Most credible sources agree that health care requires some statutory and regulatory framework to protect the public.  Supporters of the President’s health care law believe we need an extraordinary amount of oversight, while those opposed to federal further expansion into health care remain skeptical at best.

But at the end of the day, there should be one overriding guiding principle in the debate over health care reform – does the law and/or regulation(s) improve quality and enhance public safety?  Incredibly, that question remains largely unanswered by those debating over Obamacare.

Of course, there is no way to predict with 100% certitude what impact the ACA will have on the quality of American health care, but some recent confluence of events in Oregon may have given us a good glimpse of what the future might hold. Politicians in the State budgeted for expanded Medicaid coverage for approximately 30,000 Oregonians in an attempt to improve the quality of care of its uninsured citizens. The program was so popular that more than 90,000 met eligibility guidelines and applied.

Oregon officials decided to enact a lottery system to decide which citizens would actually receive the benefits.  Unwittingly, the government effectively created an opening to analyze, with some degree of validity, the impact of expanding Medicaid services with its decision to provide some, but not all, of Oregon’s citizens with public health coverage. Some of the results from two years of measurements were recently published in the New England Journal of Medicine.

Turns out that the Medicaid recipients did indeed utilize more services (35%) than those without the insurance and nearly half felt less financial and emotional strain.  But after measuring actual outcomes (blood pressure, blood sugar and cholesterol levels), the researchers determined that there was no statistically significant improvement between the newly-minted Medicaid patients and those who remained without insurance at all.

Importantly, and consistent with the behavior of Medicaid-eligible Americans today, a large portion (40% in this study) of those who won Oregon’s Medicaid lottery and could have received free care did not bother to enroll.

Many other peer-reviewed studies also undermine the belief that moving people onto Medicaid, especially from private insurance onto Medicaid, will improve outcomes while lowering costs.   For example, a 2010 study of 900,000 surgical patients pointed out that Medicaid recipients had the longest hospital stays, the highest total hospital costs, and the highest risk of death. And a report published in the journal Cancer, Medicaid patients with cancer are two-three times more likely to die than other patients.

There remains little doubt that many Americans are either unable to afford health care or health insurance and as a country we need to figure out the best way to make that happen.  But if recent research in Oregon is a harbinger of what’s to come for the rest of America, Obamare’s Medicaid expansion it not the way to go if we are looking for improved quality of care for our citizens.