May 11, 2015

A Massachusetts omen for Obamacare

More embarrassing facts for the shallow thinkers of the Left!  One sometimes wonders if they think at all

We read:

"A study of survival rates in trauma patients following health insurance reform in Massachusetts found a passing increase in adjusted mortality rates, an unexpected finding suggesting that simply providing insurance incentives and subsidies may not improve survival for trauma patients, according to a report published online by JAMA Surgery.

Massachusetts introduced health care reform in 2006 to expand health insurance coverage and improve outcomes. Some previous research has suggested improved survival rates following injury in patients with insurance. But the relationship of insurance to survival after injury may not be well understood. Some might expect that survival after traumatic injury may be unrelated to a person's insurance status because all injured persons have access to emergency care, according to the study background.

Turner Osler, M.D., M.Sc., of the University of Vermont, Colchester, and coauthors conducted a study of more than 1.5 million patients hospitalized following traumatic injury in Massachusetts or New York, a neighboring state that did not institute health care reform like Massachusetts. The study examined the 10 years (2002-2011) surrounding reform in Massachusetts.

The rates of uninsured trauma patients in Massachusetts decreased steadily from 14.9 percent in 2002 to 5 percent in 2011. The authors also found health care reform was associated with a passing increase in the adjusted mortality rate that accounted for as many as 604 excess deaths during four years.

"Fortunately, the increase in mortality among trauma patients following Massachusetts HCR [health care reform] resolved within a few years. It may not be possible to retrospectively reconstruct the causal pathway responsible for the increased excess deaths following HCR and its subsequent resolution. ... There are compelling arguments for providing health insurance to all citizens of the United States but our analysis suggests that simply providing health insurance incentives and subsidies does not improve survival for trauma patients. ... Ours is thus a cautionary tale for health care reformers: successful HCR for trauma patients will likely require more complex interventions than simply promoting health insurance coverage legislatively."

Taxachusetts was way ahead of Obamacare in giving people that wonderful publicly subsidized health insurance.  So people there don't die for want of insurance any more -- Right?  As we read above, some pesky medical researchers have just reported the evidence on that.  And???  More people DIED under the Massachusetts system.  The outcome was the exact opposite of what Leftists were so sure they could deliver.  Their meddling was harmful, not helpful.  Where have we seen that before? And will we see it from Obamacare?

The researchers describe the change they observed as "transient", meaning that the effect was seen only in the first few years of the new system. But have the Obamacare architects learned from that?  Not that I can see.  They seem in fact to have made the same mistakes. So this report probably means that Obamacare will kill tens of thousands of Americans.

Their report that earlier studies had shown better outcomes for insured people is naive.  People who took out private health insurance in the past would in general have been smarter and richer.  And both smart and rich people are known to have better  health generally than others.  It's one of the most consistent findings in medical research.  And healthier people are more survivable after misadventure.

And I don't have to be as coy as the researchers above in addressing the cause behind the findings:  The increase in the number of insured patients led to an increase in demand for medical services.  It was meant to. What would be the point of the legislation otherwise?  But that increase was not matched by a similar increase in available medical personnel.  So the healthcare system became overstretched, meaning that EVERYONE got worse care, including, sadly, emergency cases.  And Obamacare was similarly implemented.  It has, if anything, REDUCED the availability of medical personnel. If that is not turned around somehow (How?), the avoidable deaths will continue too.

So in their typically short-sighted Leftist way, the Massachusetts and Obamacare legislators did not consider the probable downstream effects of their new healthcare legislation.  But they did get what they wanted out of it -- the warm inner glow of being SEEN to be helping the poor. That they actually harmed everyone was of no concern to them.

Or, as T.S. Eliot rather generously put it over 50 years ago: "Half the harm that is done in this world is due to people who want to feel important. They don't mean to do harm -- but the harm does not interest them. Or they do not see it, or they justify it because they are absorbed in the endless struggle to think well of themselves."

I do still occasionally report my amazement at the follies I see as a result of my frequent readings in the medical journals and this finding certainly justifies that odd hobby of mine.  And it is particularly enjoyable to have a "big dig" at Taxachusetts.  Puncturing hubris is always amusing.  Journal abstract below


Survival Rates in Trauma Patients Following Health Care Reform in Massachusetts

By Turner Osler et al.

Abstract

IMPORTANCE: Massachusetts introduced health care reform (HCR) in 2006, expecting to expand health insurance coverage and improve outcomes. Because traumatic injury is a common acute condition with important health, disability, and economic consequences, examination of the effect of HCR on patients hospitalized following injury may help inform the national HCR debate.

OBJECTIVE: To examine the effect of Massachusetts HCR on survival rates of injured patients.

DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 1,520,599 patients hospitalized following traumatic injury in Massachusetts or New York during the 10 years (2002-2011) surrounding Massachusetts HCR using data from the State Inpatient Databases.

We assessed the effect of HCR on mortality rates using a difference-in-differences approach to control for temporal trends in mortality.

INTERVENTION Health care reform in Massachusetts in 2006.

MAIN OUTCOME AND MEASURE Survival until hospital discharge.

RESULTS During the 10-year study period, the rates of uninsured trauma patients in Massachusetts decreased steadily from 14.9%in 2002 to 5.0.%in 2011. In New York, the rates of uninsured trauma patients fell from 14.9%in 2002 to 10.5%in 2011.

The risk-adjusted difference-in-difference assessment revealed a transient increase of 604 excess deaths (95% CI, 419-790) in Massachusetts in the 3 years following implementation of HCR.

CONCLUSIONS AND RELEVANCE Health care reform did not affect health insurance coverage for patients hospitalized following injury but was associated with a transient increase in adjusted mortality rates. Reducing mortality rates for acutely injured patientsmay require more comprehensive interventions than simply promoting health insurance coverage through legislation.

JAMA Surg. doi:10.1001/jamasurg.2014.2464 Published onlineMay 6, 2015





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