Saturday, May 21, 2011

Health Reform In Massachusetts

From the New York Times:
Mitt Romney’s defense of the Massachusetts health care reforms was politically self-serving. It was also true.
Despite all of the bashing by conservative commentators and politicians -- and the predictions of doom for national health care reform -- the program he signed into law as governor has been a success. The real lesson from Massachusetts is that health care reform can work, and the national law should work as well or even better.
Read the complete editorial here.

Anecdotal evidence suggests that finding a primary care physician for the first time will take a while, at least until Massachusetts can absorb all of the newly insured people. Although a familiar complaint from the left about the Affordable Care Act is that complete implementation takes too long, adding 32,000,000 people to the American health care apparatus by 2014 is realistically a very ambitious undertaking.

The health care infrastructure has evolved ("designed" is too kind a word) to accommodate different levels of insurance, with the uninsured and underinsured consigned to emergency care. (Which may or may not amount to much: By law, ED's must screen and stabilize anyone reporting to an emergency room for treatment. They must treat only if the screening identifies an actual emergency condition.) Until the infrastructure can adjust and provide an adequate number of primary care physicians and facilities, it's likely that many of the newly insured will continue to seek care in ED's.

Critics will cite what is a period of adjustment as evidence of failure, but the Affordable Care Act is a massive undertaking. Rushes to judgment will make no more sense than declaring the winner of a baseball game based on the score in the first inning.


  1. Dear K., I am interested to know your view of the issue of legally requiring American citizens to have health insurance, which I believe is part of the new health care reform law. (forgive me if I may have missed an earlier statement.) Do you see this as something similar to requiring that we file income tax, and everyone will get used to it? Everyone who works know that they will be required to pay income tax on their earnings, above a certain level at least. But having been born into this world is a slightly less voluntary act than working for a living. I am usually liberal-oriented in general, and the necessity for compliance in the system is logical, but somehow it seems to me a little against the grain to actually tax our being alive. thanks, sp

  2. Sussah, it depends on your commitment to universal coverage.

    There are three ways to attain universal coverage: (1) Socializing the medical system so that it is tax financed and government-owned and operated (as with Great Britain, Ireland, Italy, Scandinavia, and Spain). The US already does this with the VA; (2) Letting the government serve as an insurer, while providers remain private (Canada, Australia, Taiwan, Medicare); (3) mandating the selling and purchase of insurance regardless of health status (most European countries, Israel, Japan).

    If you go the insurance route, sale and purchase must be mandated. If sale isn't mandated, insurance companies will filter out out preexisting conditions and anyone they perceive as a health risk. In other words, they will try to insure as many healthy people as possible and deny insurance to as many health risks as possible.

    If purchase isn't mandated by sale is, premiums will rise precipitously because there will be an influx of high risk patients into the market without a corresponding counterbalance of healthy people. A half dozen or so states attempted to mandate sale without mandating purchase and saw premiums rise something like 60%. I believe that that is what prompted the Massachusetts law.

    In the first case, a disproportionate number of healthy people are ensured; in the second, a disproportionate number of sick people.

    For what it's worth, I believe that a voucher-based plan will also require mandates, even if proponents are conveniently silent on that point. The vouchers simply are not large enough to incent insurance companies to sell without a mandate to purchase.