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October 6, 2017

"Access to Health Care and Criminal Behavior: Short-Run Evidence from the ACA Medicaid Expansions"

The title of this post is the title of this notable new empirical paper available via SSRN authored by Jacob Vogler. Here is the abstract:

I investigate the causal relationship between access to health care and criminal behavior following state decisions to expand Medicaid coverage after the Affordable Care Act. Many of the newly eligible individuals for Medicaid-provided health insurance are adults at high risk for crime.  I leverage variation in both insurance eligibility generated by state decisions to expand Medicaid and county-level treatment intensity measured by changes in insurance rates.

My findings indicate that the Medicaid expansions have resulted in significant decreases in annual rates of reported crime, including both property and violent crime, by between 3 to 5 percent per 100,000 people.  A within-state heterogeneity analysis suggests that crime impacts are more pronounced in counties that experienced larger gains in insurance rates among individuals newly eligible for Medicaid coverage.  The estimated decrease in reported crime amounts to an annual cost savings of nearly $400 million.

October 6, 2017 at 04:41 PM | Permalink


If the government was spending less money they'd be lowering taxes. Our taxes haven't gone down, so there's no savings of $400 million. Fake news.

Posted by: Taxes go down when govt saves money | Oct 6, 2017 8:45:41 PM

Thanks Obama and other Democrats for advancing criminal justice reform.

Posted by: Joe | Oct 6, 2017 10:34:30 PM

Spend $70 billion on the Medicaid expansion, and save $400 million.

On a personal note, my deductible went from $500 a year to $6000 a year, the next year. In the absence of a catastrophic illness or injury, I basically no longer had health insurance. Obama took my insurance and gave it to the parasites that voted for him, including the above thugs and criminals.

Then, there is the reality of the Medicaid expansion. Doctors appear to be paid a pittance ahead of time. So the emphasis on health maintenance and getting rewarded for saving on health care turns into doctors going into hiding, and restricting their availability. If you show up, they spend more, instead of making more. That means your chronic condition threatens their staying in business. Then you get, "The reason for your back pain is that you are a fat pig." So the patient replies, "You are rude. I am not coming back here." And, the doctor is relieved. "Tell all your friends."

Welcome to British Commie Care, assholes. You will die before getting any care. You want cheap care like a physical, a suggestion to take a Tylenol, a vaccine shot, you are in luck. You need any expensive care, it is Sayonara, Baby.

Posted by: David Behar | Oct 7, 2017 1:43:31 AM

Princess Diana would be alive today, if she had her crash in the worst slums of the United States. She was unlucky to have it in Paris, at midnight, with no traffic. It took them 45 minutes to get her out of the car. In the US, week 1 of EMT training, you have to pry open many crushed cars with the Jaws of Life in 3 minutes. They cost $500, used, on EBay. Shipping is free. No Jaws of Life in French Commie care.

Due to the deceleration of the accident, she had a small tear in her pulmonary artery, going from her heart to her lungs. It is a huge artery, pumping blood into her chest with the force of every heartbeat.

With no traffic, it took them an hour and a half to get her to the hospital. In the US? Helicopter. She would be in the OR, under the care of a Board Certified Chest surgeon in 15 minutes. He would be opening her up, and rummaging inside her chest in another 15 minutes. No helicopter in France. No helicopter in Commie Care. Instead of a chest surgeon, she had her chest pumped by Commie morons.

Then, Boy Scouts know you do not do CPR on a trauma patient. You have no idea what internal injuries you are facing. Those dirty Commies stopped the ambulance, took her out, and repeatedly did chest compressions, thus adding their strength to the spurting of blood inside her chest.

French Commie Care killed Princess Diana. She would actually be better off in a crime ridden slum of the US. Her docs would be experts in trauma care, and totally organized to address it, because they would have face a dozen such incidents a day, for years. All the tools, basic and advanced, would be in place, waiting for her,, along with a smooth and rapid team of high skill people.

Trauma care and the surgical lessons of war are a factor in the drops of the murder rates, across the US. No one has done that study.

Enjoy the trauma system of the US, while you can. It is going away since the lawyer took control of medicine. Welcome to Paris, assholes.

Posted by: David Behar | Oct 7, 2017 2:11:07 AM

Princess Diana's death was a tragic ACCIDENT, Mr. Potter.

Posted by: Dolores Umbridge | Oct 7, 2017 2:51:21 AM

PRINCESS OF WALES, of the Paget Report. Two hours in the streets.


People bring up conspiracies. No. Commie Care killed Princess Diana. She received the care of 1957, not of 1997. It was better to be the poorest person in the US, than at the pinnacle of wealth and fame in Europe, as far as health care was concerned.

But, before we get too huffy about the worthless French health system, thanks to Obama, Harvard Law School uber-assshole, we will be returning to the care of 1857 in the United States, never mind 1957. Thank the lawyer when your loved ones gets no care whatsoever.

Posted by: David Behar | Oct 7, 2017 3:51:08 AM

This Comment is about the sentencing of Weiner.

Volokh analyzes an appellate decision seeing sexting as a First Amendment matter, as you heard already, here. In that case, it was between adults. No alarm or affront took place. I have gone beyond the self evident to add, 15 years old is adult according to biology, the religions of the world, and 10,000 years of human civilization. That is also self evident, but not to the dumbass, rent seeking lawyer.


Posted by: David Behar | Oct 7, 2017 7:03:58 AM

It doesn't surprise me that access to care decreases crime. However, I do agree with @David on one point which is the point about quality of health care is not the same thing as access to health care. Where I live there is a shortage of doctors, period, regardless of what health care plan one has. My own primary care physician told me recently that within ten years "primary care" won't exist as we know it today simply because there are not enough new doctors coming through the pipeline.

Still, I remain a supporter of single payer. It is just gonna take time to work out all the kinks and it doesn't bother me that health care won't look the same because I do believe it is possible to build a better system.

Posted by: Daniel | Oct 7, 2017 11:05:24 AM

Medicare payments are below costs. Providers cannot take Medicare without charging other patients very highfees. This is a hidden tax. So, if you go single payer, there will be no more quality care.

There is no shortage of doctors. There is a shortage of doctor time. Half is consumed by lawyer government make work requirements. Nor has there been any savings, whatsoever. All the denials and reductions of health payments have gone to insurance companies.

I support direct action, hunter-killer groups of patients and of their families finding the buccaneers stealing $trillions. Beat their asses once. Next, shoot them in the knees, and deny them opiate pain killers. Then, kill them if they do not stop the piracy.

Posted by: David Behar | Oct 7, 2017 2:58:06 PM

Hey, Harvard Law uber assholes on the Supreme Court. Explain to me how mental illness is a mitigating factor, and not an aggravating factor, you morons.


Posted by: David Behar | Oct 7, 2017 4:18:00 PM


"Medicare payments are below costs. Providers cannot take Medicare without charging other patients very highfees. This is a hidden tax."

Correct. Which is why your next part makes no sense.

"So, if you go single payer, there will be no more quality care."

One of the main purposes of single payer is to make the economics transparent. Right now, the poor an being subsidized by the rich they are just being subsidized through the insurance companies indirectly rather than though the government directly. This is rent seeking by the insurance companies. So the idea that with single payer quality of care will be diminished is bogus. if anything it will increase quality of care because money that is going to insurance companies will now go to doctors.

Posted by: Daniel | Oct 7, 2017 6:44:30 PM

Daniel. You know who runs government, making 99% of policy decisions. Lawyers are the dumbest group of people in our country. No matter what lofty IQ the lawyer was born with, he ends up stupider than Life Skills students, learning to eat with a spoon.

So you will get France, no Jaws of Life, no helicopter, no organized trauma center, even if very rich and famous. You will spend 2 hours in the street, instead of in the OR with a Board certified chest surgeon.

You will get the VA, which is very well funded, but still horrible. You will get Venezuela, where doctors have not been paid in months, and no supplies remain. They are basically doing camping care. Here, drink this glass of water, you will feel better. I am going to stabilize this fracture with a stick and rope.

Anyone who supports single payer has to be healthy, just needing physicals, vaccines, and basic care. That basic care can be done by the public. If you have high blood pressure, you should be able to treat it with over the counter medication in the $4 plan. I want to put all safe medications over the counter. Those now over the counter would not be even approved by the FDA, being unbelievably dangerous both in normal use and in overdose.

I want to crush the lawyer regulators obstructing research. Kill them, including members of legislatures. Good news, the Chinese will completely outpace our innovation, and provide advances on the internet at low prices.

Posted by: David Behar | Oct 7, 2017 9:08:07 PM

When we socialized the police department, we had more police officers than we knew what to do with--just ask Chicago, there crime is so low that they have police officers just sitting around waiting to arrest people for trying to give speeches at Berkeley.

The same thing will happen with doctors. Once we socialize medicine Chicago will have just as great a medical system as it has a criminal justice system.

Posted by: Spiked Lee | Oct 7, 2017 9:10:09 PM

Spiked. Low crime places can be rich or poor, religious or secular, crowded or sparse. The single factor all of them share? Public self help. Criminals fear their neighbors far more than they do the criminal justice system. None can be over-lawyered.

Posted by: David Behar | Oct 8, 2017 12:06:36 AM

Health care can reduce crime. Mental illness makes people poor by disabling them. They are dependent on government insurance. This insurance is totally Draconian in denying access to care. They have a relentless campaign to make access more difficult. Paper work, second guessing and cancellation of medical orders, harassment of doctors by regulatory reviews and prosecutions, marked under-funding despite the highest returns on investment (ROI) of any human activity, including crime. The ROI on crime is typically 200%. On health care it is 10,000%, especially if the patient returns to being a tax payer.

These obstructions are subject to undue burden analysis, and should be found unconstitutional. Organized medicine, run by Ivy indoctrinated leaders, just rolls over, and is not defending clinical care. To understand better, think of the ABA. Worthless to lawyers and to clients. AMA. Worthless to doctors and to patients.

Here are the opportunities. Only a small fraction of people with these conditions are treated because getting into treatment is nearly impossible, thanks to rules written by lawyers. Raising the fraction of treated people would markedly impact crime rates.

1. ADHD. It is found in about 5% of the population, more in males. It is found in at least a third of people in prison. One feature is impulsivity. So all crimes involving impulsive acts would be decreased. Beyond impulsive crimes are all other intentional crimes, stealing, lying, batteries, rapes. A treated person with ADHD is better able to calculate the consequences of getting caught, or even the feelings of victims, and may decide to not commit these intentional crimes. Treated patients have stopped stealing and lying.

2. Around the world, 10% of murders are committed by very sick, untreated people with paranoid schizophrenia. Part of the disorder is to not believe one has something wrong, to be perplexed why anyone would propose taking medications, including the family. The family, by proximity, is at the highest risk of murder. Almost all rampage murders have been committed by high functioning, but untreated paranoid schizophrenics. The Supreme Court took over psychiatry in 1976, and ended treatment for necessity. It imposed a hearing, hiring 3 lawyers, to prosecute, to defend, and to judge. It imposed a really stupid requirement of a physically dangerous act before one could even have a hearing, then limits on the time of involuntary commitment. It gutted the threat of incarceration in mental hospitals. No real abuses had been committed by clinicians. The rare ones carried Draconian punishments for clinicians acting in bad faith. The Congress should reverse this highly lethal decision, that killed hundreds of thousands of people by suicide and by murder since 1976. We should return to involuntary treatments by medical necessity. Exclude any decision making by lawyers. They do not know anything about the subject of mental health.

3. Technology is available to reduce the sex drives of highly driven sex offenders to levels where they can exercise better judgement.

4. Most psychiatric medications are 100 times safer than all over the counter medications, today. They should all be over the counter so patients may try to start their treatments without undergoing the highly obstructed gauntlet of getting into mental health care. Imagine pulmonary care. Should you see a specialist for a cold? You would crush the system, and deprive people on respirators that need their level of skill. The common cold of psychiatry is trauma, being millions per year. Today, traumatized soldiers get anti-depressants at the battle field to prevent trauma from getting burned into the brain. You do not need a psychiatrist to address shyness, fidgeting, premature ejaculation, or excessive worrying. Just go to the pharmacy, as if you had a cough.

5. Close the FDA. Replace it with data showing effectiveness of a substance from anywhere in the world and with clinician and patient ratings of experience with the substance or device. There are non-stimulant, effective treatments for ADHD, a major force in criminality. They are totally non-addictive. Government insurance will not pay of over the counter medications, but the generics are cheap. Allow competition by foreign suppliers on the internet to keep prices low. People selling impure drugs should be prosecuted for fraud, and imprisoned. Then they should be sued for any damage, including the loss of opportunity to improve. The prisoner who took a bad drug, and committed a crime because of impulsivity should be granted standing.

6. Even more common than trauma is anger mood disorder. Anger is a huge factor in crime. There are now very good medications for anger. Make them available in small doses over the counter. They will work on the otherwise normal person. End all anger crimes.

7. Lastly, addicts commit 175 crimes a year to fund their addictions. Technologies are available to increase recovery to about 50%, up from 5%. The most important addiction is alcoholism. Half the murderers, half the murder victims, half the suicides, are legally drunk.

We need an antonym for rent seeking. This is an effect where government funding results in unbelievable ROI's. That 10,000% ROI is for the client's return to function. It does not include collateral benefits, productivity jumps, soaring of property values in high crime areas, drops in trauma care cost, a more productive, less hopeless culture and atmosphere, the end of disruption of work and education for the non-criminal.

The benefit would not be an imperceptible 5% or a $400 million return on a $70 billion investment. It would be 50%, and $trillions returned to the economy.

Posted by: David Behar | Oct 8, 2017 11:34:26 AM

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