Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Massachusetts, Model for Universal Health Care, Sees Ups and Downs in Policy

...The difficulties in receiving care were severest among low-income residents, who have gained the most from expanded access under the state's law, passed in 2006. It requires most residents to have health insurance and provides state-subsidized plans for the poor. Massachusetts now has the country’s lowest percentage of the uninsured -- 2.6 percent, compared with a national average of 15 percent.

But the study, which was scheduled for publication Thursday in the journal Health Affairs, found that increased demand for care from the newly insured was confronting an insufficient supply of willing physicians. One in five adults said they had been told in the last 12 months that a doctor or clinic was not accepting new patients or would not see patients with their type of insurance. The rejection rates for low-income adults and those with public insurance were double the rates for higher-income residents and those with private coverage.

Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

State seeks to revamp way doctors, hospitals are paid

...Commission [Special Commission on the Health Care Payment System] members said they will urge Governor Deval Patrick and the Legislature to replace the current system, in which insurers typically pay doctors and hospitals a negotiated fee for each individual procedure or visit, with a set payment for each patient that covers all that person's care for an entire year.

Massachusetts would be the first state to broadly adopt such a system, which would essentially put doctors and hospitals on a budget in an effort to restrain health spending.

A single, yearly fee is intended to discourage doctors and hospitals from providing unneeded tests and treatments, so patients could find it harder to get procedures of questionable benefit. And because doctors and hospitals would have to work together more closely to manage the budget, the hope is they will better coordinate care for patients, which could improve quality.

Patients' care would be compromised

Adopting a system to pay doctors and hospitals a single, yearly fee for each patient is neither bold nor experimental. It's just another variation of capitation: a system that would lead to the government rationing and ultimately compromising patient care.

Before making another costly healthcare mistake, Beacon Hill lawmakers should ask themselves how they would react if their doctor said, "We've already spent your annual healthcare allowance, and anything else we could do to treat your condition would put us deeper in the red." My guess is that it would only take one really sick lawmaker (or governor) to realize the error of their ways.

Scott Keays
Allston

Labels: LTE, MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Waits to see Hub doctors grow longer

Despite Boston's abundance of top-notch medical specialists, the waits to see dermatologists, obstetrician-gynecologists, and orthopedic surgeons for routine care have grown longer - to as much as a year for the busiest doctors.

A study of five specialties shows that the wait for a nonurgent appointment in the Boston area has increased in the past five years, and now averages 50 days - more than three weeks longer than in any other city studied.

Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Health Care Reform that Will Kill the U.S. Economy

...Massachusetts, which operates a U.S. analogue to a national government-run health-insurance market, is, in fact, a case study illustrating why health insurance run by Washington would collapse on itself. By March 2009, the state's uninsured rate fell to 2.8 percent from about 6 percent. The market, stocked with private-sector insurance policies, had insured 169,000 people in two new programs, one of which directly subsidizes uninsured individuals.

Good news, right? Wrong.

By 2009, Massachusetts enacted almost $800 million in new taxes to fund, among other things, the third year of health care reform. Now, the state government, desperate for revenue, is considering setting the prices of health insurance and essentially taking control over all health-care costs, other than Medicare and out-of-pocket spending. If this sounds like a march into a single-payer Soviet-style system, that's because it is.

...In the end, the Democrats' health care reform will require drastic rationing of health care for the sick to control its costs. Consider Canadian patients, who may wait a year or longer to get radiation therapy. Or ask one of the nearly 1.8 million Britons who are waiting to get into a hospital or have an outpatient procedure. Or talk to the German breast cancer patients who are 52 percent more likely to die from the disease than Americans.

Labels: Analysis, MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

National Health Preview: The Massachusetts debacle, coming soon to your neighborhood.

...In Massachusetts's latest crisis, Governor Deval Patrick and his Democratic colleagues are starting to move down the path that government health plans always follow when spending collides with reality -- i.e., price controls. As costs continue to rise, the inevitable results are coverage restrictions and waiting periods. It was only a matter of time.

They're trying to manage the huge costs of the subsidized middle-class insurance program that is gradually swallowing the state budget. The program provides low- or no-cost coverage to about 165,000 residents, or three-fifths of the newly insured, and is budgeted at $880 million for 2010, a 7.3% single-year increase that is likely to be optimistic. The state's overall costs on health programs have increased by 42% (!) since 2006.

...Which brings us to Washington, where Mr. Obama and Congressional Democrats are about to try their own Bay State bait and switch: First create vast new entitlements that can never be repealed, then later take the less popular step of rationing care when it's their last hope to save the federal fisc.

The consequences of that deception will be far worse than those in Massachusetts, however, given that prior to 2006 the state already had a far smaller percentage of its population uninsured than the national average. The real lesson of Massachusetts is that reform proponents won't tell Americans the truth about what "universal" coverage really means: Runaway costs followed by price controls and bureaucratic rationing.

Labels: MA, OpEd, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Less government, not more
By Jared M. Rhoads

Recently, a national organization of physicians released a report strongly criticizing the health reform effort in Massachusetts that imposes a mandate on residents to purchase health insurance.[1] Citing several studies and data sources, the group showed that the reform has added wasteful new layers of bureaucracy and has failed to control costs. The Massachusetts program, they said, is faltering badly and thus should not be held up as a national model for reform.

Not exactly a ringing endorsement of government intervention in health insurance, right?

Think again. The report was published by Physicians for a National Health Plan (PNHP), a group that exists specifically to advocate for a universal, comprehensive single-payer government system of healthcare in the United States. Since 1987, PNHP has sought a government-financed system that would eliminate private insurers altogether. The group is increasingly visible in the health policy world; with more than 15,000 members nationwide, it has rallied on the steps of the capitol, published papers in journals, and has lobbied Congress.

For PNHP, the reason that the Massachusetts reforms do not work is not because the reforms interfere with the health insurance market, but because they do not interfere enough. The state reform has failed, they argue, because it leaves too much of the private system in tact. Until residents are stripped of the ability to purchase coverage from private insurers, state agencies like Commonwealth Care cannot generate sufficient "administrative savings" -- the magical ingredient in the group's Medicare-for-all vision that will allegedly lower the cost of healthcare and make additional entitlements possible.

In effect, PNHP denounces the Massachusetts reform in order to throw its support behind a much bigger goal: the United States National Health Care Act (H.R. 676). This act, which has already been introduced and referred to committee for review, would provide universal coverage under a single payer (the government) and promise all individuals the "best quality standard of care" for everything ranging from primary care and prevention to prescription drugs, mental health services, dental services, chiropractic services, podiatric care, and more. According to the bill, this would all be made available for "free" -- no co-payments, deductibles, or coinsurance required.[2]

In short, the approach that PNHP, the California Nurses Association, Healthcare for All, the American Medical Students Association, and dozens of other groups employ is: if one big dose of government doesn't work, try a bigger dose.

Combined with the recent statements by President Obama that healthcare reform "cannot wait ... and will not wait another year," it is becoming clear just how dangerous a time it is for those who value individual rights. Government payment for medical services -- regardless of whether state or federal -- is neither a moral nor practical solution to the problems we face in healthcare. But is anyone in the mainstream media arguing that point? Activists have no right to require the young to sacrifice the old, the healthy to sick, or the productive to the poor. But is anyone in Congress about to defend those convictions?

Contrary to what big-government activists maintain, market forces do work in healthcare. Insurance works -- when policies are based on coverage that consumers actually want and when premiums are tied to actual risk profiles. New technologies lead to lower costs -- when reimbursement rates reflect real prices. And uninsured individuals are not a menace to others -- when providers are not forced to provide charity care and when states do not pick up the tab. Real markets feature competitors who are free to compete and consumers who are free to be discriminating in what they buy.[3]

Massachusetts has not had anything resembling a free market in healthcare for decades. But the answer is not to drift even closer to disaster and institute a bigger mess at the federal level. The answer is to unshackle consumers, providers, and insurers and free the markets once and for all.

_____

1 "Massachusetts’ Plan: A Failed Model for Health Care Reform" Physicians for a National Health Plan, February 18 2009

2 The United States National Health Care Act, H.R. 676 [http://www.pnhp.org/docs/nhi_bill_final1.pdf] Accessed February 27 2009

3 This is a careful improvement on a point made in Herzlinger, R. "Creating a Real Healthcare Market", Boston Globe, February 18 2009, a piece that unfortunately cedes ground to the antitrust camp.

Labels: MA, OpEd, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

The very stakeholders who were coaxed into the tent -- doctors, hospitals, insurers and consumer groups -- would probably have been driven into opposition by efforts to reduce their revenues and constrain their medical practices, they said.

Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Mandatory insurance violates insurers’ and consumers’ right to act in their own best interests by forcing insurers to sell and customers to purchase insurance on terms and prices dictated by government decree. This destroys the very conditions that give insurance any value at all.

Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

"Before, I was uninsured and couldn't see a doctor. Then I made the sacrifice to buy insurance, but I still can't find a doctor who will see me. So I still don't get to see a doctor, but it's just costing me more now."

Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Labels: CT, MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Universal coverage? First, look at the disaster in Massachusetts
By Examiner Editorial -- 1/11/09

To much fanfare from both right and left in 2006, Massachusetts became the first state in the nation to require all residents to buy health insurance. A new state health insurance clearinghouse was created, with taxpayers subsidizing those who couldn't afford to buy coverage. Then Gov. Mitt Romney, a Republican, promised that "every uninsured citizen in Massachusetts will soon have affordable health insurance." Yet just two years later, Romney's much-heralded "solution" -- touted by many as the model for a national program -- has become an embarrassing flop.

Just a year after the universal coverage law passed, The New York Times reported, state insurers were already jacking up rates to twice the national average. According to Dr. Paul Hsieh, a physician and founding member of Freedom and Individual Rights in Medicine, 43 mandatory benefits -- including those that many people did not want or need, such as in vitro fertilization -- raised the costs of coverage for Massachusetts residents by as much as 56 percent, depending upon an individual's income status. So much for "affordable" health care...

Labels: MA, OpEd, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Labels: Analysis, Countries, MA, States, Switzerland

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

...Now Mr. Daschle proposes nothing less than a giant HMO with a federal bureaucracy setting the benefit plan.

Mr. Daschle's model is Massachusetts. But Massachusetts's plan is an unfolding disaster and demonstrates how Mr. Daschle's private/public model is merely a stalking horse for government-dominated health care.

The headline claim is that the program has signed up 442,000 more people for health insurance. The reality is that 80,000 of these were simply put on Medicaid and 176,000 more on the taxpayer-subsidized plans. Costs have exploded, requiring additional tax hikes and the entire system is only possible due to sizable transfers from the federal government. The plans are so unaffordable that in 2007, 62,000 people were exempted from the individual mandate. So much for universal coverage.

The only way the Massachusetts plan will survive is with continued and increasing federal subsidies -- that is, tax revenue from the residents of other states. The only way Mr. Daschle's proposed plan would survive is with massive deficit spending -- that is, with taxpayer money from future Americans, many of whom are not yet born.

Labels: Analysis, MA, OpEd, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

In the group setting, the patients are not allowed to remove clothing for proper physical examination due to the lack of privacy. In the video, Dr. Lindsey is shown auscultating and percussing through the patients' clothing.

As a medical student, I would flunk, that's right, flunk my standardized patient examinations if I even thought of auscultating or percussing through clothing. It is obvious that the lack of privacy even in the cardiology setting restricts the doctor from doing a proper physical examination.

Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Labels: Insurance, MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Labels: Insurance, MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Every individual must have and contribute to the cost of health care coverage

Every employer must take responsibility for providing health care coverage for their employees and contribute to the cost

Every insurer must guarantee access to coverage that is affordable, gives consumers the protection they need, and delivers value

Governments must maintain their current responsibility forcoverage for seniors, disabled and certain low income people

Collective financing will be needed

Mandated insurance for children

State subsidies for those families who don't qualify for other government programs (such as Medicaid or SCHIP)

Mandates on employers to provide a "meaningful share" of employees health insurance premiums (or else pay a special fee to the government for the government plan)

Expansion of SCHIP and Medicaid government programs, "for the children"

Creating a National Health Insurance Exchange to serve as a clearinghouse where people could purchase government-approved plans

New restrictions on insurers so that they could not exclude applicants based on pre-existing conditions

Labels: CO, Insurance, MA

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Freedom to choose

SIR – The Massachusetts system of "universal" health care remains afloat only because of hundreds of millions of dollars in federal support ("In need of desperate remedies", October 18th).

One reason costs are so high in Massachusetts is that individuals are forced to purchase benefits they neither need nor want. Under any system of mandatory insurance, the state must necessarily define what constitutes an acceptable insurance policy, meaning that individuals are buying insurance on terms influenced by lobbyists and bureaucrats, rather than based on a rational assessment of their needs.

If the federal government adopts the Massachusetts system on a national scale, it would merely multiply those problems fifty-fold.

Dr Paul Hsieh
Co-founder Freedom and Individual Rights in Medicine
Sedalia, Colorado

Labels: LTE, MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Gov. Deval Patrick announced in Boston that the state and the federal Centers for Medicare and Medicaid Services had negotiated the extension of a waiver that enables federal financial support for the state's subsidized coverage plan. The agreement will allow the state to spend up to $21.2 billion on the program over the next three years, an increase of $4.3 billion over the initial three-year period.

...Massachusetts will be able to expand its first-in-the-nation healthcare law because of a federal promise of $10.6 billion over the next three years, Governor Deval Patrick said

Under the new rules, the larger companies would have to pay 33 percent of their workers' premiums within 90 days of hiring and make sure that at least 25 percent of their workers are covered by the plan. Otherwise, the employer must pay a $295 fine per worker.

Businesses with fewer employees would still be allowed to follow the old rules, Bigby said, and meet only one of the two requirements to escape the penalty.

Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Across Mass., wait to see doctors grows

The wait to see primary care doctors in Massachusetts has grown to as long as 100 days, while the number of practices accepting new patients has dipped in the past four years, with care the scarcest in some rural areas.

...[I]n Great Barrington, Volunteers in Medicine, a clinic for the uninsured, is for the first time treating insured patients. It has taken weeks for newly insured residents to find doctors who will accept new patients, and months longer to get an appointment.

...Amherst family physician Kate Atkinson decided to open her practice to new patients in January partly so she could take on the newly insured, especially since, by her count, 18 doctors in the area had closed their practices over the last two years... She closed her practice to new patients again six weeks later. "We literally have 10 calls a day from patients crying and begging," she said.

Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

"Mandatory Health Insurance: Wrong for Massachusetts, Wrong for America"

Paul Hsieh

The Plan and Its Popularity

In April 2006, Massachusetts became the first state in the nation to require that all of its residents purchase health insurance. This mandatory insurance was the centerpiece of a “universal” health care law hailed by analysts as an “innovative bipartisan plan.”[1] Republican governor (and former presidential candidate) Mitt Romney proclaimed that “every uninsured citizen in Massachusetts will soon have affordable health insurance,” that costs would be reduced through “market reforms” encouraging “personal responsibility,” and that the plan would require “no new taxes... and no government takeover.”[2] The plan had support from organizations and individuals across the political spectrum, including the conservative Heritage Foundation, the liberal group Health Care for All, and Democratic Senator Ted Kennedy.[3]

The Massachusetts plan was, in part, a response to today’s health care costs, which are rising twice as fast as inflation, making insurance increasingly unaffordable for many employers and individuals.[4] Currently, approximately 47 million Americans have no health insurance.[5] In an effort to solve the problem in their corner of the country, Governor Romney and the Massachusetts state legislature enacted this plan with the twin goals of reducing the cost of health care and guaranteeing coverage for all Massachusetts residents.

The Massachusetts plan consisted of the following major elements: The state would establish a quasi-governmental authority known as the Commonwealth Health Insurance Connector (or “Connector”) to serve as a clearinghouse through which individuals would be able to purchase state-approved insurance plans. Every resident would be required to purchase a health insurance plan, either from a private insurer or though the Connector, with stiff financial penalties for those who failed to comply.[6] Residents who could not afford insurance would have their expenses subsidized by the state in part or in full, depending on their income. Employers with more than ten employees would be required to provide health insurance for their workers or pay a special fee to subsidize coverage for low-income individuals.[7] In theory, the plan would lower individual patients’ insurance costs by enlarging the pool of insured patients. In particular, younger, healthier patients (who often choose not to purchase insurance) would be required to do so, thus paying a portion of the health costs of the larger population.[8]

The plan was attractive to liberals and conservatives alike. Liberals embraced it because it supposedly promised “universal coverage” without requiring them to support politically risky Canadian-style “single-payer” socialized medicine.[9] Conservatives embraced it because it supposedly encouraged “personal responsibility” while preserving a “market framework” for health insurance.[10]

For these reasons, mandatory health insurance has become popular with politicians in both major political parties, including Republican California governor Arnold Schwarzenegger and former Democratic presidential candidates Hillary Clinton and John Edwards.[11] The idea has been endorsed by the National Small Business Association and the National Business Group on Health (an association of large businesses).[12] Several states besides Massachusetts and California—including New Jersey, Ohio, Rhode Island, Pennsylvania, Illinois, and Colorado—have considered or are considering some version of mandatory health insurance.[13]

Yet two years after its inception, the Massachusetts plan has failed to achieve either of its goals. The plan did not lower health care costs, nor did it achieve universal coverage. Thus, given the growing popularity of mandatory health insurance, Americans would do well to take a close look at the results of the Massachusetts plan—and, more importantly, at the reasons for those results...

----------

Endnotes

Acknowledgments: I would like to thank Diana Hsieh, Lin Zinser, and Brian Schwartz for their enormously helpful suggestions and advice.

1 William C. Symonds, “In Massachusetts, Health Care for All?” Business Week, April 4, 2006.

2 Mitt Romney, “Health Care for Everyone?” Wall Street Journal, April 11, 2006.

3 Edmund F. Haislmaier, “The Significance of Massachusetts Health Reform,” Heritage Foundation Web Memo #1035, April 11, 2006; Marilyn Werber Serafini, “The Mass.-ter Plan,” National Journal, June 10, 2006, pp. 3–4.

4 Milt Freudenheim, “Health Care Costs Rise Twice as Much as Inflation,” New York Times, September 27, 2006; Julia Appleby, “Health insurance premiums vault past inflation,” USA Today, September 11, 2007.

5 John Donnelly, “47 million Americans are uninsured,” Boston Globe, August 29, 2007.

6 “Health Care Reform Act of 2006,” http://www.mass.gov/agr/news/health_care_reform_act.htm; and Boston Business Journal, “Mass. health insurance penalties to spike in ’08,” December 31, 2007, http://boston.bizjournals.com/boston/stories/2007/12/31/daily4.html.

7 Serafini, “Mass.-ter Plan,” p. 4.

8 Betsy McCaughey, “The Truth About Mandatory Health Insurance,” Wall Street Journal, January 4, 2008.

9 Christopher Lee, “Simple Question Defines Complex Health Debate,” Washington Post, February 24, 2008.

10 Edmund F. Haislmaier, “The Massachusetts Health Reform: Assessing Its Significance and Progress,” Heritage Foundation Lecture No. 1044, June 28, 2007, pp. 6–7.

11 Kevin Sack, “Massachusetts Faces a Test on Health Care,” New York Times, November 25, 2007.

12 Kent Hoover, “Business groups split over individual health mandate,” Silicon Valley/San Jose Business Journal, February 29, 2008; “Big business backs health insurance,” Associated Press, January 30, 2008.

13 David W. Chen, “New Jersey to Consider Health Plan to Cover All,” New York Times, March 18, 2008; “Healthcare Group Recommends ‘Individual Mandate’ on Health Insurance,” Gongwer News Service Ohio, March 26, 2008; “R.I. studying Mass. health plan,” Barre Montpelier Times Argus, November 26, 2007; Laurie McGinley, “Should Insurance Be Mandatory?,” Wall Street Journal, June 30, 2007; Reed Abelson, “Mandatory Coverage Is Easier Said Than Done,” New York Times, June 11, 2007; Tim Hoover, “Health coverage gets new push,” Denver Post, March 28, 2008.

Labels: Analysis, MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

To the Editor:

Far from being a "success," Massachusetts health care "reform" has cost the state hundreds of millions of dollars more than anticipated and created long waits for care.

The Massachusetts system is just socialized medicine in a new guise. It is no coincidence that the long waits for care in the state resemble the long bread lines in the Soviet Union.

The fundamental problem with the Massachusetts system (or any system of "universal health care") is that it erroneously treats health care as a "right." There is no such thing as "right" to a good or service that must be created by others — that's just state-sanctioned theft or slavery. The problems in Massachusetts are the inevitable result.

Paul Hsieh
Sedalia, Colo., Aug. 30, 2008

The writer is the co-founder of Freedom and Individual Rights in Medicine.

Massachusetts has seen its supply of physicians per capita more than double since 1976, and it now has the highest physician-to-population ratio of any state, in primary care as well as overall.

Labels: LTE, MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

More government mandates for health care?

When part of a building is on fire, panic has been known to drive a crowd directly into the fire.

Such is Froma Harrop's call for even more government interference in the health care industry.

She likes the insurance mandate in Mitt Romney's Massachusetts health plan:

"Everyone must get coverage. Those who don't, pay a penalty. The uninsured holdouts tend to be young, male and in good to excellent health. They figure that if something goes wrong, they can report to the emergency room where they'll get free care. Such people are called 'free riders.'"

The problem is real, but what is the cause? Why do people get free emergency room care? It's because of existing government mandates!

So we are to solve the problems caused by one government mandate with another government mandate? Where will it all end?

We are fast approaching the point where every aspect of life will be either mandatory or prohibited.

Clarence Manion, Lyons

Labels: Insurance, LTE, MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Dental benefits widen, waiting lines grow

Two years into the state's bold healthcare experiment, its early success in expanding dental coverage may be threatened by a shortage of dentists willing to treat newly insured patients.

...Dentists say the state's reimbursement rate for adults covers only about half their costs, and they also cite payment delays and burdensome paperwork.

...The Massachusetts Dental Society has been urging members to join, saying it is the responsible thing to do. But it's been slow going.

...Michael Wasserman, a Pittsfield dentist who treats some subsidized patients [stated,] "I think if a dentist is going to treat these patients he or she should not be forced to lose money."

Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

As this public option gets overwhelmed, budget gaskets are blowing everywhere. Mr. Patrick had already bumped up this year's spending to $869 million, $144 million over its original estimate. Liberals duly noted that these tax hikes are necessary because enrollment in Commonwealth Care is much higher than anticipated. But of course more people will have coverage if government gives it to them for free. The problem is that someone has to pay for it.

Thus the extra tab of $129 million, which may need to go higher because it relies on uncertain federal funds from Medicaid. For now, Mr. Patrick wants one-time (yeah, right) charges of $33 million on insurers and $28 million on providers, plus some shuffling of state funds. The balance comes from an estimated $33 million boost in the state's "pay or play" tax: If businesses don't offer "fair and reasonable" insurance to their employees, they get hit.

...The main reason people are uninsured is because coverage is too expensive. Massachusetts didn't have many options for reforming the way health dollars are laundered in the third-party payment system created by the federal tax code. But it could have helped make insurance cheaper by reforming its private market before defaulting to public programs.

Labels: MA, OpEd, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Sounds like Romney-care gone national, with all the right buzzwords (choice, affordable, meaningful, etc). I especially like the phrase, "For starters, every American will have the power to choose - and will be required to choose - a comprehensive health insurance plan." So reminiscent of Hillary Clinton's 'we want you all to participate voluntarily, but if you don't volunteer we are prepared to make you participate' philosophy!!

The biggest bamboozlement is the comment that the employer tax break for health care insurance "costs" the government 200 billion dollars! So instead of giving individuals a comparable tax break, they propose taking that tax break away from everybody, and funding the subsidized portion of the program with that imaginary money. Sounds like a cost shift and a new tax to me, whether it ends up being mandated onto the worker or onto the employer, somebody is going to have to chip in that money.

The other typical stuff about increased efficiency because it's the government, and decreased utilization because the worker is paying the premium, and subsidizing up to 400% FPL is not surprising. The advocates of socialized medicine have learned the vocabulary of the market without applying any of the principles. This type of plan is the health care reform equivalent of a stealth bomber, because it is sneaky and it is going to bomb, for sure. Unfortunately, it seems like a substantial number of Republicans are prepared to go along with it because it sounds good superficially. Of course, in 2-3 years, when the cost overruns kick in and the government has to step in for "cost-containment" purposes, it will be too late, we will be smack in the middle of nationalized health care.

Labels: Analysis, Insurance, MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Reform health care

Paul Hsieh, M.D., Co-founder, Freedom and Individual Rights in Medicine - Sedalia, Colo.

Mandatory insurance does not solve our underlying health care problem, which is government interference in the free market. This approach has already been tried in Massachusetts and has led to long waits, skyrocketing costs and frustrated patients ("Individual health policies leave many in the lurch," Cover story, News, Thursday).

Instead of government-imposed "universal health care," America needs free market health reforms -- reforms such as eliminating mandatory insurance benefits, repealing laws that forbid purchasing health insurance across state lines, and allowing individuals to use health savings accounts for routine expenses and low cost, catastrophic-only insurance for major expenses.

Such reforms would respect individual rights, allow patients to choose from the best offerings from all 50 states, lower costs and make health insurance available to many who currently cannot afford it.

Labels: Insurance, LTE, MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

In Massachusetts, the individual mandate and state subsidies have led to massive cost overruns. The newly insured have flooded doctors’ offices, creating a shortage of providers and forcing doctors to either turn down patients or put them on a waiting list.

What Massachusetts has found – and what advocates for the uninsured fail to recognize – is that health insurance does not necessarily mean access to health care. In fact, health insurance is partially responsible for the continuing decay of our health care system. Its desensitization of consumers from the cost of health care has created an environment that encourages overutilization.

As the demand for health care services has risen, so have their prices; proof that the economic principles of supply and demand do, in fact, apply to health care.

* It's easy to get people to enroll in health insurance if you make it free or nearly so to them. The great majority of those newly covered by insurance in Massachusetts are in plans completely or heavily subsidized by the taxpayer. Of the 330,000 newly enrolled in insurance, at least 232,000 are getting free or heavily subsidized coverage.

* The hard part is convincing people who don't get subsidies--and who face growing penalties for not enrolling--to buy insurance. The state government has the audacity to tell residents what they can and cannot afford to pay. For example, if your family income is $70,001, the state says you can afford to spend $550 a month, or $6,600 a year, for health insurance. If you don't buy it or get a waiver, you'll be fined. The penalty now is as much as $1,824 for a couple, and it will increase again next year.

* The plan is starting to strain the state budget as well. Gov. Deval Patrick (D) has asked for $869 million for fiscal 2009, but state authorities warn the cost will be closer to $1.1 billion--about as much as the state pays for its total public safety budget. The state also is concerned about another 30,000-40,000 people who have job-based coverage now but could be added to the subsidy rolls as well.

* Insurance costs continue to rise. The state has approved a 12 percent rate increase for health insurance for next year.

* Some safety net hospitals are threatening bankruptcy. Hospitals are still treating a large number of people without health insurance, but the payments they receive for uncompensated care have been cut as part of the reform deal.

* The state is finding its goal of universal coverage to be increasingly elusive. Several hundred thousand people are still without health insurance, and they will be the most difficult to enroll because the majority won't qualify for subsidies. They face rising health insurance costs, growing fines, or a complex waiver process.

* The shortage of primary care doctors is making it difficult in some parts of the state for people who are newly insured to find a doctor who will take new patients. One person wrote us, "Before, I was uninsured and couldn't see a doctor. Then I made the sacrifice to buy insurance, but I still can't find a doctor who will see me. So now I still don't get to see a doctor, but it's just costing me more."

* The state has a detailed list of minimum coverage standards for 2009 that many small businesses will not be able to meet. They find the richer package more expensive than they can afford to buy for their workers. What will the state do? Fine them? Relax its rules again?

Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Liberal proponents think of mandates as social insurance. Many of the uninsured are younger and healthier, they note, so forcing them into insurance pools will result in lower average premiums. Some conservatives, meanwhile, argue that uninsured people use emergency rooms but often don’t pay, offloading their health costs onto the rest of us. It's not simply about coverage, in other words; it's also about personal responsibility. At a debate in Texas, Clinton made a similar argument, claiming that without mandates, "every one of us with insurance will pay the hidden tax of approximately $900 a year." Conservatives like Duke University health expert Christopher Conover, former Massachusetts governor Mitt Romney, and former Republican National Committee chairman Ken Mehlman have all made some version of this claim.

...[E]vidence shows that costs are influenced much less by mandates than by consumers’ ability to buy a broad range of competing health-insurance products. An insurance policy for a single male resident in mandate-enforced Boston, for example, costs five times more than a policy for his identical twin in mandate-free Tucson. This cost disparity is due in part to the Bay State's many insurance regulations, which limit the types of policies that consumers can buy and drive up prices. As for the responsibility argument, uncompensated care costs federal and state governments roughly $40 billion a year—in a health economy that tops more than $2 trillion annually. That's a very small percentage of the total expenditure and certainly doesn’t amount to a hidden tax of $900 per person.

...Mandates offer the illusion of fixing our health-care problems by extending insurance to all.

Labels: Free Market, Insurance, MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

The New York Times reported that 340,000 of the states residents have gained coverage, including 174,000 in Commonwealth Care (the subsidized program) and the governor "has requested $869 million for Commonwealth Care, but his aides have already conceded that will not be enough."

Let's see, that is $4,994 per person in Commonwealth Care, exclusive of any premiums paid by enrollees. I suppose any state could lower its numbers of uninsured if it is willing to spend $5,000 per enrollee. Interestingly, the most expensive policy available next door in Hartford, Connecticut for a 35-year old male costs just $2,744 a year. This is for a zero deductible, zero coinsurance HMO. Other plans cost half of that or less. Massachusetts would have been better served if it simply allowed its residents to buy coverage next door and paid all of their premium.

Labels: Insurance, MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

...Mandated benefits such as in vitro fertilization or chiropractor services constitute a similar rights-violation. Individuals must spend their own money on benefits required by the state, regardless of whether they actually want those benefits. These mandates are akin to homeowners in Florida having Congress pass a law requiring Arizona residents to purchase mandatory hurricane insurance. In reality, this merely forces Arizonans to subsidize the hurricane expenses incurred by Floridians--a form of forced wealth redistribution. Similarly, Massachusetts residents are forced to purchase benefits such as in vitro fertilization in order to subsidize patients and providers with political clout.

Wall Street Journal
Taxpayers May Face Hurricane Tab
By Elizabeth Williamson, May 31, 2008

...The proposal -- backed by giant insurers Allstate Corp. and State Farm Mutual Automobile Insurance Co., as well as Florida lawmakers -- focuses on "reinsurance," the policies bought by insurers themselves to protect against catastrophic losses. The proposal envisions a taxpayer-financed reinsurance program covering all 50 states, which would essentially backstop the giant insurers in case of disaster.

...The program could also shift costs to taxpayers in states with fewer natural-disaster risks."

...Big winners would be coastal states, particularly Florida, where more than half of the nation's hurricane risk is centered.

Labels: MA, Misc, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Well, the returns are rolling in, and the critics look prescient. First, the plan isn't "universal" at all: About 350,000 more people are now insured in Massachusetts since the reform passed. Federal estimates put the prior number of uninsured at more than 657,000, so there was a reduction. But it was not secured through the market reforms that Governor Romney promised. Instead, Massachusetts also created a new state entitlement that is already trembling on the verge of bankruptcy inside of a year.

...The "new Big Dig" moniker refers to the legendary cost overruns when Boston rebuilt its traffic system. Now state legislators are pushing new schemes to offset RomneyCare's runaway expenses, including reductions in state payments to doctors and hospitals, enlarged business penalties, an increase in the state tobacco tax, and more restrictions on drug companies and insurers.

...In this respect paradoxically, we can be thankful that Massachusetts ignored the cost problems that doomed other recent liberal health insurance overhauls in California, Pennsylvania, Wisconsin and Illinois. The Bay State is showing everyone how not to reform health care.

Labels: Insurance, MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Health Insurance Mandates - Dangerous and Immoral Public Policy

Join Lin Zinser, executive director of Freedom and Individual Rights in Medicine (www.WeStandFIRM.org) in an expose of the dangers inherent in socialized medicine and what can be done to prevent it. This program is must-listening for small business owners, political activists, and others concerned with the loss of liberty.

Labels: Insurance, MA

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Costs soar for Mass. health care law
By STEVE LeBLANC, Associated Press Writer

BOSTON - Two years after the state's landmark health law was signed, the cracks are starting to show.

Costs are soaring and Massachusetts lawmakers are weighing a dollar-a-pack hike in the state's cigarette tax to help pay for a larger-than-expected enrollment in the law's subsidized insurance plans.

...Anyone earning more is required to get health insurance through their employer, on their own, or by purchasing lower-cost plans through the Health Care Connector, the independent state agency overseeing the law.

Businesses are also on the hook. Those with 11 or more full time employees who refuse to offer insurance face $295 annual penalties per employee. Already, 748 employers have failed to meet that threshold and have paid $6.6 million to the state.

Rick Lord, president of the Associated Industries of Massachusetts, said the state must be "very mindful of placing burdens on businesses that don't exist in other states."

...Michael Tanner, a senior fellow at the libertarian-leaning Cato Institute, said the law has been an unqualified failure.

Tanner was critical of the connector authority, a "super-regulatory agency" which has mandated levels of coverage. He also noted the vast majority of the newly insured are receiving subsidized care.

"They said it would get us universal coverage and reduce costs and it's done neither," Tanner said.

The biggest challenge is rising costs.

In 2006, a legislative committee estimated the law would cost about $725 million in the fiscal year starting in July. In his budget, Patrick set aside $869 million, but those overseeing the law have already acknowledged costs will rise even higher.

Labels: Insurance, MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Rocky off base on health care proposal

Contrary to the April 6 Rocky Mountain News editorial ("Health care reform for grown-ups"), Sen. Bob Hagedorn's proposed mandatory health insurance is the wrong prescription for Colorado. Massachusetts has already imposed a similar system of mandatory insurance for over a year, and it is failing badly. Like Hagedorn's proposal, Massachusetts requires everyone to purchase health insurance, with government subsidies for low-income residents. But rather than creating a health care utopia, the result has been the exact opposite - skyrocketing costs, worsened access, and lower quality health care.

The Massachusetts system violates the rights of individuals to spend their own health-care dollars according to their best judgment. Instead, individuals are forced to choose from plans approved by government bureaucrats. Special interest groups have loaded these plans with costly required benefits that many people might not otherwise voluntarily purchase, such as in vitro fertilization and chiropractor services. Although Colorado politicians promise not to impose similar expensive mandates, how long do we realistically expect this to remain true?

Due to the skyrocketing costs, the Boston Globe reports, the government will have to "cut payments to doctors and hospitals, reduce choices for patients, and possibly increase how much patients have to pay." Massachusetts is also asking the federal government to make up the shortfall of "hundreds of millions of dollars."

Instead of another massive government program, we should adopt free market reforms, such as eliminating insurance benefit mandates and allowing Colorado residents to purchase health insurance across state lines. These genuine reforms could reduce insurance costs between 20 percent and 50 percent for thousands of Coloradans, without compromising access or quality. The free market is the only moral and practical solution to our current health care crisis.

Paul Hsieh, M.D., is a practicing physician in the south Denver metro area and a co-founder of the Colorado group Freedom and Individual Rights in Medicine (FIRM).

Labels: CO, Insurance, LTE, MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Universal health care is the wrong prescription

By BRIAN SCHWARTZ
INDEPENDENCE INSTITUTE

What good is having medical insurance if you cannot get medical care? Peddlers of "universal health care" - from Hillary, Obama, to 2nd Congressional Democratic candidate Jared Polis - don't get this.

"Universal health care" is false advertising for politically controlled medicine, with government as the "single payer" monopolistic insurer. But having coverage does not guarantee getting medical care.

Since patients prepay through taxes, medical care appears "free." Hence, they have strong incentive to over-consume and providers need not compete on price.

To contain costs, governments restrict your access to life-saving treatment. In countries with such "universal coverage," patients die waiting for treatment.

The Canadian Medical Association Journal reports that in one year, 71 Ontario patients died while waiting for coronary bypass surgery and over one hundred more became "medically unfit for surgery." The Canadian Broadcasting Corporation reports that "109 people had a heart attack or suffered heart failure while on the waiting list. Fifty of those patients died."

"Physicians across Canada are in an advanced stage of burnout due to work conditions" which "causes them to retire early . . . or simply leave," a former Canadian Medical Association president told the New York Times. He "attributed much of the problem to technological shortages and the powerlessness doctors feel when patients complain about long waits for treatment."

"Access to a waiting list is not access to health care," wrote Canadian Chief Justice McLachlin when striking down legislation banning private insurance in 2005. Last year, a New York Times headline read: "As Canada's Slow-Motion Public Health System Falters, Private Medical Care Is Surging."

And England? The BBC reports that "up to 500 heart patients die each year while they wait for potentially life-saving surgery." The Times claims that a British woman "will be denied free National Health Service treatment for breast cancer if she seeks to improve her chances by paying privately for an additional drug."

A Daily Telegraph headline reads: "Sufferers pull out teeth due to lack of dentists." Another article says that "doctors are calling for NHS treatment to be withheld from patients who are too old or who lead unhealthy lives."

Consider politically controlled health care in America: Medicaid and Medicare.

Doctors are five times more likely to refuse seeing new Medicaid patients than privately insured patients. Increasing reimbursement rates won’t help much; more than two-thirds of doctors reported being overwhelmed by Medicaid's billing requirements, paperwork, and delays in payment.

ABC News says that "Medicare rules bar cancer drugs for patients," including the privately insured.

"Single payer" advocates cite international comparisons of life expectancy to support their cause. But life expectancy depends on factors unrelated to health care, such as unintentional injury and homicide. Health economist Robert Ohsfeldt found that when accounting for these two factors, life expectancy in America is comparable to that of Canada and England.

What really matters is your chance of surviving a serious illness. The American Cancer Society claims that "U.S. patients have better survival rates than European patients for most types of cancer."

So if politically controlled medicine isn’t the solution, what is? Not a Massachusetts-style "individual mandate," which forces everyone to buy insurance. This is essentially single-payer in disguise. Insurance regulations severely limit competition, so insurance companies are effectively government contractors for politically defined insurance.

The Boston Globe reports that to contain costs, Massachusetts authorities will "probably cut payments to doctors and hospitals" and "reduce choices for patients." Sound familiar?

Instead, we must recognize how government policies have crippled free markets.

Because the tax code deeply discounts employer-provided insurance, you're essentially stuck with your employer's non-portable plans. Hence, insurance companies can afford to be stingy and deny you care; they know that losing you as a customer requires that you change jobs. With government as "single payer" it's even worse: To change insurance providers you must move to a different state or country.

Our current system also encourages thoughtless over-consumption and skyrocketing costs.

The tax code punishes paying for medical care out-of-pocket and rewards buying insurance. So "insurance" has become prepaid medicine, and patients over-consume like business travelers dining on their company's expense account.

Further, legislation mandating minimum benefits makes insurance unaffordable for many. Consider: Colorado law compels widowed wives to pay higher premiums for prostate screening, maternity, and marital therapy.

Some Colorado legislators recognize this injustice. Just as businesses incorporated in other states can operate in Colorado, Coloradans should be able to buy affordable policies from insurance companies that meet less damaging regulations of another state.

While "universal health care" may provide health insurance, it doesn't guarantee health care. The uninsured are not the problem, but the symptom of the real problem - government meddling in personal choices of how we care for ourselves and our families.

Brian Schwartz, an optical engineer in Boulder, is a guest author for the Independence Institute. His free-market proposal to the Blue Ribbon Commission is at WhoOwns You.org.

Labels: Canada, CO, Insurance, MA, Medicaid, Medicare, OpEd, UK

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Mandating health care coverage is a costly mistake

The March 28, 2008 article, "Health Coverage Gets New Push" quotes State Senator Bob Hagedorn as supporting a plan to force all Coloradans to purchase mandatory health insurance, because it would be "immoral" to "sit on our hands and do nothing."

Unfortunately, the solution proposed by Senator Hagedorn is also deeply immoral and impractical. The state of Massachusetts has already imposed a similar plan of mandatory health insurance on its residents for over a year now, and it is failing badly. Like Senator Hagedorn's proposal, the Massachusetts plan requires all residents to purchase health insurance, with state subsidies for lower income residents.

But rather than creating a utopia of high-quality affordable health care, the result has been the exact opposite — skyrocketing costs, worsened access, and lower quality health care.

Massachusetts' system of government-mandated health insurance is immoral because it violates the rights of individuals to spend their own health care dollars according to their best judgment for their own benefit. Instead, individuals are forced to choose from a limited set of plans approved by the government bureaucrats.

Predictably, the government-mandated plans have been a huge magnet for special interests seeking to have their own favorite benefit included as a state requirement. These state-mandated plans therefore include numerous benefits that many individuals might not otherwise freely choose to purchase, such as in vitro fertilization, chiropractor services, prostate cancer screening, and maternity benefits. Hence, middle-aged Massachusetts women are forced to pay for prostate cancer screening, even though they have no need for that service.

Because the state-mandated health insurance is so expensive, the government must also subsidize the costs for lower income residents, which merely shifts those costs onto the taxpayers. The state has also created a huge new bureaucracy called "The Connector" to enforce these insurance requirements on individuals and businesses.

Overall, the plan is projected to cost as much as three times as originally estimated. According to the Boston Globe, the Massachusetts state government is now asking the federal government to make up the shortfall of "hundreds of millions of dollars."

Nor has the Massachusetts plan improved access or quality. The Boston Globe also reported that due to the skyrocketing costs, the state government will have to "cut payments to doctors and hospitals, reduce choices for patients, and possibly increase how much patients have to pay."

With such poor reimbursements, physicians are increasingly reluctant to take on new patients. Lee Sampson, a 47-year-old unemployed medical transcriptionist had to call 50 doctor's offices before she could find someone who would take her on as a new patient.

The Massachusetts plan has also had a "catastrophic effect" on the Cambridge Health Alliance, which serves most of the poor and uninsured in the Boston area. The high costs have forced the Alliance to fire staff and reduce services in order to stay afloat — harming the very people the plan was supposedly intended to help.

Colorado should not duplicate the failed experiment in Massachusetts. Their system of mandatory health insurance violates the rights of individuals and providers to contract freely for medical services to their mutual benefit. Instead, the government decides how people can spend their own money, and for what.

The predictable result has been skyrocketing costs, worsened access to health care, and a huge new bureaucracy, just like under any system of socialized medicine. As a practicing physician, I can't think of a more immoral "solution."

Instead, we need free market reforms, such as eliminating insurance benefit mandates and allowing Colorado residents to purchase health insurance across state lines.

These genuine reforms could reduce costs up to 20-50%, making health insurance possible to thousands of Coloradans who otherwise could not afford it, without compromising access or quality. The free market is the only moral and practical solution to our current health care crisis.

Paul Hsieh, MD, of Sedalia is a practicing physician in the south Denver metro area and also a co-founder of the Colorado group Freedom and Individual Rights in Medicine (FIRM).

Labels: CO, Insurance, MA, OpEd, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Labels: Analysis, CO, Free Market, MA

E-mail Lin Zinser / PermaLink / Comments / Trackbacks / BlogThis

"I calculated that every time I have a Medicare patient it’s like handing them a $20 bill when they leave,” she said. “I never went into medicine to get rich, but I never expected to feel as disrespected as I feel. Where is the incentive for a practice like ours?”

Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Repeal laws raising cost of health insurance

Re: "Health coverage gets new push," March 28 news story.

Democrats like state Sen. Bob Hagedorn, and state Rep. Anne McGihon want to force us all to buy medical insurance - as they define it. But government-mandated insurance does not guarantee actual care. Consider Canada, England and Massachusetts.

The Canadian Broadcasting Corporation reports that "109 people had a heart attack or suffered heart failure while on the waiting list. Fifty of those patients died." The BBC reports that "up to 500 heart patients die each year while they wait for potentially life-saving surgery." The Boston Globe reports that in response to soaring costs, Massachusetts "policymakers could face difficult choices: spend more state money or cut back the two programs by reducing enrollment, cutting subsidies, or eliminating benefits."

Sen. Hagedorn says it's "immoral for us to sit on our hands and do nothing." Hence, instead of passing more laws that kill, politicians should do something that is moral and actually works: repeal laws that make insurance prohibitively expensive.

For example, Colorado House Bill 1327 would allow us to buy insurance plans that meet less damaging regulations of other states. This would make quality, affordable insurance available to thousands of Coloradans.

Brian T. Schwartz, Boulder

Labels: Canada, CO, Countries, Insurance, LTE, MA, States, UK

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Healthcare cost increases dominate Mass. budget debate
Controlling them said key to keeping universal coverage

When Massachusetts launched its landmark universal health insurance initiative nearly two years ago, the state put off addressing rising costs so it could expand coverage immediately. Now those costs are dominating the discussion as the state faces a recession and pivotal funding decisions that could make or break health reform.

...A larger issue will also come to a head by July 1: the need to secure a new three-year commitment from the federal government to pay for half the soaring cost of insurance subsidies. Massachusetts is seeking up to $1.5 billion, but the Bush administration has been cutting back federal payments to the states.

..."If we don't grapple seriously with the cost of healthcare, the support for reform will erode and the perception will become broader that it is unaffordable," said Jon Kingsdale, executive director of the Commonwealth Health Insurance Connector, which oversees much of the reform effort.

Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

"Universal" Health Care Kills

What good is having medical insurance if you cannot get medical care? Peddlers of "universal health care" — from Hillary, Obama, to Colorado congressional candidate Jared Polis — don't get this.

"Universal health care" is false advertising for politically-controlled medicine, with government as the "single-payer" monopolistic insurer. But having coverage does not guarantee getting medical care.

Since patients prepay through taxes, medical care appears "free." Hence, they have strong incentive to over-consume and providers need not compete on price. To contain costs, governments restrict your access to life-saving treatment. In countries with such "universal coverage," patients die waiting for treatment.

The Canadian Medical Association Journal reports that in one year, 71 Ontario patients died while waiting for coronary bypass surgery and over one hundred more became "medically unfit for surgery." The Canadian Broadcasting Corporation reports that "109 people had a heart attack or suffered heart failure while on the waiting list. Fifty of those patients died."

This week the Globe and Mail reported that:

Inside Sylvia de Vries lurked an enormous tumour and fluid totalling 18 kilograms. But not even that massive weight gain and a diagnosis of ovarian cancer could assure her timely treatment in Canada.

She sought treatment in the United States, as do Canadians in need of intensive care and emergency cardiac care.

"Physicians across Canada are in an advanced stage of burnout due to work conditions" which "causes them to retire early... or simply leave," a former Canadian Medical Association president told the New York Times. He "attributed much of the problem to technological shortages and the powerlessness doctors feel when patients complain about long waits for treatment."

"Access to a waiting list is not access to healthcare," wrote Canadian Chief Justice McLachlin when striking down legislation banning private insurance in 2005. Last year a New York Times headline read: "As Canada's Slow-Motion Public Health System Falters, Private Medical Care Is Surging."

And England? The BBC reports that "up to 500 heart patients die each year while they wait for potentially life-saving surgery." The Times reports that a British woman "will be denied free National Health Service treatment for breast cancer if she seeks to improve her chances by paying privately for an additional drug." A Daily Telegraph headline reads: "Sufferers pull out teeth due to lack of dentists." "Doctors are calling for NHS treatment to be withheld from patients who are too old or who lead unhealthy lives," reports another article.

Consider politically-controlled health care in America: Medicaid and Medicare. Doctors are five times more likely to refuse seeing new Medicaid patients than privately-insured patients. Increasing reimbursement rates won't help much; more than two-thirds of doctors reported being overwhelmed by Medicaid’s billing requirements, paperwork, and delays in payment.

ABC News reports that "Medicare rules bar cancer drugs for patients," including the privately-insured. As the population ages and Medicare costs continue to increase, Medicare may further restrict patients and doctors.

"Single payer" advocates cite international comparisons of life expectancy to support their cause. But life expectancy depends on factors unrelated to healthcare, such as unintentional injury and homicide. Health economist Robert Ohsfeldt found that when accounting for these two factors, life expectancy in America is comparable to that of Canada and England.

What really matters is your chance of surviving a serious illness. The American Cancer Society reported that "U.S. patients have better survival rates than European patients for most types of cancer."

So if politically-controlled medicine isn't the solution, what is?

Not a Massachusetts-style "individual mandate," which forces everyone to buy insurance. This is essentially single-payer in disguise. Insurance regulations severely limit competition, so insurance companies are effectively government contractors for politically-defined insurance.

The Boston Globe reports that to contain costs, Massachusetts authorities will "probably cut payments to doctors and hospitals" and "reduce choices for patients." Sound familiar?

Instead, we must recognize how government policies have crippled free markets.

Because the tax code deeply discounts employer-provided insurance, you're essentially stuck with your employer's non-portable plans. Hence, insurance companies can afford to be stingy and deny you care; they know that losing you as a customer requires that you change jobs. With government as "single-payer" it's even worse: to change insurance providers you must move to a different state or country.

Our current system also encourages thoughtless over-consumption and skyrocketing costs. The tax code punishes paying for medical care out-of-pocket and rewards buying insurance. So "insurance" has become prepaid medicine, and patients over-consume like business travelers dining on their company's expense account.

Further, legislation mandating minimum benefits makes insurance unaffordable for many. Consider: Colorado law compels widowed wives to pay higher premiums for prostate screening, maternity, and marital therapy. Sponsors of Colorado House Bill 08-1327 recognize this injustice. Just as businesses incorporated in other states can operate in Colorado, Coloradans should be able to buy affordable policies from insurance companies that meet less damaging regulations of another state.

So remember, the uninsured aren't the problem, but a symptom of political meddling in our most important personal choices.

Labels: Canada, CO, Countries, MA, OpEd, States, UK

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Labels: Insurance, MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

BAD MEDICINE
Health care proposals will backfire on state

I want to thank The Gazette for its strong editorial against the ill-considered plan by the Colorado Blue Ribbon Commission on Health Care Reform ("Health care reform: It's a joke," Jan. 31). Their proposed system of mandatory health insurance already has been tried in Massachusetts and is failing. Costs there are already more than three times what was originally predicted, and the Boston Globe reports that it is expected to "cut payments to doctors and hospitals, reduce choices for patients, and possibly increase how much patients have to pay." The California state legislature has also just rejected a similar plan because it will cost too much.

These government-imposed plans violate the rights of individuals to freely choose what health insurance plans are best for them, and, as a result, lead only to rising costs and rationing. If Coloradans value their lives and their health, they will also reject this deadly proposal.

For more information on genuine free market health care reform for Colorado, please see www.WeStandFIRM.org.

Paul Hsieh, M.D.
Sedalia

Labels: 208, CA, CO, LTE, MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

The subsidized insurance program at the heart of the state's healthcare initiative is expected to roughly double in size and expense over the next three years - an unexpected level of growth that could cost state taxpayers hundreds of millions of dollars or force the state to scale back its ambitions.

If the state doesn't get all of the federal funds it is seeking, policy makers could face difficult choices: spend more state money or cut back the two programs by reducing enrollment, cutting subsidies, or eliminating benefits.

Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Is Romney's Healthcare Plan Conservative?

...Massachusetts was the first state in the country to impose an "individual mandate," which requires everyone in the state to have health coverage or face some significant penalties. Most employers -- those with 11 employees or more -- also face a mandate: Provide health insurance or pay a fine.

The criticism from other Republicans highlights one of the controversial aspects of the Massachusetts plan, which the state's Democratic legislature wanted in the legislation: Should conservatives support the government’s requiring people to buy health insurance?

The conservative Heritage Foundation does -- or at least providing some indication that an individual can pay his medical bills. Heritage analysts even played a role in developing the Massachusetts plan and is now selling it to other states. But most other conservative groups vehemently oppose both an individual and employer mandate, and it must be emphasized that Romney has not included the individual mandate in his presidential reform proposal.

Democrats Point to Massachusetts Model

Massachusetts' individual mandate has initiated a national discussion among many state elected officials, including California Gov. Arnold Schwarzenegger, who also supports an individual and employer mandate. Plus, Democratic presidential candidates New York Sen. Hillary Clinton and former North Carolina Sen. John Edwards have included an individual and employer mandate in their proposals, pointing to Massachusetts as a model.

Defenders claim that without the individual mandate, some people will remain uninsured. And when the uninsured get medical care, they can't pay for it, so those costs are shifted to those who have health insurance, driving up the cost of coverage. Therefore, the reasoning goes, by forcing all citizens to be "responsible" for their own costs (i.e., having health coverage), that will actually lower the cost of health insurance for everyone.

Since conservatives support personal responsibility, these defenders conclude, supporting an individual mandate is a conservative principle.

Ignoring Principles

But this argument ignores some other important conservative principles: one being that we don't like the government's micromanaging our healthcare.

Romney and others like to respond by noting that almost every state requires people to buy auto insurance. True enough, but the auto insurance mandate has been so unsuccessful that millions of Americans buy uninsured motorist coverage to protect themselves against uninsured drivers. The fact is that the auto insurance mandate is seldom enforced in most states, and when it is, the penalties are usually minor.

Not so with the Massachusetts mandate. Those who don't get coverage will face a $219 fine (tax?) for the first year (2008), but that fine will go up to at least $150 per person per month in the following year, according to the Boston Herald.

And that's why some of the other Republicans were chiding Romney: An annual $1,800 for each uninsured person can be a significant penalty on a lower-income family of three or four. So significant, in fact, that the state recently decided to exempt 20% of the low-income uninsured from the mandate.

One reason for that exemption was the cost of the plan. On the plus side, the uninsured are signing up in droves, faster than anticipated, although mostly for the subsidized part of the program. As a result, it appears the plan will have nearly a $150-million budget shortfall.

But wait! The whole justification for forcing everyone to have coverage was to avoid cost-shifting from the uninsured to the insured. And if you exempt 20% of the uninsured, haven't you just undermined the whole effort?

Moreover, expanding the health insurance pool apparently isn't lowering insurance premiums, as supporters have claimed it would. The Boston Globe recently reported: "Striving to hold down costs to taxpayers, a state panel [i.e., the Connector Authority, an unelected quasi-government body that governs the healthcare reform initiative] yesterday approved a range of changes for next year for the rapidly growing subsidized health insurance program. The changes will probably cut payments to doctors and hospitals, reduce choices for patients, and possibly increase how much patients have to pay."

The health plans are facing as much as a 14% increase -- higher than many health policies not associated with the Connector. So Commonwealth Care, the state-subsidized part of the Massachusetts reform initiative for modest-income workers, wants to cut healthcare provider reimbursements by 3% to 5%, according to the Globe.

Acting Like Medicaid

Said Connector Authority CFO Patrick Holland, "There's no justification to be paying more than Medicaid rates."

Wrong. At least one justification for paying more is that patients can actually see a doctor. Medicaid's low reimbursement rates are increasingly making it difficult for patients to see a doctor. The Connector wants to impose that burden on the Massachusetts plan as well. But, hey, if you're going to act like Medicaid, why not just call it Medicaid?

Several months ago, the Globe carried a story about Connector employees' salaries. Half of them made more than $100,000, and the head Connector made $225,000. I have been closely monitoring the papers to see how much their salaries are being cut in order to "keep the program affordable."

And I'm still looking.

The trouble with health insurance reform schemes is that the problems usually don't manifest themselves until a few years, maybe many years, into the new program. By that time the politicians who pushed them through have often moved on to higher office, maybe even President.

But the Massachusetts healthcare reform plan is quickly shedding any pretense of being a market-oriented solution or public-private "partnership" for covering the uninsured. Instead, it is becoming a demanding, heavy-handed, top-down program that demands people have coverage and fines them if they don't.

Mr. Matthews Jr., Ph.D., is a resident scholar for the Institute for Policy Innovation.

Labels: Analysis, Insurance, MA

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Compulsory Medical Insurance as Collective Punishment

Remember how in grade school, the teacher would punish the whole class for the actions of just a few disruptive students? This is an early lesson in collective punishment, which is usually practiced during wartime or under martial law.

Collective punishment has now arrived with compulsory medical insurance. Known as an "individual mandate," politicians of both major parties have supported it. Compulsory politically-defined insurance is law in Massachusetts, is up for consideration in California and Colorado, and Democratic presidential candidates endorse it nationally.

Politicians peddle compulsory insurance under the guise of "personal responsibility." The story is that the uninsured receive medical care without paying for it. Their freeloading passes costs onto the insured, which increases premium costs. Compulsory insurance, say its supporters, can remedy this problem by forcing both the insured and uninsured to purchase medical insurance - as defined by politicians.

This rationale is flawed. First, freeloading from the uninsured does not significantly increase insurance premiums.

Paying the medical bills for the uninsured adds little to insurance premiums - and certainly less than Colorado's scheme for compulsory insurance. A study published in Health Affairs found that uncompensated care is "only 2.8 percent of total personal health care spending," of which our tax dollars - not increased premiums - fund at least 80 percent.

In Colorado, the Lewin Group found uncompensated care to be less than four percent of total medical spending. The portion of uncompensated care that can correspond to increased premiums is around $200 million annually. This is just $85 per privately-insured resident, or one percent of the average premium.

But the billion-dollar "cure" proposed by Colorado's Commission on Healthcare Reform would cost the insured more than $85. To encourage compliance with compulsory insurance, the Commission's plan includes tax-subsidized premiums and Medicaid expansion. Privately-insured Colorado resident, the tax increase would cost about $400.

Second, holding people responsible would mean punishing freeloaders themselves and allowing providers to prevent customers from skipping out on the bill. This is the exact opposite of compulsory insurance, which forces the innocent to purchase insurance policies determined by political interests, rather than their own needs. This is collective punishment.

What if we applied the rationale for compulsory medical insurance to freeloaders who leave restaurants without paying the bill? This certainly increases prices, but forcing all citizens to purchase "diner's insurance" punishes the innocent.

Third, government controls already punish the innocent - insured and uninsured alike - by making medical care and insurance prohibitively expensive.

The federal tax exemption for employer-provided insurance coddles insurance companies by tying employees to their employer's plans, effectively discounting insurance, and shielding insurance companies from competition. It also drives demand for more comprehensive insurance than would otherwise be purchased. Insulated from medical costs, patients behave like business travelers on a company expense account, so medical providers need not compete on price. Shall we further pamper insurance companies by forcing everyone to purchase their products?

On the state level, medical providers and disease constituencies lobby to force insurance to include benefits that many customers do not need. For example, Colorado law compels widowed wives to pay higher premiums for prostate screening, maternity, and marital therapy. These mandates increase Colorado premiums by 21 to 54 percent, which dwarfs the one percent increase attributable to the uninsured. Colorado's Chief Medical Officer states that 2,500 Coloradans lose insurance for every one percent increase in premiums. Nationally, the figure is 300,000 people. These controls also reduce wages and are responsible for up to twenty-five percent of America's uninsured.

Compulsory insurance further empowers politicians to determine what insurance is best for you. For example, the Boston Globe reports that under the Massachusetts plan, "more than 200,000 people with health insurance would have to buy additional coverage to meet proposed minimum standards under the state's new health insurance law."

When government policies increase insurance costs, the first to drop coverage are the young and healthy. Those remaining in the insurance pool are at higher risk to incur medical expenses, so premiums rise again, which again drives out the healthiest remaining customers. It takes some nerve to support policies that make insurance prohibitively expensive and then make it a crime not to purchase insurance.

Compulsory insurance is based on collective punishment, a perverted form of justice found where troops patrol the streets and spitballs go splat. It punishes both the insured and uninsured for the misdeeds of politicians. Legislators should stop scapegoating the uninsured for the mess they've perpetuated. They should repeal legislation that inhibits the free market from delivering affordable high-quality medical care.

Brian T. Schwartz, Ph.D. is an optical engineer and an aspiring professional policy analyst in Boulder, Colorado. His website is wakalix.com.

Labels: CA, CO, Insurance, MA, OpEd

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

The Right Vision Of Health Care
Yaron Brook 1.08.2008

With the primary season in full swing, the presidential candidates are fighting over what to do about the spiraling cost of health care--especially the cost of health insurance, which is becoming prohibitively expensive for millions of Americans.

The Democrats, not surprisingly, are proposing a massive increase in government control, with some even calling for the outright socialism of a single-payer system. Republicans are attacking this "solution." But although they claim to oppose the expansion of government interference in medicine, Republicans don't, in fact, have a good track record of fighting it.

Indeed, Republicans have been responsible for major expansions of government health care programs: As governor of Massachusetts, Mitt Romney oversaw the enactment of the nation's first "universal coverage" plan, initially estimated at $1.5 billion per year but already overrunning cost projections. Arnold Schwarzenegger, who pledged not to raise any new taxes, has just pushed through his own "universal coverage" measure, projected to cost Californians more than $14 billion. And President Bush's colossal prescription drug entitlement--expected to cost taxpayers more than $1.2 trillion over the next decade--was the largest expansion of government control over health care in 40 years.

Today, nearly half of all spending on health care in America is government spending. Why, despite their lip service to free markets, have Republicans actually helped fuel the growth of socialized medicine and erode what remains of free-market medicine in this country?

Consider the basic factor that has driven the expansion of government medicine in America.

Prior to the government's entrance into the medical field, health care was regarded as a product to be traded voluntarily on a free market--no different from food, clothing, or any other important good or service. Medical providers competed to provide the best quality services at the lowest possible prices. Virtually all Americans could afford basic health care, while those few who could not were able to rely on abundant private charity.

Had this freedom been allowed to endure, Americans' rising productivity would have allowed them to buy better and better health care, just as, today, we buy better and more varied food and clothing than people did a century ago. There would be no crisis of affordability, as there isn't for food or clothing.

But by the time Medicare and Medicaid were enacted in 1965, this view of health care as an economic product--for which each individual must assume responsibility--had given way to a view of health care as a "right," an unearned "entitlement," to be provided at others' expense.

This entitlement mentality fueled the rise of our current third-party-payer system, a blend of government programs, such as Medicare and Medicaid, together with government-controlled employer-based health insurance (itself spawned by perverse tax incentives during the wage and price controls of World War II).

Today, what we have is not a system grounded in American individualism, but a collectivist system that aims to relieve the individual of the "burden" of paying for his own health care by coercively imposing its costs on his neighbors. For every dollar's worth of hospital care a patient consumes, that patient pays only about 3 cents out-of-pocket; the rest is paid by third-party coverage. And for the health care system as a whole, patients pay only about 14%.

The result of shifting the responsibility for health care costs away from the individuals who accrue them was an explosion in spending.

In a system in which someone else is footing the bill, consumers, encouraged to regard health care as a "right," demand medical services without having to consider their real price. When, through the 1970s and 1980s, this artificially inflated consumer demand sent expenditures soaring out of control, the government cracked down by enacting further coercive measures: price controls on medical services, cuts to medical benefits, and a crushing burden of regulations on every aspect of the health care system.

As each new intervention further distorted the health care market, driving up costs and lowering quality, belligerent voices demanded still further interventions to preserve the "right" to health care. And Republican politicians--not daring to challenge the notion of such a "right"--have, like Romney, Schwarzenegger and Bush, outdone even the Democrats in expanding government health care.

The solution to this ongoing crisis is to recognize that the very idea of a "right" to health care is a perversion. There can be no such thing as a "right" to products or services created by the effort of others, and this most definitely includes medical products and services. Rights, as our founding fathers conceived them, are not claims to economic goods, but freedoms of action.

You are free to see a doctor and pay him for his services--no one may forcibly prevent you from doing so. But you do not have a "right" to force the doctor to treat you without charge or to force others to pay for your treatment. The rights of some cannot require the coercion and sacrifice of others.

So long as Republicans fail to challenge the concept of a "right" to health care, their appeals to "market-based" solutions are worse than empty words. They will continue to abet the Democrats' expansion of government interference in medicine, right up to the dead end of a completely socialized system.

By contrast, the rejection of the entitlement mentality in favor of a proper conception of rights would provide the moral basis for real and lasting solutions to our health care problems--for breaking the regulatory chains stifling the medical industry; for lifting the government incentives that created our dysfunctional, employer-based insurance system; for inaugurating a gradual phase-out of all government health care programs, especially Medicare and Medicaid; and for restoring a true free market in medical care.

Such sweeping reforms would unleash the power of capitalism in the medical industry. They would provide the freedom for entrepreneurs motivated by profit to compete with each other to offer the best quality medical services at the lowest prices, driving innovation and bringing affordable medical care, once again, into the reach of all Americans.

Yaron Brook is managing director of BH Equity Research and executive director of the Ayn Rand Institute.

Labels: Analysis, CA, Free Market, MA, Medicaid, Medicare, OpEd

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Health care, ho!
State should avoid repeat of Massachusetts
THE GAZETTE January 3, 2008

For Colorado Democrats, a regulatory fix of the state's ailing health care system may seem irresistible during the upcoming 2008 legislative session. Imagine the attention major health care reform, or statewide "universal health care," would garner from the media in August, when the country's Democrats converge in Denver for the Democratic National Convention. Colorado could be held up as the example of how it can and should be done. Democratic leaders could be lauded for aiding 792,000 uninsured men, women and children.

House Speaker Andrew Romanoff, as quoted in The Gazette, says Coloradans are tired of waiting on a federal government that "cannot or won't fix" the health care crisis. The Blue-Ribbon Commission on Health Care Reform, appointed by legislative leaders and the governor, will present its recommendations to the Legislature on Jan. 31. The commission plans to recommend that all Colorado residents be mandated to buy insurance that meets minimum standards, and state subsidies would be extended to more of the state's poor.

Before politicians get too ambitious, however, they should take a closer look at the health care reform led by a leading Republican: Mitt Romney, the former governor of Massachusetts.

"The majority of the commission favors a government-heavy proposal," says Dr. Paul Hsieh, a Denver physician who has studied the new Massachusetts system. "They're crafting it similar to the Massachusetts model."

A year old, the Massachusetts system is resulting in rationing and shortages of care, and higher costs to taxpayers than originally expected. The Patriot Ledger newspaper tells of Lee Sampson, a 47-year-old unemployed medical transcriptionist. Sampson bought into Commonwealth Care, a state-subsidized insurance cooperative. She had to buy insurance by Jan. 1 to avoid tax penalties and fines.

But Sampson, like a growing number of other Massachusetts residents, is learning that mandatory insurance doesn't mean doctors will treat her. To receive benefits from the plan, Sampson must find a primary care physician. She reported calling 50 doctors' offices within a half-hour drive of her home. All rejected her. Most explained they were overwhelmed and accepting no new patients.

Massachusetts, like Canada, will learn that mandating health care as a universal right results in a demand for services that exceeds the supply. The demand for medical services under the new Massachusetts system has become so great, and so expensive, that state officials are cutting back on the compensation doctors receive for services, while raising patient co-pays. The medical community, struggling with high demand and inadequate reimbursement, is cutting costs by rationing services for patients like Sampson.

Ask Americans if they would enjoy free universal health care, like the Canadians have, and many will say yes. Ask the same folks if they'd like to wait several months for an MRI, a heart scan or chemotherapy -- as Canadians often do -- and they'll give a resounding "no way."

Yet one can't argue that our nation's health care system is well. As reported by The New York Times, health care costs are going up at twice the rate of inflation. With soaring costs come rising insurance rates, which fewer employers and individuals are willing or able to pay. Based on U.S. Census data, 10 million Americans were uninsured 15 years ago. Today, more than 46 million live uninsured.

While it's expedient for politicians to promise a solution in the form of a program, Massachusetts will continue showing us why it doesn't work. Government intervention, in fact, explains the failures of our current system. The IRS code drives most Americans to buy health insurance through employers. That means insurers don't have to compete for consumers, because for most Americans, shopping around for a better deal involves a career change. And because health insurance has been packaged as a "free" benefit from employers, patients have spent the past half-century consuming health care without challenging the price. For those with health plans, "insurance" has morphed into pre-paid service, seemingly paid for by someone else. Imagine a system in which large employers provided auto insurance. Would employees balk at the cost of this "free" benefit, demanding a better price? If the insurance covered routine oil and lube jobs, the way health insurance covers physicals, would consumers demand lower prices from Grease Monkey? Doubtful.

State legislators can't change the morass of federal regulation that has led to a health care system unrestrained by the conventional market forces that control other services and goods. But legislators can improve access to health care by eliminating most of the state controls that prohibit affordable coverage. State law, for example, requires that health insurance plans include coverage for childhood autism -- even for consumers with no prospect of children. Regardless of a consumer's personal needs, any policy he or she buys in Colorado must cover alcohol rehab, mental health and maternity treatments -- to name a few. Why not a law that says all cell phone plans must come with 80-channel cable TV?

Brian Schwartz, an Arvada-based optical engineer, proposed to the Blue Ribbon Commission a market-based health care reform package that mostly involved deregulation. Commission member Linda Gorman fought for it, but others scoffed.

"One commissioner said we already have a free market in health care, and it has failed," Schwartz told The Gazette. "But we don't have a free market. If you're a widow, you have to buy a policy that covers marital therapy, maternity and prostate cancer. You have no need for this, but if you want insurance you're required to buy it. Mandates raise your premium by 20 to 50 percent."

Government, as we're seeing in Massachusetts, can't make health care affordable and abundant. Market forces can and will -- if politicians ever allow them to.

Labels: 208, Canada, CO, Countries, Insurance, MA, OpEd, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Mass. panel approves changes to subsidized residents health plan
By Alice Dembner

Striving to hold down costs to taxpayers, a state panel yesterday approved a range of changes for next year for the rapidly growing subsidized health insurance program. The changes will probably cut payments to doctors and hospitals, reduce choices for patients, and possibly increase how much patients have to pay.

The program is the centerpiece of the state's landmark effort to insure nearly every resident, and there is widespread concern about long-term funding of the initiative because of growing healthcare costs.

Mass. To Cut Payments to Docs & Hospitals
Posted by Jacob Goldstein

Massachusetts’s universal health-care plan is turning out to be more expensive than predicted. Now the state is looking at cutting payments to docs and hospitals next year to make ends meet.

That fiscal reaction, which some critics of the plan warned about, sends a stark message to those of us in the other 49 states. Massachusetts has become something of a model for the national plans proposed by Hillary Clinton and John Edwards, among others.

The state requires everybody to buy health insurance. A subsidized health plan offered to the poor as part of the program has proved more popular than expected, and that’s helping to push costs 20% over what the state had budgeted. The tab could run $619 million for the current fiscal year, $147 million over budget, the Boston Globe reports.

Now the board that oversees the plans has approved cuts of 3% to 5% in reimbursements for to health-care providers caring for those in the subsidized plan. The article suggests the cuts will bring reimbursement in line with Medicaid.

Labels: Insurance, MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Success could put health plan in the red

Enrollment in the state's new subsidized health plan is growing so quickly that the state could face a funding gap as large as $147 million by the end of the fiscal year, according to a state projection.

...But the state would have to find ways to pay the insurance bills for so many more people. Options include appropriating more money, using funds allocated to care for those without insurance, or cutting extra payments to certain hospitals that were included in the law mandating insurance.

Thousands balk at health law sign-up mandate

With just seven weeks left until 2008, tens of thousands of Massachusetts residents -- up to 100,000 or more by some estimates -- have yet to sign up for insurance plans created as part of the state's historic health care reform law.

This has left insurers falling far short of expectations for signing up new customers, as countless people -- intentionally or otherwise -- come perilously close to risking fines and escalating penalties if they don't obtain insurance by the end of the year...

Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Under the plan, Coloradans would be required to provide proof of health insurance when filing their state income taxes. Failure to do so could result in a tax penalty equal to the cost of a year's worth of coverage.

About 160,000 uninsured people in the state have incomes that are too high to qualify for subsidized health insurance -- but too low to afford the lowest-cost unsubsidized plans. About 60,000 of these working poor won't face a penalty for not getting insurance, but the 100,000 others are in a bind.

"What I'm starting to see," [single mother Maureen] Linehan said, "is the people have to pay for their health care, and now they can't afford to pay their rent."

There is no individual mandate in Mr. Romney’s plan for the rest of the country. Instead, it concentrates on a "federalist" approach, premised on the belief that it is impossible to create a uniform system for the entire country.

..."He's run away from the Massachusetts plan," said Stuart Altman, a health economist at Brandeis University who worked in the Nixon administration and has helped advise many politicians since, including Senator Barack Obama, a Democratic presidential contender.

Labels: 208, Insurance, MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

"What good is health care if no doc will see you?"

Lee Sampson didn't expect to find herself without health insurance. But when her job as a medical transcriptionist got outsourced to India earlier this year, Sampson, 47, had to find a way to get covered.

She found it in Commonwealth Care, a group of subsidized health insurance plans that was created as part of the state's new law requiring people to buy coverage. While the little income Sampson had disqualified her for the state's Medicaid program, the subsidized option was more doable than pricier plans targeting the uninsured from carriers like Harvard Pilgrim and Blue Cross/Blue Shield.

Sampson was enrolled in a plan run by a subsidiary of Boston Medical Center called BMC Health Net. But before her benefits would take effect, she had to find a primary care doctor. That's when her frustration with the new system reached a boiling point.

Sampson started calling primary care doctors within a half-hour drive of her home in Kingston. The response from nearby doctors: "We're not taking (that insurance plan), we're not taking new patients."

Sampson estimated she called about 50 doctors. In some cases, administrators at doctors offices said they didn't know why they were on lists as accepting the insurance when they don’t. In others, they just weren't accepting new patients.

"One woman I talked to said, 'My son is going through the same thing,'" Sampson said. "People are very sympathetic."

Sampson's experience may become more common as residents - many who don't have insurance for financial reasons - scramble to find plans ahead of the Jan. 1 state deadline, after which people lose their state income tax personal exemption of about $219 and face the prospect of stiffer penalties later on.

Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

The state has already backed off of "universal." About 160,000 uninsured people in the state have incomes that are too high to qualify for subsidized health insurance — but too low to afford the lowest-cost unsubsidized plans. About 60,000 of these working poor won't face a penalty for not getting insurance, but the 100,000 others are in a bind.

"What I'm starting to see," [single mother Maureen] Linehan said, "is the people have to pay for their health care, and now they can't afford to pay their rent."

Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Labels: MA, States

E-mail Ari / PermaLink / Comments / Trackbacks / BlogThis

"Ultimately we are going to have to explain to people that this is an obligation, that it is not optional."

"This is going to bring me to my knees," said Deb Maguire, who runs Liam Maguire’s Irish Pub and Restaurant in Falmouth.

Linda Impemba, 58, a marketing company employee in Wakefield, said she would remain uninsured, pay penalties, and, as soon as her ailing mother dies, will leave Massachusetts. "There's no way in heaven I can possibly survive in this state," Ms. Impemba said. "Now not only is my cost going to go up, everything's going to be raised so I can pay for the other people" to be insured.

Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

"Mandatory Coverage Is Easier Said Than Done"

...Requiring people who can afford health insurance to buy it -- the same way that car owners must buy auto insurance -- appeals to those who believe that mandatory coverage is fairer than asking everyone else, directly or indirectly, to pick up the health care costs of those who choose not to buy it.

...But the state [Massachusetts] is discovering that making health insurance mandatory is easier said than done. It has spent the past year dealing with questions about how much basic coverage people need, and how much they can be expected to pay.

A mandate is critical, however, to helping the state achieve near-universal coverage,...

...Nevertheless, forcing people to buy coverage can be difficult, especially when some people do not think they need it.

"If you make everyone buy a Cadillac, you're going to have more people who can't afford it," said Devon M. Herrick, a senior fellow at the National Center for Policy Analysis, a nonprofit research group in Dallas that favors market-oriented solutions.

Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

One misconception among consumers is that the free market system hasn't worked, so the government must step in. But we don't have a free market system with health insurance. A free market system only works if it's allowed to exist unfettered from government mandates that limit competition and allow certain companies to monopolize markets.

"Free universal health care for everyone" sounds wonderful and seems to be the vision most repeated in media, but what would that actually look like?

...Citizens' Council on Healthcare (CCHC), a nonprofit patient and physician advocacy organization, did an analysis of the Massachusetts plan last year and made troubling conclusions about its impact for consumers. While the plan was created "to expand access to healthcare for Massachusetts residents, increase the affordability of health insurance products, and enhance accountability of our state’s health system," they found the plan would create an enormous set of new bureaucracies (no less than ten new agencies, six financial-management funds, and three new programs) to establish, oversee and enforce. There is no evidence to suggest that the government will do things cheaper, better or more efficiently.

The MA state plan essentially creates a monopoly of insurers residents can choose from. Every policy has to comply with the state's coverage mandates, and mandates always cost more money than they claim to save. There are thousands of insurance mandates that have been passed by state legislatures over recent years and behind every mandate is a special interest that will benefit by the product or service. A recent analysis by the Council for Affordable Health Insurance estimated that mandated benefits increase the cost for basic health insurance for everyone by 20% to more than 50%, depending on the state. Worse, a number of these mandates are for preventive "wellness" programs, screenings and treatments that are unsound, ineffective, costly, unproven, unwanted or potentially dangerous.

One misconception among consumers is that the free market system hasn't worked, so the government must step in. But we don't have a free market system with health insurance. A free market system only works if it's allowed to exist unfettered from government mandates that limit competition and allow certain companies to monopolize markets. The government has catered to special interests and created an insurer managed care system, which has resulted in higher premium costs and more people uninsured. Those who want affordable insurance alone, without a third-party managed care bureaucracy standing between them and their doctor, find it unavailable...

...Cost containment efforts will likely drive away healthcare providers and, as has been seen in other single-payer systems, result in shortage of providers and services; rationing of available care and resources; and long waits for tests, surgeries and treatment.

Health insurance coverage is not the same as access to care.

...Overall, Twila Brase, RN, president of CCHC, said of the plan:

[A]n intrusive and prescriptive bureaucracy will be authorized to ration health care and make decisions about who gets what health care when. Health-care decisions will be taken out of the hands of patients and doctors as the agendas of special interests, not the needs of patients, take precedence. The legislation is extremely intrusive.

To sum it up: People will have no choice but are being forced to buy the insurance plans the state dictates. But these are not health insurance plans, as might be believed or some might desire, which protect people from catastrophic health problems, this is managed care. The state is also the regulator, payer and enforcer — a recipe for conflicts of interest.

Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

"Health plan may exempt 20% of the uninsured"

By Alice Dembner, Globe Staff -- April 12, 2007

To remove the threat of a public backlash, the state plans to exempt nearly 20 percent of uninsured adults from the state's new requirement that everyone have health insurance.

The proposal, expected to be approved by a state board today, is based on calculations that even the lowest-cost insurance would not be affordable for an estimated 60,000 people with low and moderate incomes who do not qualify for state subsidies. Forcing them to buy insurance or pay a penalty could jeopardize the rest of the state's initiative, officials said...

Labels: MA, States

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis