Kos has a piece up today on the problems Massachusetts has been having with cost control and their health care reform experiment. While there are some great points made about over-selling the Massachusetts Miracle as a model for the country, there are some important things to emphasize.
First of all, MA has less uninsured than anyone else in the country. A Kaiser Family Foundation report (.pdf) that Kos cites also says
Since implementation of the plan began in late 2006, it is estimated that 430,000 people have gained coverage, representing two-thirds of the estimated 650,000 people who were previously uninsured.
That's no small accomplishment. An Urban Institute report goes into more detail:
Less than two years after Massachusetts' 2006 reform law was implemented, 2.6 percent of residents were uninsured—the lowest proportion ever recorded in an American state.
Now, you may argue that there's more people with Medicaid than before so that's a bad thing, but for those who had nothing, that's a good thing even though Medicaid is far from the silver spoon insurance that our Senators have, thanks to your tax dollars.
Second of all, the discussion of MA's health plan was centered around cost control and mandates. But mandates are not why so many people in MA are covered, or at least not the only reason. Again, the Urban Institute:
The state's individual mandate alone does not explain this result, since it is not enforced against adults with incomes at or below 150 percent FPL or children. During a multi-day site visit, researchers identified several factors contributing to Massachusetts' high enrollment, including an intensive marketing campaign; use of data to establish subsidy eligibility for newly-insured residents; an integrated eligibility system serving multiple subsidy programs with a single application; and healthcare provider/community-based organization-driven application assistance.
Wouldn't it be good to get administrative reform that helps us deal with insurance companies and streamlines the application process? I never expected to change the insurance industry into something different than it is (I just expected to regulate them better.) So, covering more people with insurance is potentially good, at least for catastrophic coverage and for encouraging earlier detection of illness. But as Jake and Kos and others have pointed out, "potentially good" isn’t good unless it’s actually good. And if it’s an unaffordable mandate, it’s not potentially bad, it’s actually bad. MA seems to avoid the "terrible mandate" problem to some extent.
Third, using MA as an example to compare to the Senate version of health care reform (HCR) is tricky. MA uses Medicaid/SCHIP as a "public option" of sorts, the Senate does not. In fact, I'm still not sure what the dysfunctional Senate is up to today and what they are doing for the public outside of strengthening the private insurance system. Are they proposing Medicare for all like they were last week, or Medicaid as last resort, like MA and the other states do?
What do MA residents think? This Rasmussen poll from June shows mixed feeling from the public (I'm shocked!), but like most HCR polls, it needs to be interpreted carefully.
By a 37% to 17% margin, Massachusetts liberals consider the program a success. By a 55% to 18% margin, conservatives in the state say it’s been a failure.
From a partisan perspective, Democrats are fairly evenly divided with 49% not sure if the reform effort has been a success or a failure. Sixty-six percent (66%) of Republicans say it’s been a failure. Among those not affiliated with either major party, 27% consider the reform plan a success while 41% say it’s been a failure.
Even a cursory look suggests similar reflection to current HCR polls; conservatives are against, progressives for (but with doubts.) And given how confusing it is for the politically obsessed here, who are actually trying to follow the shifting sands of the debate, I can't make any assumption about the knowledge base of the general public when it comes to HCR other than how it affects their own premiums (and even then, unless they are paying the full cost of health care, it's tricky to know what health care really costs.)
One thing we do know — in order to actually get cost control, you have to deliver less services (private insurance pre-certification and denials) or pay providers and suppliers less (Medicaid and to a lesser extent, Medicare), or both. And we also know that Republicans are only for cost control if you don't try to implement it. If you do, they attack you to score political points (see "death panels", Sarah Palin on anything, GOP on Medicare cuts (Republicans for socialized medicine!!) and GOP comments about mammograms.) So, I can't fault any political plan that tries to implement first and save dollars later. It's the only way to get anything passed in our dysfunctional society. The points about "unsustainable without cost control" is true, but that will require implementation of evidence based medicine and panels that recommend against unnecessary screening, etc. which are always going to be controversial and unpopular, so you can almost never pass that at the same time as reform. And it will require things like importation of cheaper drugs from Canada, something that needs action at the federal (not state) level.
As far as the Senate plan goes, it needs affordability, and it needs to help with job lock so that people can feel freer to move. And, yes, it needs to cover more people than are currently covered now. Whether it's something I can support or not, I can't tell you until you tell me more about what the plan looks like - not today (it changes hourly), but when it's ready for a vote. But in looking towards Massachusetts as a model, however flawed, there's plenty of good there that should not be overlooked.
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