Thursday, May 9, 2013

In Which I Call Robert Samuelson (and those like him) an Ass

Robert Samuelson in the Washington Post:

The only major health gain was psychological. Depression dropped from about 30 percent to 21 percent between the groups. One reason may have been that Medicaid recipients don’t fear huge medical bills...

Obamacare’s advocates ignored these ambiguities. They were too busy flaunting their moral superiority. Universal health insurance is a legitimate goal, but 2009 — in the midst of a major economic crisis — was the wrong time to pursue it. Predictably, it polarized public opinion and subverted confidence for what seem to have been, based on the available evidence, modest likely public health improvements. The crusade for universal coverage has been as much about advocates’ sense of self-worth as about benefits for the uninsured.

Fuck you. Depression is a serious medical condition which can lead to death and impedes the sufferer's ability to work, maintain relationships, and live a full life. Looking only at this measure* we have a very significant public health triumph. While there remains a very substantial stigma towards mental health conditions they are one of the largest public health problems in the United States as well as one of the costliest. According to NAMI "The economic cost of untreated mental illness is more than 100 billion dollars each year in the United States"** Even if we're just going to be good little capitalists and treat the working class as nothing but a potential labor pool, reducing the rate of depression is a very significant contribution to public health, not "flaunting our moral superiority" or "about advocates' sense of self-worth."

To be blunt, this attitude towards the concrete achievements of the study is nothing but knuckle-dragging, head in the sand, partisan denialism of the worst sort. Its atrocious in its disregard for the seriousness of mental illness and its dismissal of the importance of individuals' financial security. Another way to gloss just the statistically significant results is that the study found the poor protect their physical health at a substantial sacrifice to their mental and financial health. No wonder there are so many broken families among the poor, so many of them are broken and suffering from mental illness. How can people be expected to be valuable employees and raise stable families in this condition? I don't mind calling myself morally superior to someone that dismisses these concerns so breezily, I'd hope most people are morally superior to this or our country is going to hell.

Yes, I suppose I could be more analytical and deliver less ad hominems but I've been seeing a lack of concern for the mentally ill among the commentariat that I consider outside the bounds of human decency. This is awful people acting awfully and they don't deserve a fair hearing. They aren't acting like polite company and I don't believe they should be treated as such. I've read article after article (Robert Samuelson is the straw that broke the camel's back, not the first instance) that seems to dismiss this result as next to nothing, as if physical health is all that matters. I find this appalling in its lack of recognition of the real challenges depression poses in sufferer's lives and the very real damage it causes their families and the larger economy.

[Update: I forgot to actually call anyone an ass. Robert Samuelson, and similar critics, is an ass for ignoring the fact that the Medicaid study showed large and significant improvements in by far the most prevalent health condition in his conclusion, seemingly for no other reason than that depression is a mental health condition and he likes to punch hippies. You would have thought we had moved past the point where we only think physical health matters, but it seems not everyone has. It just gets worse when you realize the observed points on physical health are consistent with other research on the impact of health insurance on other measures of health, it would have been highly unusual to have observed a statistically significant impact on physical health given the size and composition of the treatment group. No one expects an intervention to reduce complex health problems by half or more in a 2 year period, these are just more difficult to treat conditions than that (ok, the blood pressure result was a bit disappointing, but the magnitude of the elevated glucose levels was fairly impressive at a 20% reduction).]

*I do have to note that as far as what I've been able to find on the subject the observed point values are consistent with the estimated magnitude of effect from other studies. It is consistent in finding stronger effects in breakouts of the population with a worse baseline health. The study is obviously underpowered, for it to find statistically significant impacts on physical health measures the observed impact would have had to have been at the tail end (or possibly outside of, I'm being generous) of the impact on health insurance found in other studies. This would probably have indicated a more serious problem with the study if the results had been outliers relative to previous research.

**No idea if this is accurate, but I'm mad and taking the first number I found.

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