• A podcast on the Medicaid study

    I spoke with Russ Roberts of EconTalk for an hour or so about the Oregon Medicaid study. The conversation took place last Thursday. As you can tell by reading more recent posts on this blog, we’ve learned more since then.


    • Good audio, though time permitted me to only listen to a bit above 50%.

      With regard to limitations of power: There were roughly 15 parameters that created the conclusions drawn that I believe you objected to on the basis of a power calculation. Each parameter had random chance and I think that it is accepted that the research was well done and non biased.

      I asked myself:

      What is the “power” of study #1? Poor and therefore one might say that the study wasn’t effective in proving the disputed conclusion. If we take another parameter, study #2, and that showed the same result one would think that would help to validate study #1 a bit despite its low power. Take that through the 15 or so studies that are demonstrating the same outcomes and I would believe that the validity would dramatically increase if we accept the validity of the researchers doing appropriate research. I don’t think the researcher’s motives or integrity were questioned.

      Depression diagnosis big increase, but did that knowledge improve health? I’ll stay away from that because a lot of conclusions with regard to mental health seem too squishy to me and because of some prior studies I reviewed.

    • Russ pushed back a bit on the utility of preventive health and for mostly right reasons. He cited Topol from an earlier episode and I think, misunderstood statin linkage with MI rate reduction. He did not make distinction between primary and secondary prevention, NNT, etc. Small quibble, but bad example. Prevention sometimes cost-effective and worth investment– which he skirted over.

      He used above to transition into a nod towards a catastrophic coverage only world.. The demarcation he made between Mcaid and others in this regard was minimal. You made the case for financial security and the need for something, in this case Medicaid, because we have no other product. I wish he would have forwarded a more formed solution beyond, “maybe we should give cash.” I wanted something more fully formed given his worldview.

      All in all however, a good discussion between two folks with opinions. I wonder if the the same comity would carry over if you both had to hash out a substantive policy solution behind closed doors?