dismal scienceThey call economics the “dismal science.” This phrase was coined by Thomas Carlyle who, per Wikipedia, used it to contrast economics to the more “gay sciences” of song and prose. The work where it was found, Occasional Discourse on the Negro Question, was about the  utility of  enslavement in improving the human condition. The dismalness,  I suppose, was that one could prove “scientifically” that slavery was a net plus. Economic analysis, in common with other sciences,  is typically based on a series of assumptions. Assumptions can either be based on empirical facts or (more commonly in economics, some say) on the introspection of the investigator. Carlyle’s “assumptions” about slavery, for example, included “slave ships aren’t that bad” and “slave owners are benevolent overlords.” Based on these assumptions, he concluded that slavery was better than the alternative of idle workers.

Troy University’s Manuel H. Johnson Center for Political Economy has determined that providing healthcare for Alabama’s poorest citizens would cost money (al,com article found here). They determined this not by doing their own bit of research but by taking studies done by UAB and UA and reanalyzing them using a different set of assumptions. Their assumptions include: 1) the chronic shortage of primary care physicians is keeping health utilization low which is a good thing 2) Alabama’s Medicaid will cost more than projected and 3) Tax revenues will be less than projected. Given these assumptions, they “demonstrate that the cost of expanding Medicaid will outpace the benefits.”

Let me offer another set of assumptions:

1) Access to health care is not a luxury but is necessary for economic growth. Improving coverage in rural Alabama will stabilize (and likely improve) care delivery making job creation more likely in these areas. In addition, creating a more rational system of care delivery based on value as opposed to encouraging over-utilization with improve the care delivery environment, leading to improved health outcomes. This can only be done with the money that comes through the Medicaid expansion. We must either support our care infrastructure or move people our of rural Alabama.

2) Demand for health care services is driven not only by care seeking behavior but by providers offering low value, high priced alternatives to patients with limited ability to discriminate value. America medicine costs more as a consequence of increase use of technology, expensive medication, and excess payments to providers that do not lead to improved care. Creating a more rational system of care delivery, which Medicaid can take the lead in facilitating if the expansion is done correctly, will allow Alabamians to receive a better value closer to home.

3) Inefficiency of the Alabama Medicaid system is a problem but some of us are working on solutions. The governor and the legislature have  created Regional Care Organizations to help move effective care delivery closer to the patients’ homes. These are community-led networks that will coordinate the health care of Medicaid patients in each region, with networks ultimately bearing the risks of contracting with the state of Alabama to provide that care.

I guess it all comes down to assumptions. I have to assume people want better health care closer to home. Am I wrong?