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Values and evidence: There's a difference.

March 12, 2012
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In her latest column at TIME Ideas, Shannon Brownlee takes on the controversy over the Obama administration's birth control rule, and links it to some of the other purportedly moral debates over the extent of health insurance coverage. The core point is that, while each person is entitled to his own opinion, we're not entitled to our own facts. In cases where the facts line up solidly against a treatment, as with some kinds of back surgery, PSA testing for prostate cancer, and other elective procedures, it makes sense to limit the extent to which taxpayers and other members of insurance pools have to subsidize care. In cases where moral beliefs are at issue, though, we have to be careful to respect differences:

...the medical issues that are now sparking debate have relatively little to do with the pure numbers or effectiveness. The controversy arises because people have different moral beliefs. In a pluralistic society, we should try to respect and even celebrate that. When it comes to decisions that are rooted in values, I don’t want anyone—be it the government, my employer, or somebody else’s religious leader—coming between me and my doctor.

What Part of Idiopathic Epistaxis Don’t You Understand?

  • By
  • Shannon Brownlee,
  • New America Foundation
October 31, 2011 |

About a year ago, I accompanied my 80-year-old mother on a visit to the cardiologist’s office. She had been having unexplained dizzy spells and a rapid, irregular heart beat and was in for tests to see what the problem was. After the first test, we sat with the electrophysiologist, who explained Mom’s results.

The Cure

  • By
  • Phillip Longman,
  • New America Foundation
October 28, 2011 |

While the partisan gap in Washington is wider than it’s been at any time in living memory, the two parties do have one remarkable agenda in common. Both have proposed cuts in Medicare so drastic that they would have been politically suicidal a decade ago and may still be. Yet neither party is backing off.

Tarnish on the Golden State

  • By
  • Leif Wellington Haase,
  • New America Foundation
  • and Mark Rukavina, Jacquelyn Kercheval
September 27, 2011

Tarnish on the Golden State, a new report issued by the New America Foundation, exposes how medical debt can lead to ill health and financial insecurity for individuals and families. Tens of millions of American families struggle to pay health insurance premiums and medical bills. In 2010, 44 million working aged American adults had medical debt or medical bills they were paying off over time. In California, over two million people had medical debt prior to the recession and the problem has likely become worse since then.

City Learns Lessons From the Storm, Many of Them the Hard Way

  • By
  • Sheri Fink,
  • New America Foundation
  • and Al Baker, Michael Barbaro
September 4, 2011 |

Changes both large and small will be made to the way New York City responds to hurricane emergencies in the future, including how evacuations will be publicized and executed, after officials learned valuable lessons from the unprecedented emptying of the waterfront as Tropical Storm Irene bore down on the five boroughs.

Next time, a neighborhood on Staten Island that was not evacuated may well be. The Housing Authority will make accommodations for pets. The city's Web site will be stripped to the news-you-can-use essentials in emergencies.

For Some Medical Evacuees, Safety Brought Its Own Difficulties

  • By
  • Sheri Fink,
  • New America Foundation
August 28, 2011 |

David Clark sat in an ambulance for hours late Saturday night in front of the Park Slope Armory in Brooklyn. Mr. Clark, who is 48 and relies on a wheelchair because of diabetes and a leg injury, was late to receive his medicines. But he still had not even been admitted to the armory, which was a designated shelter for patients with special medical needs who had been displaced because of the storm.

Medicaid Is Still Not Worse Than Being Uninsured

July 13, 2011
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Forbes blogger Avik Roy commented during yesterday’s IPAB hearing that “studies show that health outcomes for many Medicaid patients are worse than those who have no insurance at all.” That assertion has been around for a while. Unfortunately for Roy, it’s been frequently refuted, with a new study out of Oregon containing further evidence that patients do, in fact, benefit from Medicaid coverage.

The National Bureau of Economic Research study, released earlier this month, details results from  a study of Oregon’s Medicaid program. Three years ago, the state discovered that it had additional funds for Medicaid and wanted to enroll more people. But there were more eligible recipients than there was money, so the state created a lottery to decide who could apply and who couldn't.   The study, conducted by researchers from Harvard, MIT and other institutions, is the only randomized experiment ever done on the effects of having insurance compared to no insurance.* It compared utilization, health outcomes and self-reported health status, and financial hardship due to medical expenses among people who won the eligibility lottery and those who did not.

One key result: The authors describe an “overwhelming sense from the survey outcomes that individuals feel better about their health.

Individuals who won the lottery also used more medical services, had improved self-assessed physical and mental health, and reduced likelihood of medical debts being sent to a collections agency. While none of the results directly relate to mortality or other measures of actual health (because mortality among the adult population is extremely low, even without insurance), there is a clear benefit to Medicaid in terms of beneficiaries’ general well-being. (Future papers will present more data on traditional measures of health outcomes.)

So much for the claim that Medicaid makes people sicker.

*The RAND Health Insurance Experiment(the only other randomized trial looking at the effects of insurance) examined the effects of different amounts of insurance, using different cost-sharing arrangements, but did not include any participants with no insurance at all.

Health Care Can Make You Sick

  • By
  • Shannon Brownlee,
  • New America Foundation
July 4, 2011 |

Los Angeles doctors are plentiful, and Angelenos have some of the highest rates of visits to doctors and specialists in the nation. So you’d expect Angelenos to get the very best health care. But do they really?

NUMBER OF THE DAY: 41% of Births Covered by Medicaid

July 8, 2011
Medicaid Births Map

Number of the Day: 41%

Medicaid has been in the news a lot lately.  A new study was released yesterday showing the mental health and financial benefits experienced by recipients of Medicaid. Meanwhile, Medicaid continues to face big cuts in the ongoing debt ceiling talks.

With this in mind, we set out to take a quick look at the scope of Medicaid’s impact.  We discovered Medicaid covers more than four in ten births in the United States.  Surprised? We were, too.  It amounts to about 1.68 million births a year out of the over four million annual births nationwide.

Policy Periscope: Child Care and Jerry Brown 2.0

  • By
  • Kate Karpilow,
  • New America Foundation
May 31, 2011 |

“Everybody is exhausted just trying to hang on to what exists, with attacks from every direction.”

That’s a quote from a leading child care advocate in California . . . a very tired advocate.

After months of budget battles, California’s child care system was ultimately pared down with a sharp scalpel, as were most health and social service programs.

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