In 2006, [Massachusetts] lawmakers seeking to broaden health coverage made it illegal to be uninsured. It works like this: Employers have to offer you a health plan. If you are jobless or don’t like your employer’s plan, you must buy your own. If you don’t get one, you pay a stiff fine. This strategy—known as an employer and individual “mandate”—forms the backbone of the national health reform bills now making their way through Congress.
On paper, the experiment was a resounding success. According to an Urban Institute estimate, the number of uninsured residents quickly fell from 13 percent to 7 percent following the law’s passage.And yet, something strange happened. Despite having health insurance, roughly one in 10 state residents still failed to fill prescriptions, ended up with unpaid medical bills, or skipped needed medical care for financial reasons. Hundreds of millions of dollars were spent to insure more Massachusetts citizens, but many people still weren’t getting necessary care. What happened?
Assume you’re looking to buy insurance. The state has a handy Web site where you can find the cheapest plan. For a young family of four, that plan costs roughly $9,500 per year, which doesn’t include a minimum annual deductible of $3,500 before many benefits kick in. (The state helps cover some of the premiums for those who make very little money, but many still have to pay the other fees.) And if anyone is hospitalized or needs a lot of specialized care, you also pay 20 percent of that bill. In this relatively cheap plan, the family can be liable for an extra $10,000 per year of medical costs. This sort of “high deductible” health plan is clearly structured to discourage medical care.
The article goes on to detail the effects of the program, parts of which may end up in Obama’s plan. The author’s conclusion?
The expensive Massachusetts plan is not well-designed to systematically improve anyone’s health. Instead, it’s a superficial effort to clear the uninsured from the books and then clumsily limit further costs by discouraging care.
For a young family of four, that plan costs roughly $9,500 per year, which doesn’t include a minimum annual deductible of $3,500 before many benefits kick in.
Seems to me that if you got a deduction on your taxes to cover the premium, you could afford the deductible.
But that would make too much sense.
It’s easier to take the $9500 + 25% to pay a bureaucrat to manage it and then pay the bill for the citizen.
There is no free lunch. D-f’in-uh.
Force all insurers into not for profit, reduce paperwork and other overhead, keep an MD from leaving school with loans equal that of a home mortgage, and ration care. My sister received a $50K round of chemo with stage IV lung cancer that had a very small chance of increasing her lifespan, or quality. In fact she had a bad reaction and was in intensive care for five days and a hospital for a week. Only then was she released to hospice care.
1 LL,
Here we go again!
“Seems to me that if you got a deduction on your taxes to cover the premium, you could afford the deductible.”
And if you cannot afford the premium plus deduction? What then genius?
If you are jobless or don’t like your employer’s plan, you must buy your own. If you don’t get one, you pay a stiff fine. This strategy — known as an employer and individual “mandate” — forms the backbone of the national health reform bills now making their way through Congress.
I’d like to know under what constitutional authority the Congress has the power to force individuals to buy health insurance.
There is a reason why the Congress uses its so-called “power of the purse” to “persuade” the states to implement a good chunk of its programs – because it really doesn’t have the power to do it itself.
So, is Mass collecting those fines for the uninsured? I wonder how that’s going.
More insurance is not the answer. Making people who live lifestyles that lead to health issues pay through the nose is a start, and making better choices regarding care-vs-outcomes is a big second step.
For example, people facing 95% certain death shouldn’t get $100,000 treatments. I realize that’s easy for me to say and probably not so easy for someone who’s kid is at 95%, but it’s reality.
Remember government cheese? Instead we need government suntan lotion. Government walking shoes. Government health food. Instead of adding more math and geography to the high school curriculum, add personal finance and personal health care.
Throwing more money into the health care system is NOT the answer. We need to increase funding for research into the causes of cancer.
It is a step in the right direction.
The problem is that the law makers left it for the private sector to offer the insurance. Poorer people NEED help with the expensive premiums and deductibles. Paying 1/3 of your income for a health insurance policy that leaves you with $3,500 in up front co-pays is just too onerous.
The private sector doesn’t want to insure these people. It is too expensive to offer single coverage. This is designed to discourage participants more than it is to cover them.
Massachusetts should go with a single payer system where they collect all premiums. The premiums currently paid to all the private companies could then be used to pay for the system. The population as a whole would see a more efficient system and reduced costs.
Until then, you will always have coverage problems.
“If you are jobless or don’t like your employer’s plan, you must buy your own. If you don’t get one, you pay a stiff fine.”
Time to buy more ammo and bigger caliber weapons. Be back later.
# 5 Sea Lawyer said, “I’d like to know under what constitutional authority the Congress has the power to force individuals to buy health insurance.”
Bingo. Time to arm up.
#6, I’m also wondering what would lead a politician to believe that making people pay a fine, when they already can’t afford insurance, is helping anything.
I agree that the govt shouldn’t force people to buy insurance, that seems a bass-ackwards way of doing it.
Here’s the heart of the article, IMHO:
The lesson of Massachusetts is that really good health care is also really expensive. The concern isn’t who writes the checks or who writes the bills. The real question is who makes the tough decisions about the limits of the checks and bills—in other words, who ultimately rations the money. Not everybody can have everything, and the sooner we admit that, the sooner our health care debate will get realistic.
Who ultimately rations the money? Right now insurance company executives with an eye on profit do it. I’m curious to know how all the other civilized countries seem to do it successfully…
#6, Mr. Baggins,
Throwing more money into the health care system is NOT the answer.
I agree. Your comments referring to sun tan lotion is well put.
In my opinion, we need to make the money we currently spend more efficient. Most hospitals waste considerable money on the uninsured visiting ERs. Why not set up free clinics to help those without insurance / doctor handle minor complaints. Staff them with PNs where possible who could refer a serious case to a an MD.
Have Hospitals charge one price to everyone. Currently, each Insurance company negotiates with a hospital what price they will pay. That creates a hodgepodge of pricing where an appendectomy will be charged $12,000 if Blue Cross covers it and $49,000 if you are uninsured.
Make all Hospitals non-profit. Currently they are more interested in promoting the more expensive procedures and the number of patients going through their doors than they are in actual out comes. Make them part of the whole management of health care instead of just a separate section.
You’re going to make a political decision on health care based on the opinion of one analyst at SLATE? – You get what you deserve.
Fusion/Named:
#4, Here we go again!
“Seems to me that if you got a deduction on your taxes to cover the premium, you could afford the deductible.”
And if you cannot afford the premium plus deduction? What then genius?
You get the premium back.
Example 1:
You pay $9500.
You get $9500.
Thus, you pay $0.
It’s a word problem. Here it is in simple math.
9500 – 9500 = 0.
#7, Poorer people NEED help with the expensive premiums and deductibles.
Here we go with the NEED thing again. NEED constitutes GETS?
When your buddies start paying their cell phone taxes, then you can start asking us to pay for your pet projects.
Any plan that requires citizens to get their own health insurance will fail.
Only national, universal health care will work.
As usual, I thought Obama was the least worst candidate in the race. His stupid stimulus plan I could half blame on Bush the Retard but this health plan fiasco is all on him.
There is 30% easy waste and inefficiency in the system caused by “free market competition.” The idea of maintaining the status quo and adding the public option at the price of an additional 1-2 trillion dollars is truly stupdifying.
Its easy==put all the healthcare dollars in one basket, cut everyone fees by 30% as they will start practicing medicine instead of pushing paper and create a priority list of procedures/diagnoses to be covered until the money runs out. Want more healtcare==fund it more. Want to keep for profit medicine?==you get belly shot and placed at the end of the line.
Several problems solved.
“…and then clumsily limit further costs by discouraging care.” So, just like my HMO, huh?
Obama needs to push through the single payer healthcare plan.
Despite the false propaganda from the right, the services themselves are rendered by private industry.
The Obama proposal is to stem rising costs by having the government compete with the oligopoly of insurance companies that do nothing but extract $500B in annual profits.
It’s a tough fight. The deep pocketed Health Insurance industry and their bribed GOP lawmakers is certainly stiff competition.
Dennis,
Exactly. Any health insurance reform that requires people to proactively opt-in will fail.
Tax credits will fail. Public option will fail. Health cooperatives will fail.
Only a federal mandatory, universal, health insurance program will reform our disastrous, absurdly expensive conservative health insurance system.
#22, Only a federal mandatory, universal, health insurance program will reform our disastrous, absurdly expensive conservative health insurance system.
I’ve never seen so many adjectives designed to woo the sheep in one sentence before.
You are to be congratulated.
So much better to be woo’d by 3 word bumper stickers.
Like: “I need my guns.”
or
“Build more nuclear power plants.”
or
“Don’t force socialized medicine on me.”
Yea, my math skills are rather ditto-headed.
Let me get this straight.
Does a failed state plan support the idea of a national plan or detract from it?
I think it says that we need to get it right at the federal level.
# 25 Misanthropic Scott said, “Does a failed state plan support the idea of a national plan or detract from it?”
It would depend on how similar the two plans are…
I thought health insurance came from having a job that provides it as a benefit. If you don’t have a job, how could you buy health insurance? I know it cost a lot more if you try to buy it yourself rather than get it from an employer.
When I didn’t have a job, I didn’t make any money. How would I have paid for health insurance or paid the fine for not having health insurance? Would it be like child support where they put you in jail if you don’t pay? Prisoners get free health care, so I guess that would solve the problem.
Why is it any surprise that the private, for profit insurance companies would make any state health plan as expensive as possible? They will work their hardest ever to make any competing administration of health care fail, and/or to make it as expensive as possible for everyone if the insurance companies themselves are foolishly asked to administer it, as occurred in Mass.
The greatest sin of capitalism is the tendency towards monopoly, and the viciousness with which monopolies protect themselves. We’ve given these insurance companies a monopoly over whether we LIVE OR DIE; do you think they will loosen their grip on that prize without a fight?
“The greatest sin of capitalism is the tendency towards monopoly… …”
Great, so I suppose you are equally opposed to creating a monopsony.
Oops, pressed submit too soon. Oh well.
There are only two solutions to this health care cost problem, which has arisen because the doctors are incentivized to charge as much as possible, and the insurance companies are incentivized to approve flashy treatments to keep their customers, with the added incentive that they can justify higher premiums from employers too. We could go the Swiss route, and forcibly convert the insurance companies to not-for-profit charities, with strict limits on compensation for executives, or we can abolish them entirely and go single payer as most other industrialized nations have. Both systems seem to work; I favor the Swiss system myself. However, our current system, and this worst of all worlds system that O is proposing, strike me as just another way to fleece the American public and transfer wealth to the wealthy.
#29–now SL==I know you confuse being contrary with insight but still! So, go ahead and list as many characteristics as you will of tendencies of capitalism that are worse than monopolism? I’m sure Li and the rest of us will wait.
Monopsonist. Bit of a twist to apply market terminology to a government program where the player is the agent of “all the people, for the people, etc.”
Mono is not the worst thing you can get sleeping with repuglicans.
#31, I think a lot of people would disagree with the net benefit that Wal-Mart has provided. A chief criticism of the buying power of Wal-Mart is that producers are forced to find ever cheaper ways to produce their goods (e.g. moving production overseas) because they won’t get shelf space if they don’t meet Wal-Mart’s price mandate.
The thing I absolutely want to avoid is having the government, as a single payer, telling service providers “this is all we will pay you, take it or leave it, and by the way, we are the only game in town”
#32, bobbo, I know you don’t know what you are talking about when we start to delve deeper than the class in Home Ec you got on how to balance your checkbook, but as long as you continue to be impressed with yourself, I’m more than willing to humor you. You see, I too can be a team player at times.
15,
“You get the premium back.
Example 1:
You pay $9500.
You get $9500.
Thus, you pay $0.
It’s a word problem. Here it is in simple math.
9500 – 9500 = 0.
Wow. You are so clever. And what happens with 9500 is not available to pay initially? Should the underemployed be punished? should the unemployed? You probably think that they want to be poor and without insurance. Some people end up in places through situation and not choice. I don’t imagine you could even think of 1 without help since you’re obviously so self-centred.
“Here we go with the NEED thing again. NEED constitutes GETS?”
Would you like me to introduce you to Wall Street and Haliburton? One got 700 Billion for fucking around and the other got the country of Iraq. So, the NEED constituted the GET indeed. Health care is public protection which is a mandate of the government.
And what’s will the cell phone talk? I’m still not getting it?