Because President Obama’s health care law was partially modeled after Massachusetts’ 2006 health reforms, critics of the law have fixated on any piece of bad news they can find coming out of Massachusetts.
RomneyCare does have numerous defects. But the real story coming out of Massachusetts is that the whole thing is a yawner. Health reform in the Bay State has been mainly about money—who writes the checks and who cashes them.
Less Than it Appears
On paper, it looks as though the state has made major progress in insuring the uninsured. From 6.4 percent of the population in 2006, the uninsured rate now hovers around 2 percent. However, nearly all of the newly insured are on Medicaid, in a state-subsidized plan, or in an employer-subsidized plan. Only 7 percent of the newly insured, or about 30,000 people, are directly paying their own way.
It’s relatively easy to get people to sign up for insurance when coverage is free or almost free. And it’s not very expensive if you pay for subsidies using money you would have spent anyway on free care for those who can’t pay their medical bills.
But aside from moving money from one bucket to another, have any real problems been solved? The evidence isn’t positive.
Lacks Real Solutions
There are three major problems in health care all over the world: cost, quality, and access. Since nothing in the Massachusetts reform addressed the problems of rising costs and addressed quality less than adequately, those problems have remained more or less unchanged.
What about access to care? Almost all the newly insured are in health plans that pay doctors and hospitals a lot less than what private insurance pays. As in other places around the country, Massachusetts Medicaid (called MassHealth) pays providers so little that patients often turn to hospital emergency rooms and community health centers for their care when they can’t find doctors who will see them. People in the newly subsidized private insurance plans aren’t faring much better, because these plans pay only slightly more than what Medicaid pays.
Little Change for Patients
What about the effect on patients? As it turns out, there has been very little change at all. The only solid analysis of what has actually happened to patients at this point is a study by Sharon Long and Paul Masi published in the journal Health Affairs. According to the study:
- There has been no significant change in the number of Massachusetts patients seeking care in hospital emergency rooms since the reform was implemented, and there has actually been an increase in emergency room use by people with incomes below 300 percent of the poverty level.
- There has been an increase in doctor visits but no change in visits to specialists, and an actual decrease in “medical tests, treatment and follow up care” (which I assume is care for the chronically ill).
- There has been no change in the percent of the population reporting a failure to “get needed care for any reason within the past 12 months,” and remarkably that includes one-third of those with incomes below 300 percent of the poverty level.
The problem with counting up doctor visits is that a visit is not always a visit. Nationally, in the state children’s health insurance program (CHIP), doctors have responded to an increase in the demand for their services by scheduling more appointments, but they are spending less time with patients. On measures of access, the gap between the poor plus the near-poor and everyone else appears not to have changed at all.
As a society, the primary reason we care whether other people have health insurance is so people will have access to health care. But lack of access to care is a huge problem in Massachusetts right now. According to a recent survey by the Massachusetts Medical Society, more than half of all family doctors and more than half of all internists in the state are not accepting new patients.
The wait is more than a month before a new patient is able to see a family doctor, and the wait to see an internist averages 48 days. The average wait in Boston to see a family doctor is more than two months.
Bad Signs for Obamacare
In a report for the National Bureau of Economic Research, MIT Professor Jon Gruber calls Massachusetts an unqualified success, citing some of the very same studies I am citing. But since Gruber was one of the architects of the Massachusetts health reform, this is like a student grading his own exam—cherry-picking what he likes, ignoring everything else.
Obama’s law will be anything but benign. It introduces new and dangerous distortions that you don’t find in Massachusetts—partly because states don’t have the same powers as the federal government.
ObamaCare is likely to reduce access to care for our most vulnerable populations—the disabled and the elderly on Medicare, the poor on Medicaid, and the near-poor in newly subsidized private insurance. It will cause millions to lose their employer-sponsored insurance, and threatens to cost millions of people their jobs. It will also likely cause a wasteful restructuring of American industry that will make us less efficient and less competitive in the international marketplace.