There is No Managing Health Care Costs Number Today
There’s a battle raging – a battle between statistics – lovingly subject to regression and other analyses -- and stories – raw and full of emotions.
I like statistics – especially when done well. The flag bearers for using statistics to determine public policy are gifted economists Kate Baicker of the Harvard School of Public Health and Amy Finkelstein of MIT. They have helped us learn the real impact of Medicaid expansion through their studies of the Oregon natural experiment to randomly give Medicaid to some but not other equally needy residents. We’ve learned a lot about the value of Medicaid to real people from Baicker and Finkelstein – we should certainly use this knowledge when we are crafting public policy.
Baicker and Finkelstein recently wrote in Health Affairs blog:
Policies are not enacted in the abstract; they affect real people’s lives, and we should all be concerned with how policy changes help or harm them. Unfortunately, as moving as those stories can be, they can just as easily lead us in the wrong direction as the right one. What we need is evidence, not anecdote.
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Personal narratives can yield vital insight into how policies affect people’s lives, humanizing the stories behind the numbers and suggesting important areas for further research. Dismissing these compelling stories as “mere anecdotes” in favor of more rigorous—but impersonal—data analysis can seem heartless. But making policy based on unrepresentative anecdotes can inflict much greater harm on many more people. We hope that use of rigorous evidence will become the norm rather than the exception in health policy.
While policy should be driven by evidence, we won’t be able to gather support for evidence-based policy based on the research alone.
I guess I’d have to say that powerful stories, many of them transparently false, have also driven our political discourse over the last year. (John Podesta and the pizza shop child pornography ring in DC? Really? ) It’s even more distressing to hear that many of these stories were planted by Russian spies under the guidance of the Kremlin.
I’ve been looking at charts like this – that show how many of the working poor were left behind in states that did not expand Medicaid under the Affordable Care Act. Full Medicaid expansion would have brought almost 15 million more into the world of health insurance. But that number is just a number. And Kaiser Family Foundation has been producing these charts for 5 years already and Medicaid has expanded a bit - but there are still 19 states which have retained the "gap" that leaves many ineligible for either Medicaid OR ACA subsidies
Yes you read this graph right. Only one of these states EVER provides Medicaid to nondisabled nonparents, and TX and Alabama require an income of under 18% of the federal poverty limit for parents with kids to qualify. 100% FPL is $20,160 for a family of three- so a mom with two children would need to make less than $4000 a year to qualify for Medicaid in Alaabama and Texas. Really.
Last week, the New York Times magazine published “Life in the Obamacare’s Dead Zone,” deeply personal stories of mostly women in the Midwest who are irreparably harmed because their states have not expanded Medicaid. Janet Foy could not afford the sliding scale $35 therapist visits to control her depression. Suzan Emmons earned enough in Kansas to get federal assistance to purchase an exchange plan. When she took custody of her granddaughters who faced abuse at home, her income dropped into the “gap” and her subsidies were yanked away. Shanette Smith’s dreams of becoming a nurse were shattered when she was unable to matriculate at school because she couldn’t show proof of insurance.
By the way , “dead zone” gives more of a sense of what’s really going on here than “gap.” As we’ve learned from Republican strategist Frank Luntz, words matter.
So – today’s managing health care costs number will return, and I’ll still be eager for the kind of insightful research done by Baicker and Finkelstein and so many others. I hope we build our policy on that strong foundation.
But we’ll need to tell a lot of intimate, personal, and powerful stories to gain the support for making access to health care a right in this country, as we enter this new scary era.
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