Read Candace's bio and previous columns
March 13, 2009
Don’t Look to
Massachusetts to Model Heath Care Reform
The Massachusetts model
of health care reform is a costly, unsustainable failure, according to a
recently published study from three Harvard Medical School professors.
The authors are Dr. Rachel Nardin, assistant professor of neurology at
Harvard Medical School; and Dr. David Himmelstein and Dr. Steffie
Woolhander, associate professors of medicine at Harvard.
Keep this in mind
during the debate over national health care reform. One prominent
Democrat taking a lead role in drafting health care reform legislation –
Sen. Max Baucus of Montana, who chairs the Senate Finance Committee – is
talking about national reform “somewhat similar to the Massachusetts
If that’s the case, the
rest of us are shafted, big time. Not only will Congress have poured
mega-billions of our tax dollars into failed banks with no oversight, it
will “reform” health care by giving away the entire candy store to the
health insurance industry.
The foundation of
Massachusetts’s 2006 health care reform is a mandate that individuals
and businesses with 11 or more full-time equivalent employees buy health
insurance. If they don’t provide proof of purchase at tax time, they
face state penalties that rise every year.
Curiously, the Bay
State did not impose any reciprocal mandates on health insurance
companies. Carriers are free to accept or reject anyone they like, raise
premiums as far and as fast as they see fit, and rescind coverage
if/when policy-holders become ill. (Premiums for the four
state-subsidized insurance plans rose 9.4 percent for 2009, far
The result of this
lopsided deal, the Harvard physicians note, is so-called reform that,
unlike its proponents’ promises, does nothing to rein in soaring costs
and actually adds to them with an extra layer of bureaucracy called the
Massachusetts Connector. Under reform, the state’s health care tab has
soared from $629.8 million in fiscal 2007 to $1.1 billion in fiscal
2008, and is projected to be $1.3 billion this fiscal year.
And, after all that,
Massachusetts-style reform still does not provide universal health
insurance coverage. Between 20 percent and 33 percent of the state’s
uninsured in 2006 remain that way, according to various calculations
cited by the study’s three authors.
Baucus has mentioned a
combination of private-public health care reform. Is this what he means?
Massachusetts-style reform privatizes the profits for the health care
insurers while shifting onto the public – state taxpayers – the risks
and ever-rising expenses. On a national scale, we simply cannot afford
this kind of private-public partnership.
The study’s authors
also make a key point too often overlooked in the discussion. Increasing
access to health insurance does not guarantee access to actual health
care. In many cases, low-income Massachusetts residents whose physician
office visits and prescriptions used to be completely free now face
unaffordable deductibles and must do without health care as a result.
This kind of reform is not an improvement by any stretch of the
Just as bad,
Massachusetts reform shovels Medicaid dollars toward expensive care such
as CT scans and surgeries, diverting the funding from basic health care
that can reduce the need for more costly measures. This year, to meet
soaring costs of the program, the state siphoned $150 million in tax
funding from hospitals and community clinics that provide primary care
and, prior to reform, functioned as the state’s health care safety net.
The authors note that
Massachusetts isn’t the first state to attempt health care reform. Since
1988, Oregon, Maine, Minnesota, Tennessee, Vermont and Washington have
all tried to provide universal health insurance coverage – without
The problem, of course,
is conflating health insurance with actual health care. The two are not
the same. Unless and until our legislators get this message and act
accordingly, we can all look forward to outrageously expensive health
care reform that still comes up far short of its goal.
North Star Writers Group. May not be republished without permission.
Click here to talk to our writers and
editors about this column and others in our discussion forum.
To e-mail feedback
about this column,
click here. If you enjoy this writer's
work, please contact your local newspapers editors and ask them to carry
This is Column #CT145.
Request permission to publish here.