Wednesday, May 07, 2014

The first truly good positive datapoint for O'care that I've seen

And it's for Romneycare of all things.  A big randomized study shows that the mortality rate in Massachusetts fell quite a bit relative to a control sample after the implementation of Romneycare.  This is significant because the two previous randomized trials - Oregon Medicaid and Rand Corporation showed no health or mortality benefits to having health insurance.  So now we have three studies, the largest and latest of which says that there's a mortality rate payoff to universal health insurance.
Source: Annals of Internal Medicine
I will await the hardcore statistician and wonk analysis before passing judgement but I must be a Bayesian in the meantime so credit where it's due.

That's not to say I don't have a bit of a problem theoretically with the result.  The US has the highest risk adjusted life expectancy in the world already.  Massachusetts was already among the most heavily insured states in the nation before Romneycare and one of the highest of the highest in life expectancy - so they're at the bleeding edge of the healthcare innovation and mortality curve.  Yet there was a significant and immediate improvement in mortality.  This suggests that the US delivery system (well at least MA's) is not just better than all the universal systems in other advanced countries but a whole lot better with a big payoff simply from insurance coverage. If this is true then the US is in for a massive increase in life expectancy over a few years that will leave other advanced countries in the dust because the uninsured problem is much worse outside of MA.

Does this make sense?  I don't know. Usually progress is slower for those pioneering at the innovation event horizon, not faster.  And the tale thus far for Romneycare has been one of significant access problems due to higher demand meeting fixed supply.  But we will see, we will see.  And for the record, I sure hope it does.  For that means when we repeal the O'care fiasco and do it right, the level of human flourishing in America will soar.  Which would be cool.

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