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What Medicaid does and doesn’t fix according to Harvard

Medicaid has mixed record on improving health for poor, study says

By Noam N. Levey

4:00 p.m. CDT, May 1, 2013

 WASHINGTON — As state leaders debate whether to expand their Medicaid programs next year under President Obama’s healthcare law, new research suggests the government insurance plan for the poor has only a mixed record of improving health.

Medicaid beneficiaries are less likely than the uninsured to have catastrophic medical expenses and significantly less likely to suffer from depression, researchers at the Harvard School of Public Health and the Massachusetts Institute of Technology found.

But those on Medicaid did no better controlling their blood pressure or cholesterol levels, raising questions about the program’s ability by itself to help low-income Americans become healthier.

The lack of health gains came even though Medicaid beneficiaries went to the doctor’s office and the hospital and filled prescriptions more frequently than those without coverage.

“I think the study dispels two extreme arguments about Medicaid,” said Harvard’s Katherine Baiker, one of the study’s principal authors and a former member of President George W. Bush’s Council of Economic Advisors.

“Some people say this is a terrible program. Beneficiaries don’t see any improvement in health. It is a waste of resources…. That is clearly not the case. The improvements in mental health are substantial. And there are real economic protections. Medicaid very clearly improved the well-being of beneficiaries,” said Baiker, a professor of health economics.

“At the same time, the study also dispels the opposing view that this is a wonderful program that keeps people out of the hospital and that it provides all this preventive care that saves money. That is also not true.”

The study, to be published Thursday in the New England Journal of Medicine, tracked 12,000 low-income Oregonians who entered a lottery in 2008 to get into that state’s Medicaid program.

The lottery gave researchers a unique opportunity to assess Medicaid by tracking two similar, randomly selected groups: those who won a spot in the health insurance plan and those who didn’t and remained uninsured. Such a randomized trial — standard practice in scientific research — has not been possible in other Medicaid research, some of which has suggested the program leads to worse health outcomes.

Medicaid, which has generated controversy since it was created in 1965, covers more than 60 million people in the course of a year and costs taxpayers nearly $500 billion annually.

The Medicaid debate has taken on new urgency as the Obama administration pushes states to take advantage of the 2010 Affordable Care Act, which provides generous federal aid to help them expand their programs. The law’s supporters hoped state expansions would cover as many as 16 million more low-income Americans over the next decade.

But many states led by Republicans have rejected the option, saying that Medicaid is ineffective. Several conservative critics have even argued that the program is worse than no health coverage.

John Goodman, who heads the conservative National Center for Policy Analysis and advised Republican Sen. John McCain’s 2008 presidential campaign, called the study’s findings about health outcomes “stunning.” “It suggests to me that Medicaid doesn’t matter very much,” he said. “A lot of people are way too focused on health insurance and not focused enough on healthcare.”

Goodman, an economist and health policy expert, favors moving low-income Americans into commercial insurance rather than Medicaid.

The study did not analyze whether health outcomes would have been better in private insurance. But research has consistently shown that, in general, Americans in either public or private health insurance plans often fail to manage chronic medical conditions, such as diabetes and high blood pressure, though some individual health plans and medical providers have succeeded in helping patients do this.

The authors of the study note that factors other than insurance may explain why Medicaid beneficiaries did not control their blood pressure and cholesterol levels, including possible problems with access to good medical care or failures to adhere to prescriptions and doctors’ orders.

But Baiker stressed that the study’s findings of benefits from Medicaid should not be understated.

Beneficiaries were 30% less likely to suffer from depression than those without coverage and nearly 10% more likely to report that their health was the same or better than it had been a year earlier.

And researchers found a dramatic increase in financial security. “That is a basic function of health insurance,” Baiker said. “It is not just supposed to give you access to care. It is supposed to prevent you from being evicted from your house if you suffer a medical emergency.”

Foods that help you sleep

Emily Main, Organic Gardening

Tired and stressed? Join the club. Forty percent of Americans report having some symptoms of insomnia within a given year, according to the National Sleep Foundation. And it doesn’t matter whether your shut-eye is being hampered by a time change, a stressful job or some other problem in your life, being tired sucks, and it can lead to serious health problems, including heart disease and depression. But before you reach for the latest prescription drug, reach for your fork—or, at the very least, your shopping list. Revamping your diet can go a long way towards improving your sleep quality, provided you opt for foods rich in the right sleep-inducing ingredients.

Cherries
In one small study, participants drank eight ounces of tart cherry juice in the morning, and another eight ounces in the evening, for two weeks and reported better sleeping habits. Why does it work? All varieties of cherries are naturally high in melatonin, a hormone that makes you sleepy. Eat a cup of whole cherries as a late-night snack if you’d rather not drink juice.

Fish

Fish are rich in tryptophan, a natural sedative, with shrimp, cod, tuna and halibut having the highest levels, even more than turkey. But since not all seafood choices are healthy (some are high in contaminants) or for the planet (many are overfished, or methods for catching them kill other species), stick to catches like Pacific cod from Alaska or pole-caught Albacore tuna from the U.S. or British Columbia.

Lemon Balm

This lemon-scented member of the mint family has been a sleep-inducing superstar for ages, but it seems to be most effective in combination with another herb called valerian.  In one study published in the journal Phytotherapy Research, 81 percent of people with minor sleep problems who took a combination of the herbs reported sleeping better than people on a placebo. Both can be purchased as supplements, or you can make a tea by steeping 1 to 2 teaspoons of dried lemon balm and 1 teaspoon of valerian root in 1 cup of hot water for 5 to 10 minutes. (If you take other medications, though, ask a doctor or pharmacist about any potential herb-drug interactions.)

Chamomile

Another herb that works as well as lemon balm, chamomile has been used as an herbal remedy for insomnia for thousands of years. In one animal study, it calmed down mice as effectively as tranquilizers, and in the only human study to study the effectiveness of chamomile, the herb reduced mild to moderate generalized anxiety disorder much better than placebo. Ready-made chamomile teas are sold in every supermarket, so it’s an easy remedy to get your hands on.

Bananas

These perfectly snack-sized superfruits are packed with potassium and magnesium, two minerals that promote muscle relaxation. In fact, magnesium deficiencies are related to restless leg syndrome and nighttime muscle cramps, two conditions that can certainly interfere with your sleep. Make it a goal to eat one banana a day to see if that helps your sleep problems.

Spinach

In addition to being rich in potassium and magnesium, spinach is high in calcium, yet one more mineral that plays a role in sleep. Calcium helps the body generate melatonin, the hormone that helps your body maintain its circadian rhythm. You can get the same benefits from other dark leafy greens, such as Swiss chard, kale, turnip greens and collard greens.

Dairy

Like spinach, dairy products are rich in melatonin-boosting calcium, and a number of studies are finding that calcium deficiencies are linked to poor sleep quality. So there may be something to that old adage that a glass of warm milk will help you sleep, after all!

Almonds

They’re full of magnesium and yet another source of calcium. You can eat a handful of almonds or spread some almond-butter on a piece of whole grain bread, which will help you get to sleep for another reason (keep reading).

Carb/Protein Combos

There’s some debate as to how well your body handles tryptophan, and a study from the Massachusetts Institute of Technology found that getting it from high-protein foods can work against you, because protein can prevent tryptophan from entering your brain. But when you combine high-protein foods with carbs, the insulin your body produces in response to the carbs makes it easier for tryptophan to break through your brain’s barriers. So think oatmeal with bananas and almonds, for a real sleepy snack, or whole-grain cereal with organic milk.