I hope that this website cannot be accused of withholding criticism of the current governor. And writing a purely laudatory post makes me feel awkward. But it must be done. Today's New York Times bird's eye view gives us occasion to say that the Patrick admininstration's approach to health care reform has been courageous and effective — even, at times, masterful. And they've had good help in the legislature and AG's office.
There, I said it. Call me a shill, but let's look at the facts.
- The law is still in effect — it's been extremely expensive, as the Times article correctly points out, but we're still standing.
- We have by far the lowest rate of uninsured people in the country: 2.7%. Points of comparison: Texas was at 24.9% as of 2007; NC 17.2%
- Premiums for the subsidized Commonwealth Care program will decline this year.
- Patrick has threatened insurers and providers with a resumption of rate regulation if they can't control costs themselves.
And as a result of Sen. Prez Murray's efforts with last year's legislation, now the cost-control commission is going at the toughest nuts to crack in health care inflation: The perverse incentive for quantity over quality of care:
The commission is looking at various options, but all would do away with the fee-for-service system, which provides perverse incentives by paying physicians and hospitals for each patient visit. The changes under consideration include reimbursing for episodes of care rather than individual visits and bundling payments to groups of providers who would together take responsibility for a patient’s health.
And let's not forget AG Coakley, who is investigating possible collusion between the Partners provider group and insurers. Does this kind of scrutiny have an effect on behavior? You think?
Shepherding the implementation of health care reform is a steady grind, and no one's going to be 100% happy. But one can very easily imagine an administration, legislature, and AG that were a lot less courageous and engaged on this issue — and a lot less willing to confront many of the most powerful special interests in the state, on behalf of the broad public interest. It's as if the Governor's team, the lege, and the AG have all gone so far down the road that they genuinely don't want to fail the public.
This is a very good dynamic. May it continue and grow into other areas of public life.
gary says
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p>The stats you cite are 2006-07, and are therefore better stated as a benchmark, since Commonwealth Connector was just starting up.
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p>IMHO, to the extent uninsured rates decrease relative those that benchmark AND at an acceptable cost is reason for claiming Admininstration success or failure.
charley-on-the-mta says
and those are the most recent stats I could find within time constraints. But do you have reason to believe that either NC or TX uninsured rates have gone down?
christopher says
A key issue that caused me to favor Clinton over Obama in the primaries was their approaches to health care. Obama sounded like he wanted to nationalize the MA system. Granted if you make little enough you don’t get hit with a tax penalty, but you are still without coverage. Right now it’s like car insurance that the state requires you to have AND pay for. We need to get it to be like public education that is available to all simply by signing up.
charley-on-the-mta says
The big difference was that Obama did not favor the personal mandate, and Hillary did!
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p>That being said, I strongly suspect that Obama will drop his opposition to the personal mandate, in order to get the insurance cos under the tent, and to claim universality. On balance, I think that’s wise.
christopher says
I definitely got the impression during the general that Obama favored a MA style system. When its handled through taxes I guess that’s not the kind of mandate I was talking about. I think what I’m trying to say is that I favor mandated universality a la Clinton rather than a seperate personal expense which I thought Obama was advocating.
mr-lynne says
… the key difference between the two during the campaign was that Clinton has a purchase mandate and Obama didn’t. This was a point in favor of Hillary in my book. In a single payer system, purchase is totally mandated, but it’s handled through taxes. In this way, Hillary’s plan may have had an advantage in a transition to single payer eventually (although it has other problems vis-a-vis transition). This is an oversimplification, of course.
theloquaciousliberal says
Others have noted that you reversed the Clinton and Obama positions on health care.
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p>I wish to address your second point that “if you make little enough you don’t get hit with a tax penalty, but you are still without coverage.” This simply isn’t true.
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p>In fact, individuals with incomes up to 150% of the Federal Poverty Level are both not subject to any penalty and get fully subsidized (no premium, no co-pay) health insurance either through MassHealth or Commonwealth Care. Those who make “little enough” get both no penalty and free coverage.
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p>Those making 150%-300% of poverty receive subsidized health insurance through Commonwealth Care with premiums that are certainly affordable to almost all these individuals (all under 10% of income for premiums). Those who make “little enough” get no penalty and get deeply-subsidized coverage.
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p>The tax penalty applies only to those who make more than 150% of poverty, those that refuse to purchase the subsidized CommCare insurance, and those that earn more than 300% of the poverty level ($32,000 for an individual and $77,000 for a family of four).
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p>The result is that less than 5% of tax filers (relative wealthy compared to No Tax Status individuals) reported having no insurance for at least part of 2008. Less than half of those actually paid the fine (with most of the rest having been deemed “unable to afford” unsubsidized insurance).
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p>
nancy-e says
In April 2007, the state realized that there were at least 60,000 people who did not fit into their formula of affordability. They decided to exempt these individuals from the requirement because their incomes were too high to justify subsidies but too low to make coverage affordable by state standards. That number represents just over 1 percent of Massachusetts citizens – but nearly 20 percent of its uninsured adults. These people will not be required to pay the fines and penalties, but can not afford health insurance either. These are the legally uninsured. It is likely that this number will grow substantially next year as premium costs rise and incomes do not.
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p>The federal plan to build on the Massachusetts mandate is more than misguided, it is dangerous and harmful. Citizens of this state are compelled by law to have commercial (for profit) health insurance. The government tells you if you can afford it or not and if you still can’t you are punished. The penalties are enforced through the tax system and carry such penalization mechanisms as interest for non-payment, property leins, wage and even asset/estate seizure. So if you can’t afford exactly what they say you should buy, you are a lawbreaker and WILL be punished.
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p>We know that in 2008 the Connector paid MassHealth $5,298,548. to use their billing and administrative services. We know that outreach grants amount to $3,500,000. We know that the Connector administrative salaries for 43 employees amount to $4,345,274. We know that there was a $4,000,000. budget for PR and marketing last year. These costs alone amount to $17,143,822. The Connector administrative budget is over $39,000,000. for 2009. Imagine this kind of wasteful expenditure on a national level. That could be heck of a lot of doctor visits!
johnd says
Thanks for your input in this one-sided argument. I think the health plan created by the Romney administration (not the Patrick) has been a move in the right direction but clearly the details need to be fixed or we are headed to ruin and revolt.
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p>Here’s a question… we often hear of the 47 million “uninsured” Americans but nobody ever qualifies that number by how many “chose” to be uninsured. Many healthy young adults opt out of health coverage by choice.
christopher says
Since I haven’t purchased you may consider that I have “chosen” not to. Since health coverage is marketed to individuals and not just businesses so theoretically anybody who doesn’t purchase it has made that “choice”. However, it is cost prohibitive to many. I choose not to PAY for it, but if it were offered on a silver plater like public education or like it is in every other industrialized nation,I would certainly take it in a heartbeat.
david says
Also, what’s your plan if you suffer an unexpected and serious injury or illness?
christopher says
I understand I’m playing a bit of Russian roulette. I just became really jaded about it when I was in grad school. I paid $1500/year for the student plan, which I now understand was a great price. Thing is, I got a flu shot and saw a doctor a couple of times, all for free with the plan, but without the plan would have cost less than $100 total. It felt to me like I flushed more than $1000 down the drain at a time in my life when money was extremely tight.
david says
I mean, you won’t go to prison for it, but you’re required to carry health insurance in this state.
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p>As for your Russian roulette, not really. If you get sick or hurt, you’ll go to the ER and get treated. We’ll pick up the tab for you. No problem — happy to help out. :-/
christopher says
For my 2008 returns it was concluded I didn’t make enough to be required to get it. At least that’s my understanding; I didn’t get a penalty for it.
johnd says
Don’t you understand the system needs your money. The way the system works is it needs to pay for poor sick people and people who overuse medical insurance from healthy people like you. Just because you’re healthy shouldn’t let you get away with not paying tons of money for not needing services! The extra $1000 you paid while in school was not “down the drain”, it was used to pay for birth control pills or maybe some Viagra for people paying $0 because they don’t make enough money. Feel better now? Don’t we still have “freedom of choice” in this country (pun intended)?
yellow-dog says
with constructive criticism, and by the same token, there’s nothing wrong with constructive compliments. Shilling happens when compliments lack constructiveness. Both positive and negative reinforcement are important, but Constructiveness is the key.
annem says
“Courageous, effective, masterful” are we talking about the same thing here? That being Chapter 58 of the Acts of 2006, the law rammed through by legislators afraid of losing Federal Medicaid waiver money? The law that was largely written by Blue Cross and Blue Shield of MA and the Heritage Foundation (Repub Gov. Romney thanked Heritage publicly in his press release after signing the law). Chap 58 instituted the “landmark” individual mandate to purchase a commercial health insurance product under threat of tax fines. This is NOT the path to take for meaningful health care reform.
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p>One of the biggest failings of the MA health insurance law (and, believe me, there are many failings) is that it did not include creating a public insurance choice. Obama has pledged to do this and we must hold him to it. Instead, The MA Plan handed over the pocketbooks of individuals, businesses, and taxpayers to the private insurance industry. It did this by instituting the individual mandate to purchase private insurance under threat of tax penalty. We must not repeat that mistake on the national level; two groups working on this goal that need your help are http://www.HealthCareForAmeric…
And
http://www.HealthCare-Now
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p>Details on the failings of the MA Plan follow. Thank you to Senator James Eldridge for having the leadership skills (knowledge and courage, in this case) to speak out and inform the public.
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p>Testimony of Senator Jamie Eldridge (D-Acton) to a United States Congressional briefing, Washington DC, Feb 25 2009.
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p>Massachusetts Health Care Reform: Not a Model for the Nation
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p>”…The reality is that if our goal is universal coverage and universal access to healthcare, the Massachusetts model will not get us there. It’s my belief as someone who has experienced the law first hand that the Massachusetts model should not be adopted for the nation.
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p>The Failures of the Health Care Reform Law
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p>One of the biggest failures of the health care reform law has been cost control. I know the other presenters are going to talk about the problem of health care costs in much more detail, so I just want to touch briefly on some of the cost problems we’ve seen….
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p>2) Greater Costs to Consumers:
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p>The cost of health care has risen – rather than fallen — for many consumers. Despite the initial hopes, health care is not becoming more affordable for most people – and there are many people caught in the numerous loopholes of the system who have seen the overall amount they spend on health care rise dramatically.
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p>Premium rates continue to rise for most people, and low-income patients – who under the old system, received completely free care — are now facing co-payments and premiums that stop them from being able to access needed care.
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p>In addition, we’re seeing that although many more people have health insurance coverage now, that doesn’t mean that people have a greater ability to access care. The ranks of the “underinsured” are growing, and many of the patients on the new health care plans are finding the services they used to be able to access freely are now restricted. For example, mental health clinics now often have to turn patients away because they’ve “used up” the limited number of psychiatric visits covered under many of these plans.
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p>When looking at the effects of the Massachusetts law, I think we need to remember that our goal isn’t simply to have everyone insured – but to have everyone able to access the health care they need. After all – what good is health insurance if you still can’t afford to see a doctor?
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p>3) Greater Costs to Cities and Towns:
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p>Many cities and towns in Massachusetts are being driven to bankruptcy because of rising costs for public employees’ and retirees’ health insurance. As a result, cities and towns are having to either cut back benefits or make other service cuts, affecting every resident who uses public services. Public employees, who generally earn a more modest income compared to their private sector colleagues, are increasingly being targeted by local elected officials to be the victims of a “death by a thousand cuts.”
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p>4) No Help for Small Businesses:
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p>Another hope for health care reform was that, as the costs of health insurance went down, small businesses would have an easier time insuring their workers. Health care costs have gone up, not down, however – which means the law has provided no relief to small businesses that would like to insure their workers, but can’t afford to.
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p>How Did We Get There?
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p>As a legislator, I had the opportunity to closely observe the process the legislature went through to create the health care reform bill – and I’m of the opinion that the many flaws of the process led to the many flaws in the legislation.
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p> 1. The major impetus for creating the health reform legislation came from the actions of the Bush Administration – which insisted that Massachusetts reduce the block funding of indigent care through our free care pool, or forfeit $385 million in federal Medicaid funds.
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p> This had both positive and negative effects. Because there was a deadline attached, we got something done. But it also meant that the process was driven almost entirely by the need to keep those federal dollars, instead of a broader discussion about what universal health care as state legislation should really look like.
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p> It also meant that the initial focus was on reducing the number of people getting free care – rather than on improving health care access for all. This was enforced by local media coverage, which focused on health care as an individual, rather than collective, responsibility. A single-payer system, or any notion of health care as a human right, was taken off the table — thus limiting the options for expanding access from the very start. A debate that could have started comparing health care as a right, just like public education, which Massachusetts history had a deep connection to, instead allowed a Republican governor preparing to run for President to trumpet the deeply cynical notion of “personal responsibility” as a component of health care reform.
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p> 2. Giving certain groups a seat at the table greatly hurt efforts to include several key elements in the bill. For example, because health insurance companies had such a large voice in the crafting of the reform, efforts to control the costs of health insurance premiums were eliminated. The question should have been, “what would be best for the people of Massachusetts?” Instead, there was a general sense during the year-long debate that whatever health care reform the Legislature proposed, it couldn’t be something that upset the health insurance industry. In addition, the health care industry’s significant involvement in crafting the Massachusetts health care law virtually guaranteed that when it came to controlling health care costs, the government was willing to cede that control to HMOs.
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p> 3. The fact that the Massachusetts health care discussion never strayed from the notion of being employer-based meant that it was very easy for the big business community to attack plans to fund a more universal health care model. As a result, even when proposals came up to increase the amount that employers who did not provide health insurance had to pay, they were immediately squelched by these business leaders. As a result, the penalty to companies that don’t provide insurance is a miniscule $295/employee – far, far less than they would have to pay in insurance premiums. This mindset kept the media focused on the notion that health care was a mere employee benefit, as opposed to a basic human right.
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p>As Congress turns its attention to health care reform, I urge you to consider the lessons we’ve learned in Massachusetts – particularly when it comes to the process involved in creating the reform an
d which groups have that all-important “seat at the table.”
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p>As someone who has long advocated for universal health care, I had hoped the Massachusetts model would prove to be a success, even as I had concerns about the process. But after observing the effects the law has had, I strongly urge you not to adopt the Massachusetts model on a national scale.
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p>Source: James B. Eldridge, STATE SENATOR, MIDDLESEX & WORCESTER DISTRICT STATE HOUSE, ROOM 213A, BOSTON, 02133-1054, TEL. (617) 722-1120, FAX (617) 722-1089, email James.Eldridge@state.ma.us
charley-on-the-mta says
… and I appreciate Sen. Eldridge’s integrity and honesty. And I am certainly not here to claim that everything’s just glorious, and this is the best way to do things.
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p>The points about costs are well-taken, but that is, in fact, an issue that Ch. 58 was never meant to address. Cost control is simply not part of the “Massachusetts model” — at least, not at the onset. In 2006, the designers punted. They knew they were punting. They weren’t trying to fool anyone. So now we have to deal with it, in a fundamental way, or the whole thing blows up. Should a federal law include cost control? It had better.
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p>I also quibble with the point about access to care. Heck, if a lot of people don’t have insurance, they can’t very well clog up the appointment times for everyone else, can they? So yes, we need more places and people where/from whom folks can get primary care, especially.
annem says
If, as you say, “Cost control is simply not part of the “Massachusetts model”… They weren’t trying to fool anyone.”
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p>Paaahhhhleeeeez!!!!
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p>I’m all for being forward-looking, constructive, etc, etc, but if we don’t learn from the past then we’ll likely just be getting screwed again… (which is largely what I think was done with passage of the “MA Model” mandatory purchase of commercial insurance law).
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p>Let the discussions continue! And if you feel an obligation to move beyond talk and want to TAKE ACTION, you can so at http://www.HealthCareForAmeric…
And
http://www.HealthCare-Now
sabutai says
Six years’ experience with the Canadian single-payer health care system makes me extremely wary of such an approach here — care was superior for the working class, worse for everyone else! The mixed private-public system in place in Massachusetts has been going well (from what little I know), and props to everyone involved with its management and implementation. Maybe a guide for national plans, maybe not — but it works here.
lasthorseman says
of genetic tests are now being denied insurance. Report from Austrailia.
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p>In these tough economic times naturally one must criminalize Victory Gardens and organic farming and food co-ops, eating in general.
theloquaciousliberal says
I’m sure you are mischaracterizing the Australia “reports” but let’s focus on Massachusetts:
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p>In Massachusetts, it is illegal to perform a genetic test on an individual without informed consent. It is illegal to disclose the results of a genetic test to a third party without the explicit consent of the individual. Existing law prohibits individual and group health insurers from canceling or refusing to renew a policy or discriminating against a policyholder in any way based on genetic informatio. Existing law prevents mandatory genetic testing or genetic information as a condition of coverage.
An employer cannot require a genetic test or the disclosure of genetic information as a condition of employment. It is also illegal for an employer to deny or terminate employment based on genetic information.
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p>Massachusetts also has an aggressively regulated insurance system, which includes guaranteed issue, modified community rating, and prohibitions on medical underwriting. These all increase the cost of insurance premiums for those of us who are healthy but otherwise benefit the Commonwealth by ensuring that almost everyone is insurable. Premiums for “victims of genetic” tests would otherwise be priced out of reach for most.
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p>The Victory Garden is an American public television program about gardening and other outdoor activities, produced by public television station WGBH in Boston, Massachusetts. We continue to allow more than our fair share of organic farming, food co-ops and eating in general.
lasthorseman says
http://www.google.com/search?h…
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p>http://www.smh.com.au/national…
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p>Victory Gardens in this case goes back to the WWII practice which is now illegal.
Frankenfood from Monsanto
http://www.opednews.com/articl…
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p>Swat team conducts food raid
http://www.crossroad.to/articl…
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p>Last up is a chart of just how “private” your “private” medical records are.
http://www.patientprivacyright…
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p>Vaccine contamination.
http://www.healthfreedomusa.or…
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p>Avoiding the doctor, the post modern lifestyle choice!
syphax says
I don’t know jack about health care in general, but I know a few people that do.
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p>I won’t discount the possibility of collusion, but there’s a much simpler explanation.
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p>As I understand it, Partners has enormous market power. They can plausibly threaten an insurer with “no deal” if the insurer balks at the rates Partners wants to charge, simply because the insurers risk losing an enormous amount if business if they don’t have coverage @ Partners facilities. Partners is kind of the 800 lb. gorilla- they are big, prestigious, etc. Insurers need them more than Partners needs any particular insurer.
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p>So Partners may simply be playing hardball to maximize revenues. That may be bad for society, but it’s not necessarily a result of illegal (or, arguably, immoral) behavior by Partners.
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p>Please take this with a grain of salt- as mentioned, I don’t know jack, this is just what I hear (and it passes the plausibility test).
theloquaciousliberal says
The AG is reportedly investigating the entire BCBS/Partners relationship since the extraordinarily high payments cannot be explained simply by the two entities admittedly great combined market power.
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p>Rather, there are “plausible” reports that Partners and Blue Cross made a private agreement in 2000 under which Blue Cross would give Partners a significant increase in payments illegally conditioned upon a promise from Partners to negotiate for similarly big pay increases from Blue Cross’s competitors.
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p>If true, that would certainly qualify as collusion.
jhg says
Massachusetts deserves credit for trying. And the subsidized Commonwealth Care program is a step toward the type of public insurance program which I believe we need.
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p>But it’s no great accomplishment to reduce the number of uninsured people by simply passing a law requiring them to buy health insurance.
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p>And the non-subsidized Connector Health Insurance options are no great deal.
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p>Like many on this site I would prefer some form of publicly financed health insurance for all, such as the single payer model. The only advantage I can see to the individual mandate is if it leads to a reduction in costs. The jury seems to be still out on that.
norma says
chapter 58 is discrimination based on income and age even what part of the state you live in.On the Commonwealth Connector’s web site you enter AGE,INCOME,ZIP CODE.I must pay double from a 19 year old.or a lower income,this is not health reform this is the health insurance companies getting very rich and the state gave them permission to rip off it’s own citizens.