Author Archives: Gaberilla Eve

So Is Healthcare Worthwhile or Not?

Mother Jones

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Avik Roy tweets:

Oregon study, that Obamacare partisans constantly cited as “proof” that Medicaid improves health outcomes, doesn’t.

Here’s the abstract of the study:

Conclusions

This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.

This is a disappointing result that raises obvious questions about Medicaid expansion, but I’d make several comments here. First, the study found that Medicaid patients had lower rates of depression. That’s a good health outcome! Second, Medicaid “nearly eliminated catastrophic out-of-pocket medical expenditures.” This suggests that poor people without Medicaid do get treated for catastrophic problems, but mostly in emergency rooms. Medicaid is certainly an improvement here even if the health outcome is the same.

Third, Medicaid coverage “significantly increased…the use of diabetes medication, but we observed no significant effect on average glycated hemoglobin levels.” This is odd, and I wish I had access to the full report to understand this better. Is it because diabetes medication is ineffective? Or what? See update below for more on this.

Fourth, Medicaid “increased the use of many preventive services.” This is almost certainly a positive development even if it had no measurable effect within the two-year window of the study.

Fifth, the study suffers from the usual problem of measuring “outcomes,” and suffers especially because it measured only a very limited set of outcomes (primarily chronic conditions like blood pressure, cholesterol, and diabetes). This has long been one of my pet peeves. The problem is that there are lots of things that improve your quality of life but don’t show up as an improvement in either mortality rates or glycated hemoglobin levels. If I have an infection, for example, a course of antibiotics is a godsend. More than likely, though, the infection would have gone away eventually on its own. Does that mean the medication was useless? Of course not. Ditto for arthritis meds, a better pair of glasses, a new hip, a root canal, or fixing a broken ankle.

The truth is that if you take a narrow view of “outcomes,” it’s hard to find a significant effect from most of our healthcare efforts. Nonetheless, improved access to Medicaid produces plenty of improvement in acute problems; better use of preventive care; and far better financial outcomes. This is all worthwhile stuff even if controlling chronic conditions remains a challenge.

Overall, I’m a little unclear about what the conservatives who are crowing over this study really think. They obviously believe that access to healthcare is a good thing for themselves. (At least, I haven’t heard any of them swearing off doctor visits.) But you can’t have it both ways. If it’s a good thing for us middle-class types, it’s a good thing for poor people too. Conversely, if it’s useless for poor people, then it’s useless for the rest of us too. So which is it?

POSTSCRIPT: One thing I’d be interested in learning is what most of the Medicaid money was spent on during this two-year study. If half of it went toward cholesterol and diabetes treatment with little to show, that’s a terrible result. If 5 percent went to those things, with the bulk being spent on more prosaic acute problems, then the result isn’t so bad after all. I imagine this data is available somewhere.

UPDATE: Austin Frakt and Aaron Carroll have read the full study and have some more detailed thoughts here. Notably, it turns out there were improvements in blood pressure, glycated hemoglobin, and cholesterol, but the size of the study was fairly small, so the results weren’t statistically significant. Specifically, as Sam Richardson tweets, “#Oregon point estimates: Reductions of 30% in depression, 18% in high HbA1c, 17% in high chol, 8% in high BP. Big effects, little power.” As Austin and Aaron note, this is very, very different from saying there was no effect.

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So Is Healthcare Worthwhile or Not?

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How to Clean Wood Floors

Lupe G.

on

Which Profession Drinks the Most Coffee? (Infographic)

4 minutes ago

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How to Clean Wood Floors

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Your Texts May Not Be As Private As You Think

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From Richard Littlehale of the Tennessee Bureau of Investigation, explaining why wireless providers should be required to maintain long-term storage of every text message sent by every one of their subscribers:

Most cellular service providers do not retain stored text messages accessible to law enforcement for any time at all. Billions of texts are sent every day, and some surely contain key evidence about criminal activity. In some cases, this means that critical evidence is lost. Text messaging often plays a big role in investigations related to domestic violence, stalking, menacing, drug trafficking, and weapons trafficking.

How do you feel about the idea that carriers should store all of your text messages for years at a time “just in case” some law enforcement officer wants access to them someday? Probably about the same way that gun owners feel about proposals to license and register their guns just in case law enforcement wants to track them down someday. In other words, not so great.

In both cases, opposition might be softened if law enforcement were consistently required to get a search warrant before they’re allowed access to your private digital data. But they’re not, and Littlehale warns pointedly against “moving to a probable cause standard where it is not currently required.” This, he says, would have “a negative impact on the time required for law enforcement to conduct certain types of investigations.”

No doubt. Probable cause is certainly a pain the ass. But if we don’t need it in the digital world, why do we still need it in the physical world? Seems very anachronistic, doesn’t it? One consistent rule for everything would probably be much more convenient.

Mother Jones
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Your Texts May Not Be As Private As You Think

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Green Energy Tips That Anyone Can Try Out

It is up to each of us to care for planet Earth to ensure that future generations are able to enjoy it’s splendor. Green energy is a renewable way to power our lives without damaging our environment. Read on for some tips on using green energy in an efficient and cost-effective manner.

Consider installing aerating, low-flow faucets and showerheads for a good green energy tip. By doing this, you are using up less energy that it takes to heat up the water. Cheap in cost and simple-to-install, faucet aerators and low-flow shower heads can lower water heating costs and home water usage by up to 50%.

As a business owner, you can benefit from interesting tax incentives by adopting green energies. Avoid any kind of fossil fuel emanation, including oil, coal, and natural gas. Using green energies will give a positive image of your brand, and will help you save money on the long run if you decide to invest in your own green energy system.

Too often, the water heater allows water to reach a scalding temperature when trying to take a shower. Try turning the maximum heat on the water heater down by twenty degrees, and you will see a definite decrease in electricity costs. Tankless water heaters are another green energy option for anyone.

Responsibly recycling electronics is a great way to maximize resources. When people think of green energy they think of alternative energy. However, it is just as important to get the most from the non-renewable resources that we use as it is to minimize our use. Recycling electronics prevents unnecessary polluting of landfills as well as reuses resources that non-renewable.

You can save the energy it takes to generate paper bills by signing up for paperless bank statements. Most banks will allow you to view your statements online instead of receiving a multi-page paper statement. Banks also offer online bill paying features which allow you to save even more by not using a paper envelope to mail payments.

When you are cooking on your stove top, try to use a pan that fits the cooker ring just right. This will help to prevent heat loss. Also, when you can, put a lid on top of saucepans. In addition to heating your food up quicker, it will use less energy.

Opt for solar lights instead of regular lighting when installing lights for outdoor use. This helps save on your energy costs, and they are very aesthetic as well. Solar lights are becoming increasingly popular, and they are a wonderful option for lighting the patio, garden, sidewalks, garage, and many other places.

Watch to make sure your refrigerator and freezer are at the proper temperatures. Do not allow them to get too cold. The recommended temperatures are around 37-40F for your fresh food compartments and about 5F for the freezer. If your freezer is separate and used for long-term storage, keep it around 0F.

Now that you’ve read a little about how to use green energy, you should have a few ideas in your head to make your home more green. Use the ideas in this article to get you started, and to give you concrete actions you can take today to make sure you are living green.

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