Laura Wheaton, referring to O’Grady’s comment about staying away from the black box and developing something straightforward, asked what sort of additional level of complexity he was thinking about. Is taking some information from MEPS and then transporting that onto the CPS the kind of a layer of complexity that people might find objectionable? Would it be better just to stick with MEPS for this medical risk index? She has done statistical matching and imputation, which adds some time to the analysis. If MEPS seems to be clearly better in many ways in terms of the data elements, perhaps one should just stick with it.

The advantage of the CPS in having the large sample size in the states has been pointed out. MEPS has information that varies by state but is not the underlying sample size to support state analysis. Is there too much, then, when one imputes that onto the CPS, saying there is enough sample size in the CPS?

O’Grady responded that there are trade-offs. As the study panel members discuss this issue, they will consider the pros and cons of using MEPS and using the CPS. It may take a number of test runs. Utilization data and some other items are really strong on MEPS, but the priority may be to make state-level estimates. The study panel will consider that both have their strengths and weaknesses.

Citro agreed with the idea of going back a couple of years to the totally pre-ACA environment. The ACA is the law now, and various provisions will go forward; she is sure that the study panel is not interested in prejudging the outcome of the measurement but just how to appropriately measure, given all the complexities.

She also commented on the frustration in this measurement area. The country spends lots of money on health, including on Medicaid and Medicare, and it has been great. But getting credit for it in the economic measure of poverty has been a problem. Short made the comment that the purpose of medical care in some sense is to restore people to some state of health rather than get them to a higher level. Before Medicare and Medicaid, what could be done for people? They could have a broken bone set. They could be given digitalis for congestive heart failure. There were a few antibiotics and a few vaccines, but that was about it. There was no cholesterol medicine, no decent antidepressants, nor many other treatments that are now available. It is definitely a benefit that those treatments are here, but they cost money. As a comparative example, what food stamps provide is food to meet basic calorie requirements, and food intake requirements have not changed over the millennia. What medical care can provide has changed, and it is a benefit, but it is very hard to measure. Trying to put it into the same framework as food, clothing, utility bills, and the list is part of the frustration that lies behind developing this measure. That was a major motivation for the 1995 NRC panel to say yes, medical care must



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