The return of Paul DeMarco: Welcome back, Doc!

Dr. Paul DeMarco in 2006.

Dr. Paul DeMarco in 2006.

One of our regulars from the early days of this blog made an appearance over the weekend in response to this observation from current regular Jeff Mobley:

“Perhaps it is unrealistic of me to absolutely foreclose the possibility that even one person’s lifetime could have been significantly lengthened by the Medicaid expansion.”

Responding, after a long hiatus (six years!), was Dr. Paul DeMarco:

Brother (Jeff}, you can strike the “perhaps” from that sentence. I am a physician who sees patients for HopeHealth, a community health center in Florence. The majority of patients I see are uninsured and I can attest to the difference that insurance makes in their lives. Every time an uninsured patient dies suddenly, we should ask the question, did their lack of access to care contribute to their death? Sometimes the answer is no, but surely you can conceive of a patient with undiagnosed coronary artery disease ignoring it because they don’t have the funds to see a primary care physician and don’t want to run up a bill of thousands at the emergency room. If they ignore it too long, they may suffer sudden cardiac death and be found dead at home.

But helping prevent these kind of dramatic deaths is not the only attribute that Medicaid (or any insurance) provides. It provides access to expensive medications to control diabetes and hypertension to prevent coronary artery disease, stroke and kidney failure; it provides access to imaging, specialty care, and health screening services (e.g., I defy you to find me a single uninsured patient who has paid out of pocket for a screening colonoscopy); and it provides the simple peace of mind knowing that your are spared making decisions about whether to pay your rent or see the doctor.

If you are the Jeff Mobley from Columbia who ran for state senate, your profile says you work as an analyst for Blue Cross/Blue Shield. How ironic.

When you cite the Oregon study, your logic would suggest that Medicaid doesn’t change health outcomes for poor people. Then why would it change outcomes for people of means like you and I? Medicaid is good insurance, in some respects better that private insurance in its coverage (including that there is usually no significant deductible). Could Medicaid be more user-friendly and efficient? Of course. Is it subject to fraud? Certainly. But those critiques are true of BC/BS as well. See this link from 2013
You argument generalizes to “Insurance does not affect health outcomes.” It is interesting to me that every person I’ve ever heard make this argument has health insurance. You’ve added the caveat that “Insurance might work if the government paid private companies (coincidentally enough like the one for which I work) to do the job.”

However, private insurance offers its own set of troubles, including incentives that put profit above patients. See describes the huge profits BC/BC makes and the million dollar salaries their top brass rake in.

If you are really interested in learning the practical effect of insurance on patients’ lives, I’d love for you to spend a day in my office seeing patients. I suspect that time might broaden your perspective.

Welcome back, Doc!

It would be great to have a series of posts from or about fondly-remembered commenters from years past, here in my 10th anniversary year as a blogger (first post, May 17, 2005).

Any nominees?

7 thoughts on “The return of Paul DeMarco: Welcome back, Doc!

    1. Brad Warthen Post author

      I’m talking HAPPY memories here…

      But as I was typing the above, I did think about ways to smoke out some of the arch-villains of the past. It would be an interesting exercise. But it would also carry a price — it would be harder to get them back into the bottle than it would be to summon them…

      1. Doug Ross

        I saw Silence at Soda City this past Saturday. He said the blog is blocked at his work and he doesn’t have the time to engage anymore. Our loss. He’s got a beautiful little daughter to occupy his time.

        1. Brad Warthen Post author

          When all workplaces block the blog, the blog will die. I learned from watching my analytics from early on that people people read and respond to blogs during the working day. Sort of like the way they shop online, hence Cyber Monday instead of Cyber Saturday…

  1. Jeff Mobley

    I made this comment on the other thread, but I thought I’d leave it here, too:

    You argument generalizes to “Insurance does not affect health outcomes.”

    As the Ezra Klein piece I referenced noted, the results (specifically the health outcome results) of the Oregon study could imply one or more of several things. One of which could indeed be that insurance does not affect the specific health outcomes measured in the study over a short period. Klein considered that a sobering thought, but it was not the only possible implication of the study. Another could be, “Medicaid is not great insurance”.

    When conservatives point to the Oregon study, we’re not saying, “Don’t worry, poor people don’t need insurance”. What we’re saying is that federal one-size fits all programs aren’t the best way to address these needs. Frankly, I happen to think that it would be better to take average amount spent per Medicaid beneficiary and just give them that amount and let them buy the insurance plan they want. But everyone in the country shouldn’t be force-fed my solution, either. That’s why I think people like Rick Perry and Scott Walker and Paul Ryan, who say we should just block grant it to the states and let them handle it, are on to something.

    The other point I tried to make, about limited resources, goes along with the first point. It’s bad enough what we’re doing to future generations in terms of debt, but it’s even worse to think that we’re probably not even getting the results we could be getting for the money we’re spending.

    1. Paul DeMarco

      Brad, thanks for the shout out. I read the blog most days and enjoy your regular commentators. I appreciate the platform for civil discourse that you provide and wish I had more time to participate, but informed civil discourse is time-consuming. I appreciate Jeff’s measured response. Limited resources are always an issue, but my conservative friends never use that argument when they want to dismantle ISIS or build a border fence. They start with a principle or a policy position, realizing that in the end, some parts of their position will be modified by resource constraints. That’s where I start on health care. A country like our should make it possible for all its citizens to have health insurance. There are multiple ways to accomplish this, and although I trust the free market in many places, health care is not one of them. There is no economic incentive to provide care for chronically ill patients. Therefore, despite its significant flaws, a single payer system is the best of our options. But as Jeff wisely points out, cost control is the key. Any single payer program would come with significant gatekeeping (not unlike the preauthorizations that all insurance companies require).

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