It's Day 7 in the Countdown To Doom, and Megan McArdle is still plugging away at her devastating critique of Elizabeth Warren. (We shudder to think of the ammunition McArdle is amassing to be released in a fireball of factual destruction.) In the meantime, McArdle manages to make time to discuss if Medicaid kills more people than it helps. Lesser minds might automatically react with disdain. How can it possibly be worse to get medical attention than not get medical attention? Megan McArdle is glad you asked, and is happy to clear up the confusion for us.
But before we start, we would like to congratulate McArdle for expanding her base of knowledge and pool of sources and resources. McArdle approvingly quotes National Review On-Line and discusses the article's pros and cons, and links to a climate change denier for another, who says things like, "I understand that this is exactly what the Left is shooting for - an environment where the competent have no advantage over the incompetent." She also linked to Red State a while back, and of course links to her friends at Reason. Not everyone who wishes to remain respectable would do that.
We wish to congratulate her for being more accepting of new or less fashionable sources than most in the media. Of course, television dips from this well often, putting your Michelle Malkins and your Eric Ericsons on the payroll, but nobody respects any of them anyway. The Atlantic is different, and it is extremely tolerant of McArdle to link to partisan political think tanks and organizations and oil-and-gas-fueled climate change denialist magazines. Some might say that McArdle is devaluing the brand by linking to "disreputable" sources, but David G. Bradley obviously disagrees. You don't rake in that corporate cash by being picky!
Back to McArdle's post. McArdle acknowledges that some might think getting health care is better than not getting health care. Perhaps Medicaid has problems because the poor suffer from generally poorer health than the more wealthy, McArdle admits, and she has heard that Medicaid's prenatal care and maintenance care has helped many people. But when faced with evidence one should take extra care, because you never know.
That said, I take seriously [Avik] Roy's warning not to reject the notion that Medicaid might be worse than no insurance simply because it violates our "common sense" intuition. Policy history is full of "common sense" policies that didn't work, and our intuition that Medicaid must be better than nothing is not obligated to actually be correct.
Take war. Common sense tells you that wars waste money, time, lives, and infrastructure, and damage the human soul. But just because common sense tells us war is terrible, that does not mean that common sense has to be right. War might be good, because just think of all the people who might have been killed by long, lingering deaths instead. War ended that future pain with one big boom! Common sense was wrong, and this poor suffering soul was relieved of his lingering death!
Everything I know about Medicaid confirms that it is a terrible program on many levels, with a dysfunctional payment system and a byzantine bureaucracy, and procedures that vary wildly from one state to the next. While I assume it is probably better than having no insurance, I wouldn't be surprised to find out that it's not much better. And whether or not you think it is actually killing people who would be better off with no insurance at all, there's no question that it could be massively improved. [emphasis added]
As we can all plainly see, common sense and facts must be questioned when they conflict with assumptions. McArdle already knows that Medicaid is so bad that nothing could fix it and no health care at all would be better than its ministrations. She already assumes that any benefit is negligible, and even if it isn't, what does it matter when there is so much room for improvement? It's much better to go with one's assumptions than facts because assumptions are what you know in your gut to be true, and facts are just what other people tell you is true.
And what are you going to believe, your gut instincts or your lying eyes?