Over at The Health Care Blog (it's “The”, don'tyouknow), Maggie Mahar notes several of the flaws of the Massachusetts model of health care, particularly cautioning us not to take for granted the assertions that getting us to universal access will mean that all the other problems are magically solved. In particular, she has a powerful litany of the shortcomings of our own Chapter 58:
… [B]efore rushing blindly forward, we should remember Massachusetts. Despite the best of intentions, the Commonwealth’s reform shows that “universal coverage” does not mean “universal access” to sustainable, affordable care. In Massachusetts,
- Co-pays and deductibles are so high that the share of insured citizens who cannot afford to use their insurance has climbed since reform began.
- The number of uninsured has dropped from its high—but the share of Massachusetts citizens who lack insurance remains over 5.5 percent—roughly where it was eight years ago, in part because the state doesn’t have enough money to provide subsidies for everyone who, the state agrees, simply cannot afford the premiums. These citizens are left out in the cold: “exempted” from universal coverage.
- Meanwhile both the state and its employers are going broke trying to keep up the cost of covering the rest of the population.
And Massachusetts is a wealthy state. Imagine if we had Massachusetts-style healthcare reform nationwide. Do you really think this would help the economy?
Now, Mahar is probably a good bit too half-empty in her assessment. Some of these concerns are overstated, and some are not the right comparisons, and so forth. (For instance, the correct comparison of % of uninsured is not the % of a few years ago, but where we would have been now had we done nothing. Employer-based insurance has cratered in many places over the last few years.)
In any event, Mahar is right to say that it won't do to simply subsidize/mandate health “insurance” — whatever the hell that is — and then let the costs of care+insurance completely run away from us.
PS — hey, how about a public insurance option? Might that keep the screws on the private insurers to control costs?
Charlie Baker posted about the a recently released cost shift study. It was a study done by private insurers. Yes, there is a cost shift with Medicare and Medicaid. Medicaid doesn’t pay, we all know that, but that’s the reason why we’re pushing for health coverage for everyone instead. Medicare on the other hand runs a tight ship. It’s not that difficult to see that the study and the first shot by the private insurers to health care reform. I called him on it in the comments. To his credit he did post back and noted that it’s not the first time he discussed the topic. But here is what is interesting my emphasis:
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p>It’s been argued that the cost shift attributed to Medicare has to do with the way hospitals do business and how efficient they are in their practices. If you infect a patient or operate on a wrong body part, guess what, Medicare won’t pay you for the screw up only for the initial treatment. Medicare provides additional dollars for those hospitals who provide preventive services. Medicare doesn’t pay for unnecessary testing. So for those hospitals that are deficient in several areas have a payment gap with other hospitals. So private insurers say the pay more to those hospitals so they can stay in business. I got an idea, why not enforce standards? Why not hit the hospital in the wallet when they operate poorly, why enable them to continue? Paid for by the people in your plans.
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p>He says that he’s fine with competing with a public option, good. But sorry, level playing field? Medicare has inherently low administrative costs and goes after hospitals that are not efficient in their practices. You know why? Because they can. They are the only ones who can pull it off. That’s why the public option is the best path. To private insurers who complain that it’s not fair, sorry, I’ll still sleep well at night.
Ms. Mahar’s conclusions are just wrong.
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p>Claim 1: Co-pays and deductibles are so high that the share of insured citizens who cannot afford to use their insurance has climbed since reform began.
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p>Response: False. Health reform has reduced the uninsurance rate from about 7%-8% to 2.6%. Some of those insured chose high deductible plans. Some people are stuck with their employer’s choice of coverage, which could have high deductibles. But MA is the first state to limit out of pocket costs, which are going much higher in other states. All of the subsidized plans (CommCare, MassHealth) have no deductibles, and modest copays.
For people with insurance, they coverage is getting better, not worse. The Urban Inst study (link: http://www.bcbsmafoundation.or… found the percent of insured adults with cost sharing more than 5% of income went from 7.3% in 2007 to 5.6% in 2007. For those in poor health, it dropped from 11% to 7.9%.
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p>Claim 2: share of Massachusetts citizens who lack insurance remains over 5.5 percent-roughly where it was eight years ago.
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p>Response: False. The uninsurance rate is 2.6%. (Link: http://www.mass.gov/Eeohhs2/do… The whole reason health reform became high on the agenda in 2005-2006 is because uninsurance rates in MA started creeping up after reaching a low in 2000. The recession of 2002 reduced insurance levels, and levels never grew during the economic recovery. But now the state is much better than where we were 8 years ago.
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p>Claim 3: both the state and its employers are going broke trying to keep up the cost of covering the rest of the population.
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p>Response: False. The economy is in a shambles everywhere, but MA is in better shape so far than other states. We’re going broke because of the recession, not health reform.