Will ObamaCare Save Lives?
John Goodman looks at whether or not Obamacare will save lives. He starts out by defining the problem.
Being uninsured is like being unemployed. It happens to lots of people for short periods of time. Of all the people who are uninsured at a point in time, more than half will obtain insurance within 12 months and 90% will be insured within two years. So if you want to argue that being eligible for Medicaid is better than being uninsured for most people you have to have a theory that says that extending Medicaid to the temporarily uninsured saves lives.
It gets worse. Since Medicaid eligibility is conditional on income, people become eligible and ineligible as their incomes rise and fall. So like uninsurance, Medicaid eligibility also is a condition that affects a lot of people for short periods of time.
So now you need a theory that says that temporary enrollment in Medicaid for the otherwise temporarily uninsured adds to life expectancy. I know of no studies that test this proposition.
He then points out that, even if this is true, it's the exact opposite of what Obamacare does. Obamacare uses tax data (that can be up to two years out of date) to decide whether or not you can purchase health insurance on an exchange or whether you have to go on Medicare.
So what kind of reform would you want if you believe that temporary uninsurance is bad for health and continuous insurance is good? Obviously, you wouldn't want to enroll people in a plan where eligibility changes every time family income bobs up and down. You would instead want to encourage plans that cover people for long periods of time. The help (subsidy) you make available can bob up and down as income changes -- but enrollment shouldn't follow the same rollercoaster. The subsidy may be income dependent, but enrollment should not be.
Ideal health insurance actually would not include Medicaid at all. It would involve people enrolling in private plans that are portable, and travel with them from job to job. And this result is consistent with other research. For although there is some argument about how much difference health insurance makes, almost every study finds that private insurance is better than Medicaid.
Obamacare delenda est. Because it really is a bad way to solve the problem of health insurance.