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As goes Massachusetts so goes the nation?
April 5, 2006 9:32 AM   Subscribe

Massachusetts is about to pass a "nearly" universal health care plan. It's an ambitious and innovative piece of public policy that mixes tax incentives to insure yourself if you can afford it to direct government subsidies to health care insurers to help cover the poor. Businesses will be fined if they are not going to cover their workers. It still does not cover escalating costs or malpractice wildness. And, it still will leave 5% uncovered. Nor, is it the plan specifically endorsed by Physicians for a National Health Plan (who favor a single payer system) or the AMA (who favor much greater reform of insurance providers). Still, it's a start from making us "the only industrialized nation in the world" to not, well you know.....
posted by narebuc (71 comments total)

 
The goal of the change (universal health care) is sorely needed and as a supporter I can only hope for its success. Still, aside from the cost and medical liability issues, the plan still does not cover everyone (95% -- and especially working people in business of 10 employees or less). It seems to work within a broken system that spends more per capita on health care than any other country and still does not cover everyone -- and has lower rates of life expectancy and wellness totally to boot.

Mostly, I just hope it does not mess up the cause for a national health care system if it does not "work". At some point, the whole country is going to have move to it and let's just hope Massachusetts got a good thing going.
posted by narebuc at 9:36 AM on April 5, 2006


Nitpick filter: China does not have universal health care. Aren't they industrialized?

How does this compare to what was done in Washington state?
posted by caddis at 9:38 AM on April 5, 2006


And, it still will leave 5% uncovered
According to your main link, it's only 1%.
All told, the plan is expected to cover 515,000 uninsured people within three years, about 95 percent of the state's uninsured population, legislators said, leaving less than 1 percent of the population unprotected.
(emphasis mine)
posted by raedyn at 9:39 AM on April 5, 2006


The idea of financially penalizing poeple for not insuring themselves is very strange.
posted by raedyn at 9:40 AM on April 5, 2006


Ugh. What a mess. Penalties for those who can afford but don't buy private insurance. Tax subsidies to insurance companies to persuade them to offer stripped-down plans to lower incomes.
I've heard rumblings that one of the plans gaining ground nationally is the idea of gradually opening Medicare up to more people. Basically rolling back the age limit in stages.
posted by Thorzdad at 9:43 AM on April 5, 2006


Problem: Millions of people don't have health insurance.

Solution: Make it illegal not to buy health insurance!

Sounds like a heck of deal for health insurance companies. For everybody else, I don't get it.
posted by designbot at 9:47 AM on April 5, 2006


raedyn, that's pretty much exactly what I thought when I heard this on the news.

If they can't afford to pay for the compulsory health care then how is taking more money away from them going to help them pay for it?

The idea behind this is a decent one but it seems to me that the implementation is a bit draconian and stupid.

"This is probably about as close as you can get to universal," said Paul B. Ginsburg, president of the nonpartisan Center for Studying Health System Change in Washington.

No, universal healthcare is about as close as you can get. I think what he means is that this is as close as we're going to get given the inherent fuckeduppedness of the US healthcare system.
posted by fenriq at 9:47 AM on April 5, 2006


Stocks in Mass. HMO's should be skyrocketing.
posted by raedyn at 9:52 AM on April 5, 2006


From the article: Businesses with more than 10 workers that do not provide insurance will be assessed up to $295 per employee per year.

Ha! not much of an incentive, honestly, as that is less than the cost of insuring a single employee for a month. So businesses can pay either $295 per year per employee or over twelve times that? Ridiculous.

As a small business owner (who pays 100% of employee insurance) I really feel like this is counterproductive. Why not do a true single-payer program so that the entire state can reap the benefits without absurdly complicated administration and/or penalizing small businesses?

Here in Maine we have "Dirigo Health" which is different from the Mass plan but also really lame. While insurance costs rise and rise coverage gets worse and worse.
posted by miss tea at 9:52 AM on April 5, 2006


Nitpick filter: China does not have universal health care. Aren't they industrialized?

Well, they did 'till the '80s. (Ever since they got rid of it, the health care system has completely gone to pot.)
posted by designbot at 9:52 AM on April 5, 2006


No no no -- you've drank the Koolaid, narebuc. I think this plan is up to no good. It's basically a measure to make everyone purchase health insurance, which is nothing like universal coverage. Similar plans in other states have resulted in an extensive market in "faux insurance," plans that have super-low premiums but have $3000+ deductibles and no hospital coverage (!) -- essentially useless to anyone who wasn't going to be covered by an employer in the first place.

This is an excuse to get people "insured" just so we can say they're insured and stop pretending to give a damn whether they actually have useful access to care.

From the article: "This is probably about as close as you can get to universal," said Paul B. Ginsburg, president of the nonpartisan Center for Studying Health System Change in Washington. The hell it is -- the closest you can get to universal is universal. Canada does it, Singapore does it, basically all of Europe does it.

This is not the health care solution you're looking for. If I have time later I'll try to browse the statute and back up what I'm saying, but I'm really skeptical that this is going to accomplish anything good.
posted by rkent at 9:53 AM on April 5, 2006


This is an excuse to get people "insured" just so we can say they're insured and stop pretending to give a damn whether they actually have useful access to care. - rkent

That's exactly what it looks like to me, to.

/fortunate enough to be born somewhere with universal health care
posted by raedyn at 9:58 AM on April 5, 2006


Sadly, I seriously doubt true, single-payer will never see the light of day in the US, due, almost entirely, to the entrenchment of the insurance industry. Just too much money to be made to let it go. In the end, any national program will have the Blues and other payers at its heart. Probably tax-subsidized (as in the Mass. plan) but still brokered and administered by insurers...which will still, most likely, mean exclusions and rates that prohibit many from getting the care they need.
posted by Thorzdad at 9:59 AM on April 5, 2006


It's basically a measure to make everyone purchase health insurance, which is nothing like universal coverage.

This doesn't seem too out of the ordinary to me. I lived in Connecticut for a while, and they required that you purchase basic liability car insurance. When you were pulled over, the cop would ask for your license, registration, and insurance card.

Now that I live in Wisconsin, when I just bought my new car, the car salesman looked at me funny when I said something to the effect of: "Aren't I required to get insurance?"

Each house I've owned has required title insurance, as well as some sort of homeowner's policy. I don't know if that's a state law, however, or a simply a stipulation of every mortgage company I've dealt with.

Of course, we're talking about people here, and not cars or houses. It just seemed a pretty good parallel that legislation should mandate inclusion into some sort of insurance plan for a human being when it may already do it for other insurable objects in our lives.
posted by thanotopsis at 10:00 AM on April 5, 2006


If they can't afford to pay for the compulsory health care then how is taking more money away from them going to help them pay for it?

According to this Yahoo link:
The Massachusetts policy provides insurance to the lowest-earning residents by offering low- or no-cost plans, with premiums and co-payments paid entirely by the state.

Residents who can afford insurance but do not choose a plan by July 1, 2007, will face tax penalties that year, as incentive to take out insurance in an attempt to reduce health-care costs statewide.
So it is really more of a case that those who can afford it but don't buy insurance will be penalized.

From the NY Times link:
Eric Fehrnstrom, the governor's communications director, said that for those people with incomes above 300 percent of poverty, "our assumption was that these would be mostly single mothers who just did not have the wherewithal to get insurance. It turned out it was mostly young males. In some cases they are making very attractive salaries. These are people who just don't imagine themselves needing care, but of course when they break a leg when they're out bungee jumping they go to the hospital and we end up paying for their care anyway."
posted by Secret Life of Gravy at 10:03 AM on April 5, 2006


As a small business owner (who pays 100% of employee insurance) I really feel like this is counterproductive. Why not do a true single-payer program so that the entire state can reap the benefits without absurdly complicated administration and/or penalizing small businesses?

In my opinion we have the insurance lobbies to thank for the half-assed state plans that are in the works. And Dirigo is proof that it's really hard to implement something like this on a small scale.

If there were a true universal system and it was administered properly a lot more small businesses would start and flourish. The key is running a system like this efficiently, and I'm doubtful that either the feds or most states have what it takes.
posted by SteveInMaine at 10:05 AM on April 5, 2006


The Massachusetts policy provides insurance to the lowest-earning residents by offering low- or no-cost plans, with premiums and co-payments paid entirely by the state.

Hm. Sounds good on its face, but just wait and see if has the features I mentioned above -- huge deductibles and major gaps in coverage (like hospitalization).
posted by rkent at 10:07 AM on April 5, 2006


Sadly, I seriously doubt true, single-payer will never see the light of day in the US, due, almost entirely, to the entrenchment of the insurance industry.

I think America will get single-payer, universal health care. We can't afford not to -- our system is irrevocably fucked, and getting worse by the minute. American business won't be able to compete in the near future because of crippling health care costs.

There are two ways out of that mess: support universal health care, or make America a nation of uninsured people.

Initially, big business being in the Republican sphere, the latter will happen. At which point, America will become a shitty place to live for awhile. Eventually, some crisis a la the Great Depression will awake the great, slumbering masses, and after years of damage and trillions in pillaging, people will finally wake up to the con game that has been played at their expense under the name of Republicanism. At that point, universal healthcare will be a certainty in America.

But it's going to hurt like hell to get there. It's all just a little bit of history repeating.
posted by teece at 10:08 AM on April 5, 2006


  1. Cut the US defense budget by 10%.
  2. Universal health care.
  3. There is no step 3.
We could still spend as much as every other country put together on defense, and we wouldn't have to raise taxes.
Isn't it pretty to think so?
posted by kirkaracha at 10:12 AM on April 5, 2006


As I understand it, the reason to force people who can afford to have insurance to get it is to reduce the cost for those with less money. The more people that are buying insurance, the lower the premium the insurance companies can charge and still make money. Since the advent of insurance programs that allow you to pay less a month, but have a higher co-pay, so many healthy young people (who have fewer hospital visits and prescription needs) have opted for this that the insurance companies had to up the cost of the premiums for people who use their services more (the older people, usually with less money and more needs). At least, that's how I understand it.
posted by JonahBlack at 10:15 AM on April 5, 2006


It's even easier, kirkaracha -

1. Fire all the health care administrators whose only job is to pass the bills to someone else.
2. Use the savings (over a third of all health care expenditures!!) to provide coverage to all the uninsured.
posted by rkent at 10:15 AM on April 5, 2006


3. (thus making useless the positions we eliminated in step 1...)
posted by rkent at 10:16 AM on April 5, 2006


teece has it ... it's going to take some major hurt to get the american people off their asses and do something about our dystunctional system
posted by pyramid termite at 10:21 AM on April 5, 2006


Aren't businesses in Mass. already hurting because of the tax load there?
Deval Patrick, Democrat for Governor of Massachusetts

Jobs, and the businesses that create them, have been leaving Massachusetts in alarming numbers. Nearly 192,000 non-agricultural jobs have been lost since December 2000, compared to a modest increase nationwide. Out-of-state conglomerates have acquired longstanding Massachusetts businesses such as Gillette, Hancock, Fleet and Polaroid, moving jobs and civic leadership out of state. As a result, the only state in the nation to have lost population last year - nearly 60,000 people net out-migration between 2003 and 2004 -- mainly young families who can no longer afford the high housing costs. Massachusetts is losing her future.
So - the answer is to provide health care and essentially tax the end user and businesses more to provide it?

Somehow, I think the Law of Unintended Consequences applies here. They might want to build a border wall to keep people from leaving.
posted by JB71 at 10:29 AM on April 5, 2006


...it's going to take some major hurt to get the american people off their asses and do something about our dystunctional system
I dunno. Millions are already living without health coverage and I've yet to see any crowds on the march. Americans have been so conditioned to just accept whatever they are handed...and assume any hardships are their own fault.
What will truly move us toward single-payer will be when big business finally has enough of it and barks a strong "fuck you" to the insurers and pressures the feds to finally do something substantive.
posted by Thorzdad at 10:32 AM on April 5, 2006


This doesn't seem too out of the ordinary to me. I lived in Connecticut for a while, and they required that you purchase basic liability car insurance.

The idea there being that it protects the people you might hurt with your car.

Each house I've owned has required title insurance, as well as some sort of homeowner's policy. I don't know if that's a state law, however, or a simply a stipulation of every mortgage company I've dealt with.

Stipulation of the mortgage companies, so they have some protection against losing their investment. If you bought your home cash, you'd be foolhardy but completely free to choose not to purchase insurance.

It just seemed a pretty good parallel that legislation should mandate inclusion into some sort of insurance plan for a human being when it may already do it for other insurable objects in our lives. - thanotopsis

I see what you're getting at, but the difference in your examples is that in those examples, you aren't forced to do buy insurace for you OWN protection, you're buying it for someone else's protection.

So - the answer is to provide health care and essentially tax the end user and businesses more to provide it? - JB71

If helps if you read the article. There is no new taxes to fund this, because there is very little new state dollars dgoin into the plan. It's mostly a plan to make people go buy their own coverage & have more employers provide coverage.
posted by raedyn at 10:41 AM on April 5, 2006


This really is a poisoned plan that sounds good in newsbites (and helps Romney in his 08 bid) but sucks. We can't rely on business- or job-based coverage, and there are no requirements for HMOs to stop denying people coverage. This looks like a giant windfall for HMOs as well, without requirements for them to regulate prices they charge people.

Any real solution cannot rely on the same broken systems of HMOs and job-based coverage--we have to build on what used to be wonderful Medicaid/Medicare and WIC plans. It has to not rely on private companies but if it does must regulate and enforce and fine them heavily for noncompliance or price gouging, which certainly won't happen in Mass.

There are almost 50 million uninsured Americans and the number is rising each year. What's going to happen when it's 1/3 of the population? (which will be soon, the way the jobmarket is). And what about the WalMarts, who don't give coverage to most of their employees?

And why punish people who can't afford it? That's the worst part of this plan.
posted by amberglow at 10:44 AM on April 5, 2006


Is there any mention anywhere about whether the very high cost of living in Mass (one of the highest in the country), and their job growth stats and types of new jobs created were at all thought of when crafting this? the Times had nothing about that.
posted by amberglow at 10:47 AM on April 5, 2006


Thorzdad said "What will truly move us toward single-payer will be when big business finally has enough of it and barks a strong "fuck you" to the insurers and pressures the feds to finally do something substantive."

Wrong.

Insurance companies are stockpile of cash. They use said cash to finance banks and invest in enormous mutual funds. The banks handle loans to Big Business. Big Business knows which side it's bread is buttered on. You will _NEVER_ see a large corporation go after the insurance companies. Should any large single insurance company pull it's money from the market, Wall Street would go apeshit and fall on it's knees begging them to reinvest. It's the same reason we don't do anything to make China directly upset with us (like, you know, invading North Korea, since, you know, it's on the same continent as the rest of China, and they'd see that as the U.S. preparing to invade mainland China , as silly a notion as that might be).

Insurance is the "Big Sock Theory" escalated to the ludicrous
zone. You don't mess with the guy who you've contacted to pay for your health bills, especially when he is also paying your salary by investing his money in your company. It's just one of those things that is not done.
posted by daq at 10:48 AM on April 5, 2006


As I understand it, the reason to force people who can afford to have insurance to get it is to reduce the cost for those with less money.

But here's my question--don't hospitals only cover indigent uninsured? So in the hypothetical case of the affluent 25 y.o. man who breaks his leg, they would send him a bill and he would be obliged to pay it just like any other bill, unless he declared bankruptcy, which would probably be unlikely given his purported affluence. It's nonsensical circular argument to say that the affluent healthy are incurring all the costs that drive up health care overall.

And regarding the tax situation-- although businesses do not in fact pay a 'tax' on health insurance, their income is reduced by the amount they pay for the insurance, thus reducing the tax base.

And in an aside to Steve-- isn't it ironic that Dirigo is basically making the insurers even more money? It's also absurdly administered. My husband, who is self-employed, sent away for information TWICE and never got it-- and then looked on the website which said enrollment for self-employed people was already closed. WTF.
posted by miss tea at 11:04 AM on April 5, 2006


I see what you're getting at, but the difference in your examples is that in those examples, you aren't forced to do buy insurace for you OWN protection, you're buying it for someone else's protection.

True you're not protecting another individual, but you are protecting "society." You get seriously injured or ill and don't have insurance, the state pays. You get seriously injured or ill, the investment that the state made in you (primarily via compulsory education) becomes a big fat waste.
posted by 1-2punch at 11:06 AM on April 5, 2006


Interesting point, daq.

The problem is this: any discussion of a universal health-care system is sort of bankrupt without defining the context in which the system needs to exist. The decision to be made is not who pays what and for whom and why.

The decision to be made is more along the lines of determining which is more important: 1) a society in which every citizen can rest assured that medical training and technology (ie: one of the most human endeavours ever) is available to them, or 2) a society which adheres to the bottom line, and allows itself to fall into the contortions that you've outlined so that a few thousand people who are never going to get sick anyway can afford a three-car garage and a crystal kitty litter box.

Obviously, through my language, it's easy to understand that I prefer the former system. That's the kind of society (Canada) I was raised in.

The latter system can't be conquered until you don't care about the rich as much as they don't care about you (and I mean all of you. The real sinkholes of society probably aren't fretting away in this thread.) They don't care if you die? Good, you don't care if they die. They enact policies which plunge large swaths of the population into poverty, disease and addiction, eventually leading to death?

One grasps the point.
posted by jon_kill at 11:13 AM on April 5, 2006


How does this help the unemployed?
posted by delmoi at 11:15 AM on April 5, 2006


> You get seriously injured or ill and don't have insurance, the state pays.

For the poor on Medicare, the state pays, but they couldn't afford insurance anyway, under the old system or this new one. For anyone else the state does NOT pay -- the hospital and the doctors bill the patient directly, and eventually sic a collection agency on him if he doesn't pay. Hospitals won't let you in the door until you've signed a document acknowledging responsibility for payment.
posted by jfuller at 11:23 AM on April 5, 2006


...the hospital and the doctors bill the patient directly, and eventually sic a collection agency on him
The truly heinous part of this is that the patient will have to pay the full non-discounted rate, unlike the heavily-discounted rates providers negotiate with the insurers. This can mean paying double (or more) the rate paid by the insurer.
posted by Thorzdad at 11:28 AM on April 5, 2006


From the Boston Globe article:
As for the requirement on individuals, those who don't get coverage would first lose their personal income tax exemption. Eventually, they could face a yearly fee to the state equal to half of the lowest-cost available insurance plan.
But those aren't the "tax incentives" people are talking about. The incentives go, of course, to the insurance industry. they get the carrot; we get the stick.
Also:
The final bill also affords Romney something he desperately wanted: the power to veto individual sections of the bill while approving others, which means he can pick and choose what he wants to be included.
He's about the last person on Earth I'd like to see tinkering with a healthcare-payment system. And if you're wondering about the impetus behind it:
One question that remains is whether the state has moved quickly enough to satisfy federal officials who had threatened to end $385 million in annual federal Medicaid funding. Massachusetts needed to demonstrate substantial progress in reducing the number of uninsured to continue getting the money, and federal officials had urged the state to have a plan in place by January.
It's just another windfall for the insurance leeches.
posted by Kirth Gerson at 11:32 AM on April 5, 2006


Note: My current job goes away with Universal Health Care.

#include std_disclaimer.h

Having said that.

The current US job-based insurance system is insane. For one thing, it breaks the rule of efficent insurance -- you want the largest population pool possible, but instead, we break the pool into thousands of smaller ones (and throw a third of the country out of the pool completely.)

Now, add in the pervese effects of job changes. Insurance companies are no longer will to spend much money on prevention, because if you change jobs, you may change carriers, which means they've just lost the money they've spent on prevention on you, and made you a better risk for a competitor.

So, in this situation, the way to increase profitiability is to restrict care and increase premiums. Thus, as we go on, higher copays, and more restricted care. Those of you who had coverage five or ten years ago, go dig it out and compare to what you get now. You'll probably not be pleased. If you can, find out the true cost of those plans, and compare.

The US has the highest quality healthcare available -- for about 40% of the population. It has somewhat good, but finacially castatrophic in severe cases, healthcare for about 25%. The rest? They have no health care other than thier own pockets, which doesn't buy much for the vast majority of those uncovered.

This situtation will not improve. Money talks in the US, the US Health Insurance industy has staggering amounts of money.

Hell, the complexity of insurance is insane. That's why my company exists, we help providers (that's the industry term for Doctors and the like -- the people who actually treat you and those who help them) get the claims through the system as fast as possible, since it is in the best interest of the insurance companies to slow them as much as possible, if they can't deny outright. So, they game the claim, and we game back -- they want double dotted i's, we do that. Plus, we can file with most electronically, since we batch, which smaller providers can't easily do. But I'm sounding like a sales pitch, I'm sorry.

The point I really want to make is my company shouldn't need to exist. The insurance game is so whacked that there's a very real market for middlemen to figure out the oddball rules. In some way, I dislike even being part of it, but at least I can sleep with the though that I'm working to get Doctors paid and patients claims approved.

Of course, all of that helps thirty some percent of the US population none.
posted by eriko at 11:37 AM on April 5, 2006


I still don't understand where this consensus about medical care came from. Why is it normal to demand health insurance from the government, and not, say, guaranteed food or housing? Why are people all up in arms about the numbers of people with no health insurance, and not about the numbers of people who are one paycheck away from disaster for any of a host of other reasons?
posted by Mars Saxman at 11:51 AM on April 5, 2006


he hospital and the doctors bill the patient directly, and eventually sic a collection agency on him

In reality, ER & hospital bills for one-time care for acute conditions are commonly forgiven or drastically reduced for the poor and uninsured.

Blue-collar middle-aged man has a stroke and racks up $10,000 in ER and neurologist bills? It's pretty common for the hospital to say, "Um. Pay us $1000 and we'll forget about the rest," because they know the alternative is to drag the poor stroke victim to court, generate a whole lot of bad publicity and legal fees for themselves, and end up with the guy declaring bankruptcy anyway.

Also, it is very frequent for doctors, particularly specialists, to reduce their fees for self-payers. They may tell the insurance companies, "A consultation in our office costs $300." but if you walk in the door and offer to pay right away they'll only charge $200. There's a hospital near my home that if you pay your ER bill within 30 days they'll slash it by 50%.

I'm not saying the system isn't broken. It's horribly, horribly broken, and these are just ways that the doctors and facilities are trying to make their ends meet without totally screwing over their patients. What ultimately ends up happening is that the insurance companies and the government ends up footing the bill for these slashed rates and discarded bills. If an ER can't make ends meet, either the hospital will re-negotiate prices with the insurance companies to raise their fees across all other services, or they get a subsidy from state or local government.

So those of us in the higher echelons of income and insurance coverage are already paying the bills for the uninsured and poor. We're just doing it in the most roundabout, ineffecient way possible.

And of course, people who don't have insurance find it daunting, to say the least, to obtain preventative care - even if the doctor is willing to give you a 25% discount, there's always the "$200 is a lot of money right now, it can wait until next week." factor. Of course, a dollar of prevention is worth a hundred dollars of cure - so we have poor people who for lack of a yearly visit to a cardiologist end up going to the ER for a heart attack, costing the hospital 10x as much (or more) that they would have had they just seen a doctor in the first place. And, again, the ER bills are likely to end up shouldered by the taxpayers and the insurance companies.

The latter system can't be conquered until you don't care about the rich as much as they don't care about you

There are benefits to a universal health care system beyond just redistributing the cost. This is not a rich versus poor issue - the rich are already footing the bill.

And now I hit "Post Comment" and wait for the eventual GYOFB.
posted by Feral at 11:52 AM on April 5, 2006


I dunno. Millions are already living without health coverage and I've yet to see any crowds on the march. Americans have been so conditioned to just accept whatever they are handed...and assume any hardships are their own fault.

My observation is that there are a huge chunk of people raised with the brainwashing that America is the best there is, and who haven't lived in any other country, and it just doesn't occur to people that things are really that bad here. You especially see this is any discussion of poverty - many thing that the poor in the US are doing ok compared to other countries, when they're worse off (unless you consider the peers of the USA to be the third world).

Even in healthcare, which most people know is universal elsewhere, you hear signs that deep down, people assume it's a trick - that universal healthcare is a socialism that will eventually harm those countries, or persistant myths that the health system of [insert country here] is on the verge of collapse. (The health system of [insert any country here] has been "on the verge of collapse" since before I was born, and still delivers far better healthcare than the US system, with no sign of stopping any time soon).

So many here seem to just fundamentally assume that since it's how the USA does it, it's not thatbad. It might have its flaws and its quirks, sure, but it's an acceptable system, because it's what the USA does.

There is no frame of reference. When I've described healthcare where I grew up, it blows people's minds.

People simply don't know what universal healthcare means at a personal level - the vast and deep ramifications that affect all layers of how society functions. As long as "universal healthcare" is thought to just mean the current broken insurance system for everyone, few here will "get" it, and if no-one gets the concept, no-one will fight for it.
posted by -harlequin- at 12:02 PM on April 5, 2006


Here's the real problem with this: requiring everyone to carry health insurance does NOT provide everyone with health care. This isn't a way to make sure the residents of Massachusetts stay healthy; this is a way to make sure the insurance companies of Massachusetts maintain a healthy cash flow.

We don't need affordable (mandatory) health INSURANCE, we need affordable health CARE. The two are not synonymous, and this law does nothing to fix the underlying problem, which is that adequate, affordable health CARE is outside the reach of many Americans. Even with insurance.
posted by jennaratrix at 12:06 PM on April 5, 2006


Well put, jennaratrix.
posted by raedyn at 12:14 PM on April 5, 2006


I figured the analysis -- the smart analysis at least -- would lie along the lines. This plan seems ready to be an expensive failure. Even at the $300 penalty for not covering yourself I can't see how many people will find it prohibitive.

I look at good health care in such a way: Will it let a 55 yo waitress working full time in a diner (say that has less than ten employees -- which is expempt fromt the Mass law) -- get a mammogram?

This plan still won't. Instead, if the lady has breast cancer, she'll have to wait till it grows and becomes inoperable and spend a long, slow much more expensive death in the hospital.

Its a simplistic analogy yes -- but the economics AND THE MORALITY behind it are hard as rock.

As posters have said, insurers are coming out ok and possibly ahead here. Always be suspicious when the Big Insurance is not saying anything or not complaining.

A single payer is your best source. Of course, I'd still let the wealthy pay and get out of it if they want (something that is culturally much more ok here than in England) but it's the only thing that will help you keep your insurance for you and your family through thick and thin. Imagine -- being fired or even being able to leave a job you just hate and never having to worry about insurance!
posted by narebuc at 12:33 PM on April 5, 2006


Millions are already living without health coverage and I've yet to see any crowds on the march.

I think jennaratrix makes some great comments, but there is one other factor.

Look at which Americans are uninsured right now. By and large, they are an unrepresented group, that does not have major say in either party apparatus, and that does not regularly get to the polls and vote.

It's when uninsured people go completely and massively mainstream, which is going to happen, that this system begins to collapse. Right now, enough Americans are passably happy, enough to not care about the insurance situation, and the ones that are getting screwed by this current system are not organized enough to do anything about their plight.
posted by teece at 12:36 PM on April 5, 2006


rkent -- I am indeed skeptical. Its just that media is going to cover this plan as the "most ambitious step towards universal health care" (and Romney certainly will) and, so the debate will be held in that regard.

Its such an important issue to our purpose as a country and also our economy.....I just hope it does more good than bad. Its set up to do more bad for the greater cause, I fear.
posted by narebuc at 12:36 PM on April 5, 2006


it is in the best interest of the insurance companies to slow them as much as possible, if they can't deny outright.

Which they often do, even if it is a covered service. My experience with Blue Cross is that they deny payment on just about everything, until you complain. Then, they agree to pay, while making it sound like they're doing you a big favor.

This bill is, of course, irrelevant to health care; it's about mandating insurance, not care.

Remember W saying during one of the debates, "Our healthcare system is the envy of the world"? Did you think you were included in that "our"? You're not.
posted by Kirth Gerson at 12:53 PM on April 5, 2006


Mars Saxman: I still don't understand where this consensus about medical care came from. Why is it normal to demand health insurance from the government, and not, say, guaranteed food or housing? Why are people all up in arms about the numbers of people with no health insurance, and not about the numbers of people who are one paycheck away from disaster for any of a host of other reasons?

I think it's a combination of the fact that other places have universal health care, even if they haven't solved problems of poverty and universal housing -- it's out there, we can see that it works. Or at least, policy wonks can. Also, these things are all wrapped up together: lack of affordable health care leads to lack of money for proper food and housing. See "The Two Income Trap" and some of Elizabeth Warren's subsequent work.
posted by rkent at 1:01 PM on April 5, 2006


So if the State decides that you can afford insurance, the
cheapest way for you to get out of it is to simply take the
hit on your yearly state taxes, to the tune of about half of
the yearly premium for the cheapest policy (the Boston
Globe reports that penalties could be as much as $1000 a
year). Lots of people short on money do the cheapest thing.

I assume that this penalty taxation goes into the general
fund and is not earmarked for supporting the medical costs
incurred by the state for aiding the indigent or uninsured
(there was no mention of the disposition of the penalty
taxation in the report).

The Boston Globe reports "Lobbyists for hospitals, insurance
companies, and other major players in the healthcare industry
were paid at least $7.5 million in 2005 as the Legislature took
up a major healthcare bill, records show."
posted by the Real Dan at 1:20 PM on April 5, 2006


This isn't a way to make sure the residents of Massachusetts stay healthy; this is a way to make sure the insurance companies of Massachusetts maintain a healthy cash flow.

We don't need affordable (mandatory) health INSURANCE, we need affordable health CARE. The two are not synonymous,


Not exactly. The way things work in medicine these days is that if you present with a symptom that raises serious concern, even a basic, minimal work-up is catastrophically expensive, and this will allow a person to have the same level of investigation of their concerns as someone with plenty of money/insurance. This is hardly a windfall for insurance companies. The poor/underinsured tend to be unhealthier. They are now going to be utilizing services they didn't before. Who will be mandated to pay for their CT scans, consults, and labs? The HMO's you disparage.

But on the upside, a lot of people who would have sat at home watching their feet rot off because they couldn't afford medication for diabetes now will live out a lot better years and also save you and society a lot of money in the process. Oversimplified a bit for brevity, but for Christ's sake, get off the Universal Health Care soapbox and give MA some credit.

Why should mandating health insurance carriage be any different than auto insurance?
posted by docpops at 1:34 PM on April 5, 2006


Who will be mandated to pay for their CT scans, consults, and labs? The HMO's you disparage.

You think there's anything in this bill to make the insurance companies pay for those things? Seriously?

this will allow a person to have the same level of investigation of their concerns as someone with plenty of money/insurance.

Again, you actually believe that? What kind of insurance do you have?
posted by Kirth Gerson at 1:46 PM on April 5, 2006


They can make a law that says Joe Average has to buy insurance, but it doesn't mean anything unless they also make a law that says the insurance company has to write him a policy at a reasonable rate.

This does not compare to having to have car insurance on your car or homeowners insurance on your house. You can get out of those requirements by not owning a car (choose to use mass transit) or not owning a house (rent). You can not choose to not have a body.

I know people who cannot get private health insurance because of pre-existing conditions, and I know people who can get health insurance but at ludicrously high rates. And I even know one person who had to get a signed statement from the company he works for as a contractor saying he is not eligible to get health insurance from them before he could get private health insurance. This law may help the demand side of the health insurance, but it certainly doesn't help the supply side.

I'll also point out that the penalty for employers who do not provide coverage is $295 per year. Since that's just a shade more than it should cost to provide health insurance for one month I officially find this fine laughable. And as the final insult to intelligence, this is a state law and therefore does nothing about the Federal tax implications of health insurance, which is a deductible expense for employers but not for employees.
posted by ilsa at 1:55 PM on April 5, 2006


this will allow a person to have the same level of investigation of their concerns as someone with plenty of money/insurance.

Again, you actually believe that? What kind of insurance do you have?
posted by Kirth Gerson at 1:46 PM PST on April 5 [!]


Kirth - Yeah, I do. I'm a doctor, and in Oregon we have a similar thing called OHP (oregon health plan) and absolutely, we can and do order the same workup and get it paid for and covered for any person with that plan. They just don't cover a lot of things "below the line", which, if you are the patient, may seem like an unfair deal, but it covers thousands of people from medical and financial ruin.

And yes, the HMO's will put reviews on the types of care ordered, but they have to. I can understand people's cynicism, and I'm not defending the insurance industry (God knows, I'm not), but this is the sort of effort from states that needs to happen more broadly to seed support for more universal coverage on a federal level.
posted by docpops at 2:03 PM on April 5, 2006


I guess the question I have for the haters is this - was the old system somehow better? Wait, I already know the answer - if it isn't Universal, totally free, without constraint or expctation of personal responsibility, then it's flawed and unfair from the outset.
posted by docpops at 2:05 PM on April 5, 2006


Why is it normal to demand health insurance from the government, and not, say, guaranteed food or housing? Why are people all up in arms about the numbers of people with no health insurance, and not about the numbers of people who are one paycheck away from disaster for any of a host of other reasons?

What rkent said. Health care is one example of a universal service that every other major industrialized nation offers to its citizens, along with public schools, police services and publicly maintained infrastructure (roads, sewers, water, power). Like these other goods, the costs of providing them at an accessible level is high, but the cost of not having them is higher.

Oh, and publicly funded health care isn't 'free' -- it's paid for through taxes and regulated by the state. You pay for it the same way you pay for freeways to be cleared of snow or for clean drinking water, and it's about as universally necessary.

And yes, I'm Canadian. We've only had universal health care since 1968, and it started, back in 1962, with one of the smallest, poorest provinces. It spread quickly, as with most good ideas. I've still met people who lost relations because they lacked the money for medical care in the days before healthcare.
posted by jrochest at 2:07 PM on April 5, 2006


And we're paying for it now anyway--thru emergency rooms and public hospitals. No preventative care, and no catching of things before they become serious/deadly/a risk to a community/etc.

Universal Health Care is also cheaper than what we have now--for people, companies, and the government--it's win-win for everyone except HMOs.
posted by amberglow at 2:31 PM on April 5, 2006


Why should mandating health insurance carriage be any different than auto insurance?

Yeah, see, I ain't real crazy about that, either – though, you know, it's liability insurance that's mandatory, so there's a little better rationale. So much for ever moving back to Massachusetts.
posted by furiousthought at 2:39 PM on April 5, 2006


The first failure of Universal Health Care is implementation and staffing. In order to meet the demand of a system to cover _all_ citizens, you will have to at least quintuple the number of administrators, nurses, nurse practitioners, accountants, and doctors. The various medical schools will have to raise their limits of doctors that graduate. Teaching hospitals will have to increase their intern programs. Blah, blah, blah. So are tax payers supposed to pay for this? Doubtful. Insurance companies? Not likely. So it won't happen.
Next problem will be quality. Invariably, since the number of doctors has increased, the competition will increase. Back to the education front, I'll use a great joke. What do you call the guy who graduated last in his class at medical school? Answer: Doctor. Think about that one kids.
How many nurses have you had wait on you in the hospital? How many seemed happy to be there? How many seemed like they wanted to be anywhere else doing something other than dealing with your sick ass? Yeah, another winning solution. How many nurses went into the field because it paid better than beauty school? Sure, sure, I'm just stereotyping. There a lots of people who genuinely care about people and go into health care because they like working with people and helping people. For about the first 2 years, at which point the veneer starts to fade and they see one too many OD's and one too many drunk driving accidents, and one too many GSW's.
Suprisingly, the only hospitals I've seen that actually function somewhat close to what the "ideal" situation would be military base hospitals. Which is kind of funny really. But in the military, all soldiers are required to report for yearly physicals. With the "ideal" Universal Healthcare plans that everyone seems to dream about, are all citizens required to show up for yearly physicals? What happens if they don't? What happens if they show up drunk? Or stoned? Or high? Does the doctor have them arrested?
Next we have the tracking of patients. Medical records are protected by law as private personal information. But you get a National system and suddenly you have to have a National database for everybodies records. Suddenly instead of the file clerk at the hospital and the doctor who sees you, you have 20 more people in the middle who _have_ to see your medical records. This means your privacy is open to viewing by more people you don't know. And that really bugs me, I don't know about you.
I'm sorry, Democrat Mommy-staters, I'm not ready to give up my privacy, my right to die, my right to hurt myself doing things I consider fun, my right to be stupid, just because you want to be free from paying some evil corporation. Any system that comes out now will simply be the incorporation of the existing structure into the health care system, only government mandated, which means mandatory health insurance for those who are "able" to pay.

Thank you, I've read too much Heinlein.
posted by daq at 3:04 PM on April 5, 2006


Blue-collar middle-aged man has a stroke and racks up $10,000 in ER and neurologist bills? It's pretty common for the hospital to say, "Um. Pay us $1000 and we'll forget about the rest," because they know the alternative is to drag the poor stroke victim to court, generate a whole lot of bad publicity and legal fees for themselves, and end up with the guy declaring bankruptcy anyway.

Tell that to Yale-New Haven. Acute care, under $10,000, and they still go after it. This is a nasty, nasty hospital.
posted by jb at 3:15 PM on April 5, 2006


Blue-collar middle-aged man has a stroke and racks up $10,000 in ER and neurologist bills?

Try 20-30,000.
posted by docpops at 3:27 PM on April 5, 2006


Next we have the tracking of patients. Medical records are protected by law as private personal information. But you get a National system and suddenly you have to have a National database for everybodies records. Suddenly instead of the file clerk at the hospital and the doctor who sees you, you have 20 more people in the middle who _have_ to see your medical records. This means your privacy is open to viewing by more people you don't know. And that really bugs me, I don't know about you.
Nowadays, tho, they are being used against people with sometimes dire effects--HMOs and employers release them all the time. People are not hired bec of them, people are charged higher insurance rates or denied insurance altogether bec of them, people are kicked off of health plans for what's called "overuse" of them, people have to release them to get into college (esp. vaccinations), etc.

And very few hospitals write off debts anymore--they pass them on to collection agencies--even Public Hospitals.
posted by amberglow at 3:33 PM on April 5, 2006


daq - have you researched how it works in countries with universal health care at all? It doesn't sound like it.

You bring up a bunch of scary sounding scenarios that don't happen in any other country with universal health care, so there's no reason that they need to happen in your country.

Using Canada as an example, since it's the country I know best:

are all citizens required to show up for yearly physicals?
No. But they are more likely to do it, because there is no longer a reason not to. You don't have to come with a chequebook when it's time for a physical.

What happens if they don't?
Nothing. See above.

What happens if they show up drunk? Or stoned? Or high? Does the doctor have them arrested?
What happens in the US right now when a patient shows up in these conditions? There's no reason to change the approach.

Next we have the tracking of patients. Medical records are protected by law as private personal information.
Medical records are protected by law as private personal information in Canada as well.

But you get a National system and suddenly you have to have a National database for everybodies records.
No. Your whole medical files aren't in the provincial database. Your family doctor's office and the specialists you see each keep their own files. If you go see Dr. X at a walk-in clinic one day, he won't forward the file to Dr. Y, your regular family doctor without your express permission. The only thing in the provincial database is the things providers are billing for. This already exists in your system, it's just your insurance comany that has the data rather than a government department.

Suddenly instead of the file clerk at the hospital and the doctor who sees you, you have 20 more people in the middle who _have_ to see your medical records. This means your privacy is open to viewing by more people you don't know.
Portions of your records are already viewed by many people. The people in your doctor's office, the people in the company your doctor employs to help her get paid (like where eriko works), various people at your insurance company. Each person only gets to see what they need to in order to do their job, and they all sign confidentiality agreements. It's the same under a single payer plan, just they have a different employer.

I'm not ready to give up my privacy, my right to die, my right to hurt myself doing things I consider fun, my right to be stupid
People in Canada & other nations with similar healthcare plans still have all these things. How would universal health care prevent any of these things? What a bizarre arguement.

With Universal Health Care, there is no route for information to get back to your employer. There is no such thing as being denied coverage because you've got a "pre-existing condition". All your family's visits to the doctor are without cost to you - even if you've got athsma, or heart disease, or have recently changed jobs. It's a whole different world.

Something to consider - part of how Canada affords all this is because (with a few exceptions) hospitals are all public, so there's fewer middlemen trying to profit somewhere in the process. It reduces the costs somewhat.
posted by raedyn at 3:45 PM on April 5, 2006


The first failure of Universal Health Care is implementation and staffing. In order to meet the demand of a system to cover _all_ citizens, you will have to at least quintuple the number of administrators, nurses, nurse practitioners, accountants, and doctors.

Nice to finally see some real hard statistics in support of the anti-universal health care argument.

However, I'm afriad quintupling won't be nearly enough. According to this study I just pulled out of my ass, we will need 50 kajillion billion more administrators if we replace the hundreds of health insurance companies with one federal agency!

Just look at what happened to Imaginatistan, the country where they adopted universal health care and it didn't make things better—you can't even find it on the map anymore!
posted by designbot at 3:54 PM on April 5, 2006


Thank you, I've read too much Heinlein.

Pretty much sums up that entire post.
posted by Feral at 4:22 PM on April 5, 2006


I tend to think this is going to work about as well as the new prescription drug benefit....which is so complicated to begin with. For example the fact that you have to choose one company (based on the drugs you currently take) you are locked into that choice for a year....but the company you chose is under no obligation to continue to cover your specific drugs. In fact there is nothing to stop them from dropping that drug from it's list the next day....and you are screwwed. I predict this system will fail for similar reasons...it favors the insurance company's bottom line, not society.
posted by SweetIceT at 4:31 PM on April 5, 2006


In the past four months I've had the misfortune of going to the doctor's office seven times and the emergency room once. I also went for X-rays at a private lab. The only time I opened my wallet to take out my provincial health care card. Heck, at the emergency room they even gave me a day's worth of morphine and some other pills because it was late and the doc didn't know where the nearest 24hr pharmacy was.

In all instances service was fast, courteous, and competent. I wouldn't expect anything less, and I wouldn't expect anything less for anyone else, even though it means my paycheck is smaller than what it could be. The peace of mind it brings me is worth every penny.

It would be nice if the US did the same thing. It would be nice.
posted by furtive at 5:05 PM on April 5, 2006


Suprisingly, the only hospitals I've seen that actually function somewhat close to what the "ideal" situation would be military base hospitals.

In other words, the best health care system you've seen is government-run health care provided free of charge to all, regardless of insurance coverage. Excellent argument.

I'm sorry, Democrat Mommy-staters, I'm not ready to give up my privacy because I entrust it only to the caring hands of my doctor's office, my network specialists, my insurance broker, my HMO, and various other entities I have no control over, my right to die because universal health care will make everyone immortal, my right to hurt myself doing things I consider fun because getting my injuries treated for free would take all the fun out of it, my right to be stupid because if we actually had universal health care I wouldn't be able to make these moronic arguments anymore , just because you want to be free from paying some evil corporation because I think giving all my money to evil corporations ROCKS!
posted by designbot at 5:07 PM on April 5, 2006


If our gay marriage hasn't caused the sky to fall yet, I'm willing to give universal healthcare a chance.
posted by VulcanMike at 6:02 PM on April 5, 2006




It's broken. This bill does nothing to fix it.
posted by Kirth Gerson at 8:02 AM on April 6, 2006


Just look at what happened to Imaginatistan, the country where they adopted universal health care and it didn't make things better—you can't even find it on the map anymore!
posted by designbot at 6:54 PM EST on April 5 [!]
Holy SNAP! I am so stealing this!
posted by Secret Life of Gravy at 9:04 AM on April 6, 2006


says a male in his early twenties (the supposed target of this plan): this is what you get when the asshat republican presidential hopeful of a governor introduces a universal healthcare plan.
posted by es_de_bah at 9:42 AM on April 6, 2006


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