Yep, guilty. I'm guilty as charged. I am demonizing a mandate for everyone in the U.S. to be forced to buy health insurance.
Why?
Because getting everyone health insurance won't necessarily get everyone health care.
Because a U.S. mandate to buy health insurance will not be structured to effectively help health care consumers. It will be structured to help health insurance companies.
A U. S. mandate for all to buy health insurance is a bail out of the health insurance and pharmaceutical industries.
Can I support these statements?
Well, yes, I can.
I wouldn't be writing this diary if I thought the U.S. was going to put togther an effective plan that would be framed around a system that uses effective mandates like the Netherlands or Switzerland. I wouldn't be writing this if we were going to get something like the health care systems in France or Germany. A system like what is working fairly well in San Francisco wouldn't be bad either. I'm writing this because it looks like policy makers like the marginally effective system currently in use in Massachusetts.
Massachusetts actually voted to make their state a huge social experiment. If I were a researcher and suggested a study be done on this wide a scale with people being forced to participate in it or face financial sanctions; my research grant would be denied on ethical grounds alone. The voters in MA approved this experiment health care reform proposal and should be thanked for giving the rest of the country a lot of data to ponder and I suspect that some of the people there would like a mulligan.
Massachusetts only had 12% of their population uninsured in 2006 when they passed their mandate. They have also had some success with their program in that the uninsured rate is now under 6% in MA; but the costs were more than projected. The issue is can Congress take the best of this system, correct the difficiencies and successfully expand it across the United States? Do we want to have a 50% effective program that costs a lot more than projected? Probably not, but we should plan on a mandate being part of U.S. health care reform and prepare for it.
Looking at costs, this group had a few observations in the course of their study.
The problem of limited competition makes it extremely difficult for the state to address the growth in health care costs. If health care costs cannot be controlled, more and more people will become exempt from the individual mandate, and the cost of both Medicaid and low-income subsidies will increase. At stake ultimately is whether the Massachusetts reforms can survive.
This article proposes 4 options or suggestions:
- Expand the managed competition model.
- Develop a public plan to compete with other insurers in the market and negotiate more effectively with providers.
- Have the Connector negotiate on behalf of all CommCare and CommChoice plans over hospital and physician rates.
- Develop an all-payer rate-setting system; all payers other than Medicare would use these rates, and they would apply to all providers.
The first is a reinvention of Clinton's 1993 proposal and the others sound like this group is suggesting single payer in all but name; which they reinforce with their final recommendation.
Last, we suggest that Massachusetts take the final steps toward universal coverage by extending its mandate to children, restructuring subsidies to help more people, and addressing equity problems.
The Commonwealth fund had their own observations:
The affordability of health coverage is tied to the individual mandate: if coverage is deemed affordable by the state but is not actually affordable to residents, people will be unfairly penalized for not being covered. The CCA has been working to hold down premium increases. While premiums statewide rose by double digits over the course of the last seven years, the Connector was able to keep premium increases within Commonwealth Choice plans for the coming year to an average of 5 percent.[9] It will be difficult to maintain affordable rates, however, in an environment of high health care cost inflation.
Further, residents who feel they cannot afford partially subsidized or unsubsidized care may have fewer options to access care through the safety net. The health reform law reduced funds that reimburse hospitals for providing care to low-income uninsured, shifting dollars to coverage expansion activities.
Approximately 17,000 individuals have enrolled in one of the Commonwealth Choice plans since July 2007. Of those, 40 percent chose the bronze option, which has the lowest premium, and 23 percent and 9 percent chose the silver and gold options, respectively. Because the bronze plans have higher cost-sharing and deductibles, some advocates worry that Commonwealth Choice enrollees will be underinsured, thereby putting pressure on the state's safety net providers.
Finally, it will be crucial to secure sustainable financing. In the short term, Massachusetts is considering a $1-per-pack increase in the cigarette tax, with the expected $152 million in resulting revenue earmarked for health care reform. By July 1, the state will be seeking to confirm a commitment of $1.5 billion in funding over three years from the federal government. Other strategies may include requiring increases in contributions from coalition partners and expanding the number of companies subject to the "Fair Share" assessment.
Ok, let's cut the yada, yada, yada down to something short, if not so sweet.
Massachusetts focused on Health Insurance for all instead of Health Care for all.
The Massachusetts mandate reduced the uninsured down by 50% (less than hoped for).
The Massachusetts mandate converted most of the uninsured to an underinsured
status (a dubious success).
The Massachusetts mandate cost 33% more than projected and raised 25% of the projected revenues (by no means, fiscally neutral).
If we take the Massachusetts program and learn from it and improve upon it; then that would be terrific. And, that's the problem. I doubt if lawmakers will learn from MA's mistakes or improve their plan. What we will get will be a watered down, ineffective health care reform if we don't force lawmakers to deal with the basic, systemic inequities of our health care system. We cannot accept a mandate without Universal Health Care, but watered down and ineffective is exactly what we'll get if we don't make our voices heard.
We must continue to call the White House, the House and Senate and tell them what we want for health care reform.
Our lives depend upon it.