Paul Ryan’s Path to Prosperity document includes the following statement:
Recent studies have indicated that Medicaid patients are more likely to die after coronary artery bypass surgery, less likely to get standard care for blocked heart arteries, and more likelyto die from treatable cancer, than those with other coverage options. By some measures, such as in-hospital death rates following major surgeries, Medicaid patients fared even worse than the uninsured.
As Austin Frakt explains, the Ryan folks leave a very misleading impression. (They should have read this NEJM essay to get the issues straight.) Moreover, Ryan’s proposed cuts and block grants would make Medicaid’s genuine reimbursement problems, about which he expresses concern, even worse.
Aaron Carroll finds further problems, including basic errors in citation, as he tried to track down the references in Ryan’s original document.
The lack of professionalism in Path to Prosperity won’t matter much, politically. Still, it’s a pretty depressing signal about the quality of policy thinking that underlays Ryan’s widely- and wrong-praised proposals.
The silver lining may be that Ryan’s proposal will force the Democrats, finally, to explain why we have Medicaid and why it is in everyone’s best interests to help pay for it, even if that means raising taxes — at least, until the United States restructures health care delivery in general.
Harold, you don’t really mean to suggest that you are surprised that Ryan and his policy people have problems understanding that correlation isn’t (necessarily) cause? I’m on our College’s curriculum committee and we have an accreditation visit coming shortly. One of the things we’re trying to do is implement critical thinking among our students.
The model we’re using classifies thinkers by “levels.” Level 0 thinkers are fact-gatherers. Level 1 thinkers collect facts and try to organize them coherently. Where they fail is in recognizing that there may be competing explanations for the facts: they tend to wear blinders, ignoring inconvenient facts or explaining them away.
Or in this case, taking the facts (Medicaid patients fare worse under certain surgeries than privately insured patients) and interpreting them to support their preferred conclusion (Medicaid is bad.) So incompetence is an explanation for this.
Personally, I think this represents intellectual dishonesty rather than poor thinking skills. This does go against the rule my father taught me: Take care in attributing to malice things you can explain with incompetence. Of course, the explanation for the mendacity could vary among Republicants.
The silver lining may be that Ryan’s proposal will force the Democrats, finally, to explain why we have Medicaid and why it is in everyone’s best interests to help pay for it, even if that means raising taxes — at least, until the United States restructures health care delivery in general.
We should start a blog pool, like an office pool. We can wager on what date there are no more people who think the Democrats can turn something to their advantage for a political opportunity. Unless that day has already passed and the exercise is moot.
You were expecting… well, what exactly?
I don’t think a lot of micro-analysis matters at this point. The Democrats should follow the same game plan they followed in 2005-2006 when Bush proposed privatizing Social Security. The Republicans didn’t run on privatizing Medicare, they have no mandate to do it, the people are against it, and it’ll scare the shit out of seniors. “This will end Medicare as we know it” should be rammed down their throats from now until election day.
Dan Staley, you are an optimist. Here’s David Plouffe, Obama adviser, on Meet the Press this morning:
“You’re going to have to look at Medicare and Medicaid and see what kind of savings you can get..”
Harold, you don’t really mean to suggest that you are surprised…
The undertones of his post don’t suggest “surprise” to me.
More like resigned bewilderment…
My sense is that he expects better of the other side, and is stupefied at how they have no concern for fair public policy or managing the social net that meliorates suffering and fear. I suspect that Harold never imagined he’d see the day where exerting pain on the poor seems to be the new national sport.
No. It’s not sloppy homework. It’s salesmanship.
Do you expect a used car salesman’s arguments to be rigorously researched, and to withstand close scrutiny. Of course not. So why expect it of Ryan?
Bernard, we also don’t expect any policy papers or “research briefs” from the right wing shops to stand scrutiny either. Nor do we expect the faithful to check the “research” for themselves or be outraged when it doesn’t stand scrutiny.
EB, that is not to say Plouffe’s statement is not a clever ploy to rope a dope and come out of the corner hard and…and…I crack me up sometimes.
Dan Staley: the soft bigotry of low expectations. Obviously the only way to show respect for soi-disant conservatives is to subject them to the highest possible level of scrutiny.