It turns out that we’ve got a lot fewer uninsured folks in MA than 2004. There are big questions about who’s got the best numbers, but according to the State, the ranks of the uninsured are down a whopping 19% since 2004. Wow. The press release credits the early-stage implementation of the new health care law and job growth for the drop.
Now, the press release is missing its backup data; John McDonough suggests it’s because the Romney administration wanted to get out the numbers before the US Census Bureau’s numbers, which come out tomorrow. The Census generally shows much higher numbers of uninsured.
Mitt says, “Early phases of healthcare reform are bearing fruit,” — when in fact, it’s the low-hanging fruit that we’ve collected: Those eligible for Medicaid (MassHealth) but were unenrolled. That was really the slam-dunk part of the new health care law — getting those folks covered. Well, now they are.
So, for all the angst about the new health care law, the relatively easy first part has been successful. The scary part — figuring out how much to subsidize the health care of lower-income folks, and how and on whom to implement the personal mandate — is being ground out right now by the “Connector”, the panel of folks charged with writing the regulations. (Healthy Blog’s always got all the gory details.)
Bottom line: Fiscally, it looks like the health care bill got a lot easier to manage. If the Feds’ numbers basically agree with the trend, a sigh of relief may well be in order — pretty uncommon in health care recently.
… By the way, check out how the politics shake out in Ohio governor’s race, now that one of the candidates has proposed a Massachusetts-style health care reform. (Don’t peek! Guess: R or D?)
Are you actually crediting Romney? Bravo!
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I was pretty nervous about any plan which shoots at universal health care, and damned trepidatious about requiring people to buy something they might not want. But, on balance, they already get free health care in emergencies anyway so as long as that holds, we might as well force them to pay for it. Force everyone to pay for their entitlements and then we’ll see how much they are really wanted, huh?
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A nice example of new, creative ideas to solve difficult issues though.
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How about Romney for president? Or at least for the R nomination? Or would you rather have someone else on the R ticket?
Your approach to health care — keep people away from it unless they wanna pay — is a main reason why it’s so flippin’ expensive. Preventative care is cheap — intensive care, not so. That’s the problem with so-called “Consumer-Driven Health Care.”
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In response to the rest: Insofar as he made a common sense, consensus proposal for moving folks out of the Free Care Pool and into MassHealth, sure Romney deserves credit. That was a point of agreement between him and the legislature.
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You want more? Romney hired Doug Foy as development secretary, and pursued a smart-growth policy. Too bad Foy left over differences with inexcusable Romney policies, like pulling out of Regional Greenhouse Gas Initiative. But hey, he had the guy for three years.
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Here’s another: As far as I know, he’s run a clean ship — no taint of scandal. I don’t know of anyone in that administration who’s been found to be corrupt. Maybe someone can correct me on that. That’s not a small virtue.
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Here’s another, related point: I am told that Romney appoints generally competent people to important but wonky positions — that is, he actually respects the basic functioning of government on some level. Now, to me that’s just baseline competence, but it’s much, much more than you can say for the nauseating, incompetent hack-frenzy that has been the Bush Administration.
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There, four nice things about Romney. I hope to say many more and more profound nice things about our Democratic governor in ’07.
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I don’t care who’s the Republican in ’08, since I don’t plan on voting for him in any event. If it’s Romney, good for him. I doubt it will be.
was a good move, in theory. But in practice, Romney froze him out and didn’t let him accomplish much. Foy was a very, very good sport to stick around as long as he did.
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Clean ship? Two words: Angelo Buonopane.
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Competent wonks? Dunno. Depends who you’re talking about.
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On health care, you know more about it than I do. But his initial proposal was unacceptable. And sure, he signed parts of the legislature’s “compromise” bill – but then he vetoed big important chunks of it, IIRC without even the courtesy of a phone call to Sal & Trav who were scheduled to show up at the big Faneuil Hall signing ceremony – they learned of his vetoes from the Wall St. Journal op-ed that Romney published the same morning. So he did what he did, knowing full well that unless his vetoes were overridden the thing wouldn’t even get off the ground. Nice.
Do you think Buonopane is part of a pattern — or was he an “isolated incident” of no-show?
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And David, please — I’m going out on a limb already. Don’t start sawing …
Nicely done. I’m impressed.
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Your approach to health care — keep people away from it unless they wanna pay — is a main reason why it’s so flippin’ expensive. Preventative care is cheap — intensive care, not so. That’s the problem with so-called “Consumer-Driven Health Care.”
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… but I can’t totally agree with this on several grounds:
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1. My approach to healthcare and the status quo are not necessarily the same
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2. In particular, my approach to healthcare would likely be much more market driven – i.e. remove barriers to entry in the medical profession, and remove the nearly vertical demand curve created by semi universal coverage levels.
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3. I only slightly buy the notion that the reason healthcare is so expensive is because we don’t do adequate maintenance. I mean, really – more maintenance (via universal care!) is going to knock out heart attacks, car wrecks, gunshot wounds and cancer? You’d be better off banning smoking.
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Healthcare is expensive, I think, because both sides of the market are broken: supply is weirdly and artificailly constrained, and demand is this massively tiered insurance/HMO hybrid that says you can get basically whatever you need, at worst for a co-pay. This situation will not improve with universal coverage.
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Also, advances in medicine like, oh I dunno, MRIs, laser surgery, advanced drug therapies etc have been expensive to produce. Some advances in medicine which give treatments where none existed before do not scale well, and possibly require highly trained expertise to boot. This expense is rolled in with the rest, and automatically granted to all who qualify.
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Broken supply, unforgiving and absolute demand. Bam. Price spirals.
And suck up a lot of time, but I’ll try to respond. Some of these are my pre-packaged health care talking points, and I apologize in advance to anyone who’s read them already:
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1. As a % of GDP, we spend far, far more in the US for health care than any industrialized country that has universal care — and we’re leaving out 40 million-some people. So please don’t tell me “universal care = expensive”. It just ain’t so.
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2. You may be right about the bottleneck for medical professionals in the US — constraining supply. But I don’t think that’s why it’s so expensive. The real reason is adverse selection (I know, I know, it’s Krugman — read it anyway): Insurers can cherry-pick who they want in their risk pool, and individuals can cherry-pick themselves out of the risk pool. So you get folks who pay huge amounts and get everything, folks who pay nothing and get nothing, folks who pay nothing and get quite a bit — and not a whole lot in between.
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3. Yes, more maintenance does indeed knock out heart attacks and cancer! If you’re under a doctor’s care for high blood pressure, high cholesterol, obesity, — yes, quitting smoking — that’s a hell of a lot cheaper than bypass surgery. Ounce of prevention, anyone?
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And sure, banning smoking would be a terrific public health measure, all things being equal. But a lot of folks love their smokes; there doesn’t seem to be the political appetite for such a step. Judging from the history of prohibition, that’s probably wise.
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By the way, Princeton health care economist Uwe Reinhardt takes issue with the idea that health care demand is absolute and unforgiving:
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Anyway, here’s my health care reading list, if you want to know where I’m coming from.
Yea you’re right this could go on and on in 10 different directions.
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As for % of GDP etc – I find that arguing with statistics is almost always a bad idea. We lead the world in healthcare, we invent a whopping amount of new treatments and new drugs (which other countries can pirate if they don’t like our terms), we have an incredible legal / insurance boondoggle going on, and we force a limited number of doctors to train for like 100 years before they can practice – of course its going to be expensive. Oh yea and the demand curve is…
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… you are right, its not purely vertical overall because most people dont need all treatments at all times; but it is nearly purely vertical whenever anyone does need a treatment. In other words, the afflicted population has a vertical demand curve for services which can’t reasonably scale.
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Preventive medicine helps a little, but what percent (!? sorry!!) of health care costs is realistically spent on preventable stuff? Plenty of well insured folks are getting heart attacks and all other manner of maladies. Eventually, we all get old and catch something or other catastrophic, or so it seems…
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As for Krugman, UGH!@ I mean really, one hates to prejudge but I don’t know that I could possibly stomach reading anything by that guy. His leftist myopia points us wrong so frequently as to resemble evil.
… in the countries who have vaunted socialized medicine, the vertical demand curve against limited supply often means long waits for treatments, or, no treatments. That’s why Canadians come to the US when it really matters, right?
… but what does an uninsured person in the US do when he needs an MRI? His wait is … forever. Sorry.
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BTW, in France they have universal care with choice and no waiting to speak of. Just because Canada’s system is imperfect does not mean that’s the fate of all universal care.
and has worked in the healthcare field for almost 30 years total, who has a sister with serious chronic illness, and is a health policy wonk of sorts, I would like to share my holistic or “big picture” view and suggest that there is a way out of our dysfunctional and wasteful healthcare system mess.
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I’d wager that the new MA state stats on the number of uninsured are low (see US Census data released today), but hey I’ll accept the trend and say I’m glad the total number is going down. What I and everyone else should not like, and should not tolerate, is how ripped-off we all are getting by the current healthcare financing and delivery “system”. The system is largely a sham that benefits corporate interests at the expense of people’s health, their lives (literally), and their wallets.
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In addition to Charley’s reading list that’s linked in this post (Kudos to Charley), see Sager & Socolar’s recent report, “Massachusetts Health Spending Soars to $62.1 Billion in 2006″-Spending Is World’s Highest–33% Above U.S.A. Average, An Unprecedented Excess”, 28 June 2006. Report is 86 pages with 40 exhibits posted on their site’s Access and Affordability Monitoring Project (AAMP) page.
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I’d also like to suggest that BMG readers take 5 and visit our MA Healthcare Activist website to get up to speed on MA homegrown universal coverage reform efforts. Namely, making affordable comprehensive health insurance coverage a permanent right for all. Hey, we’ll be joining the rest of the civilized and wealthy world once we do that! Isn’t that a novel idea?…
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Last thought. Keep 2 themes in mind as you think about and evaluate any public policy option, be it healthcare reform or energy policy or military spending:
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1) Follow the money trail.
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2) Who wins and who loses with the proposed reform?
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If you dig a little on these 2 fronts you’ll learn a lot and realize that our U.S. “healthcare system” including what we’ve got right here in good ol’ MA is one of the biggest rip-offs to the ordinary person this country has going these days, in addition to the war in Iraq of course…
Although the US census data does not break down state by state stats, an activist colleague in NY sent me this link that does just that
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My thanks to Tom Garvey at the [ThePolicyCenter in NY! http://www.thepolicy…
Sorry. I meant to click on “preview” but somehow “post” occurred before I could confirm the correct link to ThePolicyCenter. Not wanting to give short shrift to Tom Garvey, the Center’s founder who is a former HMO exec turned health reform activist, I’ll add this correction. I hope you’ll check out their site. Thanks.