showed a lesser, statistically insignificant trend. Both whites and non-whites fared better after reform.
Wisconsin politics has never been so polarized. Now, those political divisions are playing out in the final frontier: the courts.But wait... a few hours later:
On Tuesday night, a judge ordered that a secretive investigation into the funding of Gov. Scott Walker's recall campaign be halted. In his ruling, U.S. District Judge Rudolph Randa found that the secretive investigation violated the First Amendment rights of its targets—conservative political groups.
Prosecutors investigating Gov. Scott Walker's 2012 recall campaign and conservative groups that supported him won a victory Wednesday with a federal appeals court ruling that, at least for now, blocks a judge's ruling that halted the probe.Rick Hasan's take on the WI shenanigans is here.
Let’s say you have two biased coins, one that comes up heads 49 percent of the time and another that comes up heads 55 percent of the time. You want to figure out which one is the 55 percent coin. If you flip both coins repeatedly and choose whichever coin comes up heads more often, how many coin flips would it take to be confident that you’d made the right choice?Amanda Hess:
The answer: 375. It would take 375 flips to be correct 95 percent of the time. If it took you five seconds to flip both coins (and record your answers, all the while keeping track of which coin is which), it would take a you half an hour of doing nothing but flipping coins to be able to confidently differentiate one coin from the other.
The race for Senate control really is still a tossup.
Monica Lewinsky has unwittingly done this country a great service. In 1998, she forced America to bumble through an unprecedented national conversation about sex, power, and sexism. And in 2014, she has returned to compel us to review how we handled the assignment. New York Times columnist Maureen Dowd—who covered the scandal obsessively and, as my colleague Mike Pesca notes in his podcast “The Gist” on Wednesday, won the Pulitzer Prize for that work—is as good a case study as any for examining what’s changed in the 16 years since Monicagate hit.