That’s how I feel about the health care bill. I’m happy that more
people will be covered under MassHealth (est. 92,500 by FY2009) or the
new Commonwealth Care program (est. 207,500 by FY09); ambivalent,
because the personal mandate will
doubtless hit some people — like the self-employed — pretty hard,
especially those somewhat (but not glamorously) above the subsidized
level (about $30k per year).
As many have pointed out, the bill punts on any number of really
important issues:
- What is an “affordable” premium for an uninsured person above the
subsidized income level? Right now the word is that a bare-bones plan
might cost $325 a month for an
individual; and let’s not kid ourselves, that is a lot of money for
someone below median income.<a
href=”http://www.boston.com/news/globe/editorial_opinion/oped/articles/2006/04/07/will_public_buy_the_healthcare_plan/”>Quoth
the Duke:“It is all a question of what it is going to cost people,” notes
Dukakis. ”If a guy making $30,000 is going to have to come up with
$3,600 or so, you are hitting people of very moderate incomes pretty
hard.”Yup.
- What are you paying
for? If it’s a high-deductible plan, you’re basically paying for the
right not to go into the poorhouse if you get sick,
but not for anything <a
href=”http://www.boston.com/news/local/massachusetts/articles/2006/04/06/health_bill_premiums_may_exceed_predictions/”>preventative,
like prescription drugs. - Speaking of drugs, nothing about the state bulk-purchasing drugs
to get lower prices. (There’s <a
href=”http://www.mass.gov/legis/bills/senate/st00/st00399.htm”>another
bill to deal with that.) - Cost-control is simply not dealt with. Nothing about a
best-practices research organization, which was originally a part of
the Senate plan. Too bad; such a thing might make MA a real leader in knowing what we’re doing with our health care dollar. - Re-insurance, in which the state would take over catastrophic
care costs, apparently went out the window. Last I heard it seemed to
be working well in New York State, and it was originally a part of
Travaglini’s plan. It definitely would have led to lower premiums,
although it would have been expensive for the state. I suspect that
this went out with Romney’s insistence that the whole thing be
“revenue-neutral.”
Bottom line? Health care reform isn’t finished, not by any
stretch. What we have here is a framework; what’s most critical now is
to figure out how to get care for the vulnerable people just above the
subsidy levels; and how to control costs in the system at large.
By the way, check out <a
href=”http://www.hcfama.org/blog/2006/04/dont-get-wiggly-on-us.html”>this
post from John McDonough and <a
href=”http://massbackwards.blogspot.com/2006/04/as-luke-skywalker-once-said.html”>this
post from “Differently Winged” Bruce at mAss Backwards; aside from
the general tone, you’ll find they share areas of concern.
I’m generally happy that the idea of health care for all is back on the front burner in Massachusetts after a 16 year vacation. But I do worry about this law.
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If there is one type of person that we don’t want to lose here in Massachusetts it would be a young single (remember: married people have it easier, because only one needs to work for a company with insurance) self-employed upstarter who is struggling to start a consulting business. These people are smart, creative, have a lot to add to the economy, and they probably have the flexibility to set up and run their business from any corner of the world. (probably from any starbucks in the world!) But if they chose to come to Massachusetts, they will get demands and tax penalties to participate in a health insurance program.
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Should they be insured: yes. But, many young single self-employed types may choose not to be, and may be pretty sick of a state with this sort of a mandate. The law is a great step forward, but there needs to be an answer to this problem, or we are going to take an economic step backwards when the founder of the next great tech firm starts her business in Rhode Island or New Hampshire because, when she worked alone, the crazy state of Massachusetts was making her spend 10% of her annual income on a high-cost low-return health plan so that she could subsidize insurance for everybody else
The critical question is: how much will the various elements cost. If Massachusetts can provide health care at a cost that is the lowest in the nation, which it should be able to do, if it has the largest pool because everyone is covered and because its system cuts some administrative costs, then people will flock here. If instead it is a “high-cost low-return health plan so that she could subsidize insurance for everybody else,” then forget it. I personally don’t like the sound of $325 a month. Small businesses in MA can pay $250 per month per employee for very good BCBS coverage right now, so that doesn’t sound like much of a bargain. At $100-150 per month, however, I think the roads will be jammed with entrepreneurs trying to get here to start companies.
I started my own business a few years back. And I talk to a lot of people who would like to start businesses at entrepreneurs groups–they are high energy folks with great ideas. But the first question they always ask me is: how do you get health insurance?
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Also, I talked with someone who I would consider hiring. But flat out she said she can’t leave her corporate job that she hates because she can’t risk losing the good insurance for her family. Her husband is a landscape/lawn care type, self-employed, and so she carries the insurance.
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I’d like to know where you can get the BC/BS for $250. I’m paying $388/month for my plan, with no prescription coverage.
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If you want to see my rate options, they are here:
http://i4.photobucket.com/albums/y147/mem_from_somerville/rates.jpg
It will never happen here. And friends in other states tell me that it is already available elsewhere. We have A LONG WAY to go.
I’ve been banging the drum on exactly this point for months now. The individual mandate strikes me as an excellent incentive for young, unattached, highly mobile people to leave Massachusetts, and to prevent such people from coming here. I mean, think about it: if you’ve just graduated from college and you’re deciding what state to move to, and you know that if you move to MA you will be forced to purchase health insurance on pain of substantial tax penalties, are you really likely to come here?
I don’t think there’s any doubt that it would be a disincentive to many young folks. But if we had cheaper rates for better care than anywhere else, it would be an incentive to move in for those who considered it important: Yes, you have to have it, but it might be cheaper and better than you’d get elsewhere.
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And as John McDonough points out: who knows if it would even apply to you?
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That’s why this thing ain’t over, not by a long shot.
from the beginning, the governor banged the drum about all of the people who choose, for whatever reason, not to get health coverage as being this major drag on the system. conservatives have thus taken up this hoohah, complaining about the need to shake out all of the ‘free riders’, ‘freeloaders’, (or as rep. bob hargraves (r) of the healthcare financing committee so quaintly phrases them; ‘pikers.’
yet, i have real doubts about how many people are truly making all of this money and spending it all on beer and tivo’s instead of buying health insurance for themselves. and i have never heard any of the boosters of this notion present any real figures. so a lot of this rhetoric sure smacks of reagans welfare queens driving cadillacs.
on the wbur forum yesterday, right after romney had suggested once again the freeloader theory, at least three fully employed citizens called up to say that they could neither access or afford health coverage and yet had never taken any freecare service.
so, how much of an influence the ‘voluntarily insured’ demographic has on the big picture seems very questionable.
What about all those people who can’t afford police protection but use it anyway? And people who can’t afford to pay for a judge’s time, but go to small claims court? Who can’t afford to pay for road maintenance, but drive their old clunker cars on those roads anyway?
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When we have fully employed people who can’t afford or access health care and who avoid freecare because of this kind of idiotic rhetoric, that’s a serious problem.
Young and Self Employed –
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Every penny counts. The fact that you have to write quarterly checks to actually PAY taxes really makes it hit home how much they are. It isn’t like when you worked for somebody else, and the boss had to pay half of your Social Security – now you have to pay it ALL yourself, like you were some kind of Fortune 500 company! (Did you know that years ago, the self-employed rate was 11% instead of the full 15%? Graualy, that was eliminated to try to keep Social Security solvent). NOW, on TOP of your taxes, they want you to pay HEALTH INSURANCE? At $500 per MONTH? Really, that’s as much as RENT! And your’re HEALTHY! Don’t smoke, work out, take supplements – and NOW they want to charge you THAT MUCH?
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Screw it, if you get the flu, you can go to CVS. It’s just not WORTH it.
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Then, one day, you fall off a ladder and tear your ACL. And you find out that it will cost $7,000 to have surgery. Just for a little knee thing.
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Oh, well – hospitals have millions. Just like insurance companies, with their tax loopholes and stuff. It isn’t like YOUR $7,000 will make any difference in some fat cat’s bottom line. Or tax bill.
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Sound familiar? Multiply by 200,000 and stir….
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I wonder how many of these bright, vital young people we can AFFORD…
200,000 uninsured people a year needing and having major surgery?
wow, sounds like this state is an even more dangerous place to live than i thought.
Y’know, Sarcastic One, if you look at the Uncompensated Care Pool statistics, 200,000 statewide is probably a LOW estimate!