National health care reform has been kicked, trashed and beaten so much — from left and right — that we forget what a success our law has been here.
- 98.1% of Massachusetts residents had health insurance coverage during the 2010 Massachusetts Health Insurance Survey (MHIS) period. This represents a statistically significant gain from spring 2009, when insurance coverage in the state was at 97.3%. Approximately 120,000 Massachusetts residents were found to be uninsured in the spring of 2010.
- The increase in health insurance coverage was driven largely by expanded coverage of children.
- Virtually all Massachusetts children had health insurance coverage in 2010 (99.8%). The uninsured rate for Massachusetts children fell from 1.9% in 2009 to 0.2% in 2010. At the time of the survey, about 3,300 children were uninsured.
- State survey findings have been validated by national survey data sources which find that Massachusetts has the highest health insurance coverage rate in the nation.
That's damned good, folks. Good faith criticisms are all fine and well, and of course we've got a huge problem of exploding health care costs, fueled by our delightfully fat-n'-happy academic hospitals who are busily building lovely glass towers up to the sky with your premium dollars.
No, the 2006 law was not the Make-Everything-Perfect-For-All-Time-And-Make-Me-Chocolate-Chip-Cookies Act.
But if you can't call this a major public policy and humane success … what exactly are you waiting for?
And would you not jump on the chance to export this to the rest of the country — as we pretty much did?
Our president and the Democrats in Congress who got health reform done, deserve credit. And on the local level, credit goes at least partly to Mitt Romney — whether he wants it or not.
(I'd like to point out that we have no public option in MA.)
My tired head is not up to a constitutional analysis of the health care mandate, and the Ccommerce Clause – todays Oral Argument in our own Appeals Court and my work load have left me too short of time, energy, and neurotransmitters to dig into this issue.
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p>Fortunately for me, and you The Washington Post analyzed this in March of 2010 and while that analysis is not the be all and end all, it is a fine start.
kids being insured, but I don’t this insurance scheme will stand in the long term. And, knowing people who live under it, it is incredibly difficult to keep your subsidized health care. There is a barrage of paper work over the course of a year to endlessly prove you qualify. You are at constant risk of losing your insurance. Insurance companies still bill patients for things they decide they won’t cover, so here you have patients without financial means facing big health care bills. I don’t think the problem is the academic hospitals. I think it’s paying a private industry for something the state can do a lot cheaper. If people in MA were so happy with our health finance system, why do they keep overwhelmingly passing ballot initiatives in support of a single payer system? I must admit I’m a little jealous of Vermont. Fewer than 10% of the population there lacks insurance, and this without an individual mandate, and yet they are poised to enact their own single payer system. I think it will be those systems, not MA or the national MA system, that will win out in the end. I wish the pols here would listen to the results of all these ballot initiatives and at least put single payer on the table.
tell me about the % of people who are getting good care, not the % of people who have crappy insurance they may or may not be able to afford to use when they need it. Any other numbers are a smokescreen. 99.8% of kids in Massachusetts may have a plastic card which tells them they have insurance, but that doesn’t mean anywhere close to that 99.8% have parents who can actually afford to get them the care they need when they need it.
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p>Believe it or not, this isn’t just a distinction without a difference, and reporting these sorts of numbers as if they’re a Holy Grail not only misses the point, but masks it to such an extent that we’re not going to get the reform we need to address the real problems. We’ve got to stop patting ourselves on the back and fix the real and legitimate problems in our system.
This stuff isn’t all that easy to find, but come on, don’t just toss out some vague criticisms with no data and expect me to go fetch you some like a dog.
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p>Start here:
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p>http://blog.hcfama.org/2010/06…
http://www.mass.gov/?pageID=eo…
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p>And why don’t you tell us — beyond anecdotes — what’s going on with ability to pay, quality of insurance, and the public health effect of having insurance vs. not.
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p>If you’re criticizing, you’re volunteering.
33% had trouble getting health care that they needed.
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p>Link, armed and ready. Just scroll to page one.
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p>And, if you’re not old, and you’re not young, you can raise that rate to a whopping 40%.
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p>
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p>Far from this rate improving since the study was completed, I’d stake my life that — given unemployment (and the numbers of people who can’t afford cobra) and the general trends that wages are going, versus copays and deductibles — we’re actually worse off.
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p>I’m sorry, Charley, this is one argument you aren’t going to win. Our health care system, even in the almighty Hub of the Universe, is TeH Suck. We may suck slightly less than most other states — though not by the margins many of us would wish — but we still suck. We can pat ourselves on the back for being able to print out 6 million plastic cards that tells people they have insurance, but for at least 1 in 5 people, that card is worth no more than the plastic it’s made out of. Given the way things are going, a whole lot more people are going to join them.
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p>Again, as a government, painting politics by numbers, we may be better off forcing upon these people — who can’t afford the insurance they’re forced to have — to carry that albatross around their necks, but they truly get nothing out of it that they wouldn’t get if they had no insurance at all (lifesaving emergency care regardless of their ability to pay). At least that way, they may be able to better afford their food, clothing and rent. Until our “mandate” is made up of truly excellent coverage for everyone, that everyone can afford, it’s really a rotten deal for everyone forced to get Blue Crap Blue Shield who can’t afford to use the damn thing. It’s like buying a car without the money for gas. I’m not at all opposed to a mandate, but I am opposed to this mandate, at least for that 1 in 5.
You’re really saying it’s better for people to be uninsured? Really? “Lifesaving emergency care” is not what a young woman needs when she’s pregnant, hombre. She needs continuous care. She needs health insurance. And if you had diabetes or Crohn’s, or some other chronic condition, same thing. You could get hit by a bus tomorrow; is it right to foist the cost of that onto other people, who are also struggling to pay their insurance premiums?
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p>There but for the grace of God go all of us.
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p>OK, so we’ve got some real problems, as you point out. The access problem is real, and I’m really sympathetic to the idea that there should be more docs, or at least more primary care providers like Nurse Practitioners and Minute Clinics. Let a thousand flowers bloom — and soon, please.
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p>And here’s the problem with premiums and insurance quality: You squeeze the balloon at one end, it bulges at the other. If you offer cheap premiums, the insurance doesn’t cover as much: higher co-pays and deductibles. It sucks, yes indeed!
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p>But what’s your solution? Is going without insurance the answer? On the national scale, is blowing the whole thing up (or allowing/enabling the GOP to do it) the answer?
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p>It is an ongoing process. But you can’t convince me that those kids — and their parents — would be better off going uninsured.
yes.
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p>For them, all they can afford ANYWAY is emergency care. That’s about 1 in 5 people in this state.
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p>What we have here — with this intense focus on the pool — is the majority ticked off at the relatively small minority because they can’t afford to pay. So we make them pay it if they like it or not — it doesn’t matter that what we make them buy is complete and utter shit, Charley.
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p>So I’ll take a mandate, when the mandate is for high-quality coverage that won’t bankrupt families who struggle to pay or it or try to use it. If you pay thousands and thousands of dollars for a plastic card, but face thousands and thousands more just to go to the ER if you think you’re badly sick, and wouldn’t bother to go to the doctors before then because you couldn’t afford to that insurance is less than worthless to those people — it’s paying giant sums of one’s income for complete and utter shit.
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p>I don’t think they should have to do it, not until it’s more affordable and the coverage they get isn’t going to be a crushing cost if they’re in need of using it.
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p>
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p>Look around. Other countries don’t have that problem, at least not nearly to the extent we do.
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p>But what’s your solution? Is going without insurance the answer? On the national scale, is blowing the whole thing up… the answer?
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p>YES! A thousand times yes! Let’s blow up the fucking system and replace it with single payer. In a heartbeat, yes. Short of that, no one should have to pay for $10+k horse manure when they need health care — and if your current system can’t do that, if insurance companies can’t create that kind of change, fuck them. Blow them up. They’re useless middle men we don’t need — and, in the end, it’s inevitable this is going to happen. The only question is when — all we’re doing is pushing the inevitable off for a little while longer by desperately searching for ways to turn horse manure into gold. It ain’t gonna happen.
Ryan, I don’t want to pile on, so please forgive me in advance if you perceive my following comment in that way. Something you said really struck me, though. You wrote earlier
Later you add:
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p>On the face of it, I can get behind that. What matters is health care, not health insurance rates. Massachusetts’ reform, in my view, was health insurance reform. Insurance is not the end, good quality care is.
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p>But it irritates me that the first reaction to a story about universal insurance for children is glass half empty. Having all but universal health insurance for all children in Massachusetts is unmistakably a remarkable accomplishment achieved in no small part because of our health insurance reform effort. Should there be improvements? Uh, yeah. I hope to see you during the next phase of health insurance reform organizing for that. We need to improve quality and decrease costs. We’ve got everybody in the boat, now we need to make sure it doesn’t sink. But it’s extremely appropriate and important to pat ourselves on the back for this and other achievements.
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p>Seriously, folks, Charley makes a point about how great it is that we’ve achieved this milestone. So, Masslib writes for the need for single payer. Ryan notes that there is more work to be done. Christopher questions Charley’s motives for even supporting this kind of reform. Really, guys? I mean, really.
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p>For me, this is symptomatic of what progressives tend to do to ourselves time and time again. Our virtues become our vice; we cannot accept a victory when we see one because we are working to always fight the status quo, always move toward our ideal, always have a healthy skepticism of what people in authority say.
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p>Instead, let’s define our success, celebrate it when we achieve, then go back to work. Here are some rules of thumb that help me celebrate success. I’m not saying this is how we should all measure our political lives, but these help me.
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p>I know this is getting long, and maybe I should make a separate post about this. But that’s why I saw national health care reform as wildly successful — even without the public option and without single payer. (As an aside, I thought the tax deal is wildly unsuccessful — they are not the same type of compromise at all, but that’s a different post.) We know that the health insurance reform bill passed by Pelosi/Reid/Obama will help insure more people, eliminate pre-existing conditions, extend insurance for people up to 26 yrs old, create a more fair market for insurance in the exchanges, help protect consumers in any number of ways, achieve more equality for women in their health insurance, and more. Those are real accomplishments. Is it perfect? Hell, no. Did I want the public option? Yes! Yes I did. But it’s a great step in the right direction. Civil rights wasn’t passed in one bill. It took the Civil Rights Act of 1957, then a major reform in the Civil Rights Act of 1964. And you know what? You can’t have real civil rights without voting rights, so they passed a law about that, too, in 1965. I think health insurance reform in America will be like that, if we can keep it. Progressives should be championing this major victory, just like we in Massachusetts should be championing the fact that almost no children go without some form of insurance. It is a step, but it’s damn important.
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p>End rant.
I’ll expand on some points because I think they’re a little incomplete but mostly copy much of this if you don’t mind duplication.
here you go.
The Massachusetts “solution” has become the status quo. The national debate was centered around our “success,” but our success was only ever defined by the % of people who had a plastic card. That’s not health care. We may have 97 or 98% insured. Someday we may get to 100%. That’s not the point, though. Our 98% may not really look very different from Hawaii’s 91%, or Vermont, or any other state with decent (for America) plastic-card rates… once we pull the curtain out from behind the Wizard.
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p>If “patting ourselves on the back” becomes the new status quo, I’m here to tell the world no… freaking… way. We can do much, much better, but only if we’re willing to get tough on the people feeding us the manure.
is that Arizona has just cut off Medicaid subscribers from certain transplants, and I haven’t heard any prominent Democrat in Congress, or certainly the White House, step up and propose amending their health bill to make sure these things don’t happen. This would not have happened if the law passed in Congress had included nationalizing Medicaid as the progressive caucus wanted, nor of course, if we had enacted a single payer health system.
What’s behind your assumption that nationalizing Medicaid wouldn’t prevent rationing, like AZ is doing? Sure, it would prevent a state from doing it, but single-payer doesn’t all the sudden mean you’ve got infinite resources.
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p>Rationing is a part of health care, no matter what, whether it’s done by insurers, the gov’t, individuals, or a nifty managed-cooperative-Kum-Ba-Yah-care group like the Mayo Clinic. The question is who’s doing it, and on what grounds?
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p>Do you think Canada’s waitlists on elective surgery are un-controversial there? Is health care not a major issue of contention in every country, regardless of system?
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p>You’ve got limited resources and everyone wants to live forever. How could it not be controversial?
This is a death sentence for these people based solely on economic status. I do not think for one minute that many citizens in this country would just shrug their shoulders and say well rationing happens if suddenly their neighbors were cut off from proven, need transplants. By nationalizing the program you make states less vulnerable to economic turmoil and the unconscionable Medicaid cuts that go with it, particularly like the type Arizona. Further, in Canada they ration based on need NOT wealth. It’s not the people most at risk of dying who have to wait, or as in the case of Arizona, are completely cut off from certain transplant surgeries at all again because of their economic status. I find it charming that you celebrate the kids and their insurance and then basically sneer at the poor in Arizona who have been effectively cut off from life saving transplant surgeries.
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p>”Is health care not a major issue of contention in every country?”
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p>No, actually, it isn’t. Residents of several industrialized countries including Canada love their health care system.
“Sneering at the poor in Arizona”? Nonsense. Show me where I did anything like that.
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p>My point is that single-payer is not magic, and the cutoff happens somewhere, by someone. So what’s your solution? What does single-payer pay for, and when? If it’s not an insurer that’s deciding, then it’s the gov’t. No free lunch.
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p>If health care is not a major bone of contention in Canada, then why this?
http://www.montrealgazette.com…
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p>http://www.vancouverobserver.c…
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p>and on and on.
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p>http://www.google.com/search?q…
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p>No, the fact of single-payer in Canada is not seriously in question, but what it covers and how to pay for it decidedly is in question.
No, it’s the doctors, in consultation with their patients and the family of their patients when necessary. You should know better than to make a statement like that.
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p>I don’t know very many single payer systems in modern, developed democracies where governments are interceding with the life-saving treatments of doctors on things like transplants. Generally, it’s the doctors who are ultimately making the decisions on necessary care, even if governments create incentives and disincentives to keep the costs down.
are to improve and protect the system. There is a small group of conservatives that would like to dismantle the system and turn it into something like we just passed. There is virtually no public support for that at all.
… and yet, even within that context, there are inevitably questions as to how to spend limited resources. So the disagreements and controversies move around, but they don’t go away.
in Canada over the health system.
As I’ve already pointed out. I’m done.
If we had single payer tomorrow, then next week there would be a story on the television about some poor someone who was denied Treatment X and must therefore suffer Consequence Y, or else pay Sum Z in order to pay out of pocket. Then coverage of Treatment X would be a new goodie for politicians to give away to constituents, and the entire thing will become steadily more expensive, and thus steadily more unsustainable.
…that nothing created by people is going to be perfect in every way. Since we’re all fallible so is everything we might create. However, given all I’ve learned if I had to choose our system or Canada’s system in toto, warts and all, I’ll take Canada in a heartbeat.
This is lifesaving treatment we’re fully capable of doing, but not, because they’re poor.
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p>Other rationing certainly happens — though almost certainly less of it than happens per capita in the US (60 million uninsured counts as rationing, right?).
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p>Gah, Charley, come on… you’re better than ‘we’re not giving out liver transplants to the poor and young with families anymore.’
I am better than that. So don’t put words in my mouth.
…when it is mandated to purchase, but I still feel left out of the loop. I was living paycheck to paycheck last year and my employer offered insurance that required more withholdings from my paycheck. I gambled that I was young and healthy and that I was making too little to be penalized so I said thanks but no thanks. Plus being domiciled in VA I thought it might not apply to me. Turns out since I kept my voter registration and drivers license in MA the state considered me a resident and has assessed me a $500 penalty that I now half to figure out how to pay on income comparable to last year. There is still a cost component which is hard for someone in my position to justify. You’ve always been so quick to defend this “reform” that I’m tempted to ask if there are any disclosures you should make.
When you gambled that you were “young and healthy”, you placed a bet with other people’s money. Had you, for example, had an unexpected serious illness or injury (even healthy young people fall on ice and get head injuries), then you would have received care anyway — care that the rest of us pay for.
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p>The fact that you are relatively young and healthy, and therefore less likely to make claims than someone older and infirm, together with the fact that there are lots of young and healthy people like you, is why mandated health insurance makes any sense at all (I think we agree that single payer is preferable).
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p>One way or another, unless you want to live in a society that stands by while otherwise-healthy young people die of easily treatable illnesses and accidents because they can’t pay for the treatment, society must pay for its health care. The question is how that payment is most fairly spread across the society.
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p>Requiring that every resident pay a small amount is the best we’ve come up with so far. The frustrating truth is that an enormous portion of that premium you are forced to pay is a direct transfer from your wallet to the bank accounts of shareholders of the already-wealthy insurance companies and health care providers. It is a coerced transfer of wealth from those can least afford it (like you) to those who are already wealthy.
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p>These injustices will only get worse. There is a class war going on, a war that has been fought in earnest since the Reagan era. You are under assault by the right wing, and they do strive to strip you of every penny and every asset they can get away with. They call this “the free market”. Welcome to the Gilded Age redux.
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p>The question is whether we are willing to fight back, and whether or not we can somehow contain that fight to the ballot box.
I completely get the logic behind the requirement in the abstract, and why I have to pay one way or the other, but when I’m just this side of making rent and doing without all but essentials, then the state still thinks I made enough that I should have gotten insurance somethings gotta give.
This really is serious — deadly serious — stuff.
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p>My two oldest daughters are in the same bind you’re in. We should not forget the other financial calamity facing virtually everyone under 30: crushing debts from exploding education expenses.
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p>You’re absolutely right that “somethings gotta give”.
If like me (and officially 10% of us) you’re unemployed your loan payments start getting behind, then they threaten to report you to the credit bureaus which reduce your rating thus resulting in your having to pay even more in future loans and possibly make it difficult to get a job. Does anyone else think there’s a huge racket going here whereby the credit industry forces you into a vicious downward spiral in which the people most struggling to pay cannot get to the point where they can pay by getting a job or getting a break on their commitments?
There are a great many ways to fix a student loan problem, short term. Of course paying less now means paying more later, but life is a series of tradeoffs. In any event, using these tools isn’t damaging to one’s credit; skipping payments is. So don’t deal with a problem by ignoring it. EOM.
…thus risk losing credit when times get tough. We as a society have become to credit-driven. Too many goods are priced out of range for those of us who don’t like debt, but would rather only spend what we have. Don’t judge me though; it’s not like I make a conscious decision to miss payments because I feel like it. Plus, I generally actually do OK in getting my payments in, but just barely.
and personal. I’m tempted to delete it for that reason.
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p>I disclose that I am self-employed, a musician, with many self-employed friends; many of whom have at various times and in various states have also found it difficult to get health insurance.
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p>I have been active on health care since the ballot push of 2004-2006. One of the main reasons I do this blog is my personal and second-hand experience with the health care market. I’ve been writing consistently on health care pretty much since we started in 2004. And I do this blog basically for free.
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p>I know it’s expensive, and I know it puts many people in a bind. It creates agonizing choices — actually, it just reveals them, because the choice of being uninsured is also agonizing. There are plenty of books, videos, TV shows where you can read up on people who were uninsured (or “uninsurable”) and lost … but I doubt I need to tell you this.
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p>So what’s our next step together, Christopher? Now that we’re in this boat together, what do we do now?
You have awfully thin skin if my suggestion that disclosure may be warranted is a “cheap shot” that tempted you to delete.
The suggestion that someone who disagrees with you probably has something nefarious to hide is unworthy.
It’s that he constantly defends this particular law to the hilt and seems to object to fighting harder. I hear this is what we have – deal with it. Besides, I don’t see it as “nefarious” to have something that may be worth disclosing. I think you both interpreted my suggestion more harshly than I intended.
Well, then perhaps you should have worded your suggestion differently. Because what you were, in effect, saying is “your position strikes me as so unreasonable that it seems likely to me that you have failed to disclose a financial or other personal interest in this matter – even though you, as one of the proprietors of this blog, have insisted that others disclose such interests, thereby making you both a shill and a hypocrite.” I think one can forgive Charley for not reacting positively to such a suggestion.
…that either his position was unreasonable, or that he was a hypocrite. Lord knows I hate the former attributed to me with regards to casinos. It was just a nudge. Sometimes it doesn’t even occur to us, myself included, to disclose something that maybe it would be helpful or appropriate if we did. I just didn’t think asking was per se offensive enough to almost get deleted. My apologies for it being taken that way.
Aside from your first sentence I found your comment heartfelt and sincere. As to where we go from here the more I learn about this issue the more convinced I become that single-payer is the only real option, both pragmatically and morally. Barring that I would alleviate the moral hazard of signing up once you have a condition by having a narrow window for enrollment annually.