The Massachusetts example
What is happening at the national level in part mirrors the Massachusetts experience with health care reform. So what has happened in MA?
It’s quite simple, more people are covered by health insurance and costs continue to go up at a rate many times inflation.
But keep in the mind the objective of the reform. According to Michael Widmer of the Massachusetts Taxpayers Foundation, “Virtually all stakeholders involved in the passage of the 2006 law understood that its principal intent was to achieve near universal access, and that the next chapter would be to deal with escalating health care costs.” In fact, premiums in Massachusetts are expected to rise 7% to 12%.
Some would argue, including apparently most members of Congress, that this is ok; the goal is to get people covered. This is certainly an easy to swallow short term goal and relatively easy to implement. The problem is “short term” is not the concern; it is what happens next that we should be worrying about. In my view the next chapter should be the first chapter.
Medicare provides universal coverage for those of us over age 65, Medicare is also one of the major causes for the federal deficit and will have to be dealt with very soon which in turn will cause, well who knows, higher taxes, more debt, a cut in benefits or all three. In short, a greater portion of available resources to sustain uncontrolled costs, a situation by the way not unique to the United States.
The questions we should be asking is who is better at controlling health care costs and what changes are we really willing to make to achieve that goal.
When answering that question consider that the federal government has nearly forty-five years of experience with Medicare and in that time has not controlled costs, but rather has controlled the cost of the program largely by cutting benefits and cutting what it pays for health services. That works ok as long as you have some place to shift the costs, i.e. the public sector. But what does a universal system do to actually control the cost of its program? It does many things such as:
- Rely on others to fund the cost of research and innovation (as long as there is someone else)
- Fix prices
- Limit or reduce benefits on a regular basis
- Tightly control provision of elective procedures
- Accept waiting times as normal
- Use health clinics to provide care
- Accept lower physician incomes
- Accept what Americans would consider inconvenience in traveling for health care
- Ration care in some manner
- Create an alternative system for those who can afford it.
Again, some people in favor of a universal government system will not find the above objectionable and that’s ok too as long as we all agree that is what we want and that is what we are willing to accept to make health care “affordable.”
Now let’s think about quality…
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