Here is another fact to add to your list of health care talking points.Today, I received this alarming email from Physicians For a National Health Plan:
Significantly, in Massachusetts, where an individual-mandate health reform law, much like what President Obama is proposing on a national scale, was passed in 2006, at least 352,000 people, or 5.5 percent of the population, remained uninsured in 2008. That number was actually (but non-significantly) higher than the number of uninsured in 2007, before strict enforcement of the individual and employer mandates went into effect.
"The legislation championed by the president and the congressional leadership is a virtual clone of the Massachusetts plan," said Dr. Steffie Woolhandler, professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program (PNHP). "Today's numbers show that plans that require people to buy private insurance don't work. Obama's plan to replicate Massachusetts' reform nationally risks failure on a massive scale."
Keep in mind that Massachusetts has a relatively low percent uninsured. I live in Texas, which has the highest rate of uninsured in the nation (
25%!) despite being the country’s second richest state and the world’s 15th largest economy. If Mass was unable to make mandatory private insurance work, how on earth are the states that really need help going to get by?
Answer: they won’t. Mandatory private insurance is nothing but a scam being run against the American people by private insurers who stand to make a fortune writing policies for healthy young people who will not use their insurance and older, sick folks who will be sold paper only policies that do nothing but save them from paying the fine for being uninsured.
But insurance is insurance.Ha! An insurance policy with a two to three thousand dollar deductible sold to working class Americans will only be used in the event of a major emergency. People will not seek care for chronic problems like hypertension and diabetes, and they will not get preventive care like check ups and Pap smears. Indeed, if forced to pay a thousand dollars or more for a policy like this, folks will be even less likely to get necessary care since they will be $1000 poorer.
Universal healthcare in countries like France and Canada work--i.e. they do not break the national budget---because they are designed to encourage folks to get necessary preventive care. That makes them healthier so they are less likely to require expensive emergency care. Most of the world's industrialized countries pay less than half per person for health care (compared to the U.S.) and achieve better results in measures of public health like life expectancy and infant mortality. That is the benefit of prevention. A sane universal health plan emphasizes prevention. In contrast, our insane Congress's health plan emphasizes insurance company profits.
What about managed care plans? HMOs have to pay for well care. Technically, managed care plans are required to accept all comer and pay for every type of care, including preventive services (Pap smears, immunizations). In fact, these plans have made an art of denying members promised care. They do this by contracting with a tiny numbers of health care providers. An insurance policy written by a company with an “exclusive provider network” will not be used if the insurer has no doctors in your area. Note that some plans are trying to get Congress to allow them to sell across state lines. Again, these are likely to be “affordable” (if you have an extra one to two thousand dollars floating around) but worthless, since the out of state company may have no doctors, hospitals and ancillary medical facilities signed up in your area. And even if there are a handful of local providers, they are likely to be swamped---which leads to the "not accepting new ___members" problem. Or, there may be one specialist to cover a three hundred mile area (and how many of us can take a day off work and travel to another city to see a doctor?).
But Joe’s Fly By Night HMO swears that I will be able to see my own doctor! Yeah, and I know a bridge I can sell you. Cheap. Insurers are notorious for promising folks the sun and the moon to get them to sign up. They will lie and say that doctors who do not accept their insurance accept it. They will tell you that you can always get a referral out of network for emergencies, without telling you that their definition of an emergency is not the same as yours. These roadblocks are thrown up in order to encourage the people who actually need health care to seek insurance elsewhere, while the insurer keeps collecting premiums from those who never require medical care. Reverse cherry picking, if you will.
But at least the mandatory private insurance plan will net a lot of revenue for the federal government from the folks who elect to pay the fine rather than purchasing insurance. As I documented in a recent journal, Congress is actually counting upon millions of Americans remaining uninsured to cover the premiums which the federal government will have to pay for those who decide they do want coverage and who happen to be poor enough that the feds will have to supply that coverage. Now, what kind of “universal” health plan depends upon lack of universal coverage in order to stay solvent? Answer: the Mass plan. And boy, were they shocked in Massachusetts to discover that people were not kidding when they said that they wanted health insurance coverage.
The Massachusetts plan, passed in 2006 with the support of then-Governor Mitt Romney, is stumbling financially because far more people need help than Romney originally estimated; the state now believes there may be as many as 650,000 uninsured, not 400,000. And there's a shortfall in funds to cover the subsidies those people have been promised. The uninsured have come out of the proverbial woodwork to buy insurance rather than face tax penalties, and since many of them cannot afford coverage, the state is on the hook for their premiums. "Romney won acceptability by obscuring how much money is really needed in the absence of genuine cost controls," says Boston University professor Alan Sager, who specializes in healthcare costs.
Massachusetts had budgeted $472 million for the current fiscal year, but it needs an additional appropriation of $150 million, which will come out of the public purse. Next year could be bad too. When the law was passed, a legislative conference committee projected that $725 million would be needed for subsidies in the third year. Now it looks like the program will need $869 million to cover premiums for those who can't afford them. "I wouldn't characterize the situation as dire," says Jon Kingsdale, chief executive of the Commonwealth Health Insurance Connector Authority, which administers the program. "The affordability issue has always been there." Just last Thursday Leslie Kirwan, state budget director and chair of the authority, said the program next year will cost "significantly" more than $869 million. Money counted on by the law's architects has not materialized. Lawmakers had counted on getting about $500 million to $600 million from the state's free-care pool, which paid hospitals to treat the poor. The theory was that more insured residents would mean less need for free care. But apparently people are still uninsured and need care, so that money is not available. And assessments from employers are not adequate either. Instead of requiring them to cover their workers, the law allows employers to pay $295 per employee per year to help cover the uninsured. The sum was a compromise to keep employers from fighting a mandate that would have required them to spend upwards of $9,000 a year on real insurance for each employee. The state has collected only $6 million so far. One reason: before he left office, Romney changed the rules so fewer employers would be subject to penalties.
http://www.thenation.com/doc/20080407/liebermanIf "universal health care" bankrupts the federal government (while filling the coffers of private insurers), it will fail. Sane cost containment has to be part of a successful program. Disease prevention is one way to keep costs down. But that takes time. The fastest way to reduce expenses is to cut the inflated overhead associated with private plans. Government run insurance like Medicare operates with a tiny overhead. And when you are talking about health care expenses of $7000/person (on average) for a total of 15% of the GNP, trimming overhead costs by ten to 20% can make a real difference. Which is better? Covering 750 people while paying the private insurers a whopping 25% extra for their CEO salaries? Or covering 1000 people while keeping overhead at the low rate of government programs like Medicare? Before you answer, remember that there is a hidden cost associated with the first option. Since those 250 uninsured folks will eventually get sick and go on Medicare or Medicaid, one way or another we are going to provide them health care. Our choice is give everyone relatively inexpensive care to keep them healthy or wait and give some people extremely costly care to keep them from dying.
I know that people who have been unable to get insurance for pre-existing conditions think that their problems will be solved if the feds just force Blue Cross or United to write then a policy. But Mass, where private insurers have had to cover everyone who was willing to pay for a policy since 1977, proves that this just is not true.
The Massachusetts Health Care Plan, negotiated by former Governor Mitt Romney and the legislature, is proving to be expensive, just as critics warned, with the lowest cost plan costing state residents as much as $9,560 per year in out-of-pocket expenses if they suffer a serious illness.
http://www.progressivestates.org/journalists/532/mass-health-care-plan-proves-costly-to-individual-citizensHow many Americans will be better off if they get sick (and can not work) and have to pay $10,000 out of pocket on top of the premiums they already pay? It is not wonder that sickness is the number one cause of individual bankruptcy in this country.
Even if you are lucky (or unlucky) enough to qualify for federal subsides (meaning you are poor), you may still find health care costs are too high. From the Nation article about Massachusetts above:
All people eligible for the subsidies pay co-payments, which are increasing this year from $5 to $15 for doctor visits. Those whose incomes are above 150 percent of the federal poverty level--about $31,000--also pay premiums, and last week the Connector board approved hikes of 10 percent. The lowest premiums will now range from $39 to $116 a month. "We have closed some of the fiscal gap here, but we have not closed most of it," Kirwan said.
Copayments are designed to keep people from misusing their insurance. The theory is that if you have to pay $15 a visit, you will not go to the doctor just to get your kid free Tylenol. Copayments were not supposed to be high enough to keep people from seeing the doctor for necessary services. But that is how private insurance has used them. Some folks pay as much as $30 just to see their family doctor. Prescriptions also have hefty copayments. So do hospital stays. Mental health benefits are notorious for their whopping patient share. Do the math, and you will see that few people who make less than 150 percent of the federal poverty level ($10,000 for one, $22,000 for a family of four) have extra cash to pay towards copayments. These are folks who can barely afford the $4 prescription service at Wall Mart. And remember that those who live in poverty are more likely to suffer from a whole host of disparity related diseases. If you have a family of four and make $33,000 a year, you may be required to pay an additional $100/month per person to get your "free government healthcare." Old math, new math, no matter what system you use, that adds up to "break the family budget".
Here is a nice summary of the problem which Massachusetts faces:
"We've said from the beginning that the basic problem with the reform is that if you don't restructure the system, it becomes rapidly unaffordable and the commitment to cover people begins to fade," said Dr. David Himmelstein, an associate professor at Harvard Medical School and a founder of Physicians for a National Health Program, which advocates for a government-run health system like Canada's. "We're seeing that begin to happen."
http://www.boston.com/news/local/articles/2008/03/26/healthcare_cost_increases_dominate_mass_budget_debate/Rising costs. Lowered commitment to cover everyone. Those are Massachusetts problems now...and they will be problems for all of us if Congress goes through with its plans to design health care reform to benefit insurance companies rather than citizens.
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