Massachusetts health reform is in the news driven by reports of long waits for care and its architect’s presidential ambitions. Former Massachusetts governor and GOP presidential hopeful Mitt Romney delivered a widely panned speech the week before last on health care.
The three-part speech attempted the impossible: It defended his Massachusetts plan, lambasted President Obama’s copycat plan that took it nationwide and laid out an agenda at odds with his signature achievement.
Unfortunately, he passed up the opportunity to declare the experiment a failure and detail the lessons learned.
The first is that health insurance does not equal access to health care.
The Massachusetts Medical Society just released a study that showed waiting times are, on average, 48 days to see a family doctor, and up to a year for some specialists. Getting a new doctor is tough. One in two family physicians isn’t accepting new patients.
The best definition of socialism is a utopia in which everything is free and nothing is available. That’s long been the case in Canada, where people wait 18.2 weeks on average from seeing a primary care doctor to getting treatment by a specialist. The lines are now extending south.
The Conference Board of Canada just released a study finding that while Canada spends a lot on public health care, its outcomes are middling compared to other developed nations. Not one country above Canada on the list outlaws private insurance for treatment in private clinics as Canada does.
The second lesson is that universal coverage can’t be the overriding goal if one values freedom. It is, however, quite consistent with an intrusive government.
The very controversial individual mandate, which Romney endorsed nationally in 1994 and delivered to the Bay State in 2006, is the logical solution if one maintains that everyone must be covered by third-party insurance.
Yet just as mandatory car insurance does not solve the problem of uninsured drivers, forcing people to purchase insurance will not solve the problem of access to health care. The individual mandate was supported by a number of lies that will give government more control over our health care.
The first fiction? That the uninsured drive up private insurance rates. In Massachusetts, taxpayers were promised that the reform would shift dollars from an uncompensated care pool to insurance premiums.
In reality, government payers Medicare and Medicaid underpay providers and shift costs to private payers. In spite of near-universal insurance, the uncompensated care pool is still shelling out $405 million annually.
Most Important Lesson
Expensive emergency room use has not decreased, as promised by reformers. It instead increased by 9%, or 3 million users, from 2004 to 2008. The biggest users are not the uninsured but those covered by government insurance.
The Bay State’s plan was only possible because it took massive subsidies from the taxpayers of other states. The entire scheme was concocted to ensure that $1 billion of federal money poured into the state. Four out of five newly insured have been merely placed on government-paid plans not private insurance.
This leads to the biggest lesson of all. More government spending requires more taxes.
And it’ll take more than wishful thinking to control costs. Romney wrote in 2006 that “we need no new taxes, no employer mandate and no government takeover to make (reform) happen.”
Yet taxes were increased and will go up again. Costs exploded, and the new party line is that the plan was never about controlling costs. The same will be true of President Obama’s plan.
In Massachusetts, Gov. Deval Patrick is well into phase two of his state’s health reform. The charge of phase two is to radically reorient the payment system to one of global budgets a sort of giant HMO similar to Canada’s system of provincial budgets that leads to restrictions on access to care. In the 1990s, Americans rejected the most restrictive HMOs. Now, they’re coming back sponsored by a government near you.
There’s nothing wrong with being wrong. Some experiments fail. Romney needs to admit it if he wants to fulfill his dream of becoming president.