If you like your reduced ER use, you can keep it

IMG_1553The latest results are in from the great Oregon Health Insurance Experiment (OHIE).

In a randomized experiment, individuals offered Medicaid coverage showed higher rates of emergency department (ED) use than did their otherwise comparable peers not given the same opportunity.

The effect size was pretty small—about one extra ED 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.

They 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.

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.

More here.

Getting the knowledge on health reform from the New Republic’s Jonathan Cohn

During the health reform fight, a handful of people emerged with distinctive voices, who had a huge impact. The best of them combined the policy expertise, empathy, and graceful writing to command public attention as we finally extended health insurance coverage to millions of people.

Jonathan Cohn, senior editor of the New Republic was certainly one of those people. His award-winning 2007 book Sick chronicled the plight of uninsured and underinsured Americans. The New Yorker’s Atul Gawande called Sick “stunningly important … In one damning true story after another, Jonathan Cohn lays bare the tragedy of our health care system.”

Jonathan also originated and ran an influential blog called “The Treatment,” covering the daily fight over health reform. I was a special correspondent for “The Treatment” during 2009 and 2010. Having Jonathan as my editor there was a just a very special opportunity for me in my midlife-crisis journalism career.

Jonathan and I sat down for a two-part video conversation at healthinsurance.org regarding how health reform is going, the President’s inaugural address, and other matters. Please check it out.

Some of the video is included above. An edited  transcript follows, below the fold, for those who prefer.

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