Stanley Feld M.D.,FACP,MACE
I hesitate to spend more time on the impending failure of the new Massachusetts healthcare law. However, the results of this experiment have consequences for the up coming presidential election. I have previous stated that Hillary Clinton healthcare plan is similar to the Massachusetts plan. The difference is Ms. Clinton would have the government plan competing with the insurance companies plan. It is destined to fail. The outcome will be the complete government take over of the healthcare system, an entitlement plan America can ill afford.
America can not afford the future value of our present entitlements. The debt will be compounded by adding the entire population to the healthcare insurance rolls. Politicians at all levels have ignored the debt problem of 100 trillion dollars.
Hopefully, someone will wake up and realize the present healthcare insurance system must change. .
“Two years after the state's landmark health law was signed, the cracks are starting to show.”
“Costs are soaring and Massachusetts lawmakers are weighing a dollar-a-pack hike in the state's cigarette tax to help pay for a larger-than-expected enrollment in the law's subsidized insurance plans”.
I believe the cracks were present before the law was passed. Governor Romney was going to run for President and needed an innovative and heroic accomplishment. A bipartisan healthcare law with mandated universal coverage was politically driven and foolishly passed.
“But that hasn't dampened enthusiasm at the Statehouse. Leaders there boast that in the two years since former Gov. Mitt Romney signed the law with a choreographed flourish at historic Faneuil Hall, the number of insured residents has soared by nearly 350,000.”
The lawmakers in Massachusetts are living in a dream world denying the problem of the program’s cost and the increased state spending deficit. The state is raising the healthcare premium, decreasing the healthcare coverage and increasing taxes. Nonetheless, the state can not afford the entitlement.
“Along the way the law has been scrutinized by other states, sparked the ire of critics on the right and left, and drawn the attention of presidential candidates.”
The blind are leading the blind. One state develops a healthcare system that does not work and all the others try to jump in with slight modifications of the same plan with its mistakes.
"It's the very first question I get when I'm with other governors," said Massachusetts Gov. Deval Patrick. "I don't think anybody is prepared to say that what we have done here in Massachusetts is necessarily the formula for the rest of the country or for a national reform, but at least we are trying."
Massachusetts has tried to maintain the private healthcare insurance system without reforming the private healthcare insurance system. It has to fail because the basic problem is the incentives for the private healthcare insurance industry have not been changed.
"The Massachusetts reform law remains the focal point for other states and the nation in trying to figure out if state-based reform is possible," said Alan Weil, head of the Maine-based National Academy for State Health Policy. "It's the biggest game in town."
“One of the most radical fixtures of the law is the so-called "individual mandate" — the requirement that virtually everyone have health insurance or face tax penalties.”
Policy makers are always thinking in punitive terms toward patients and physicians rather than creating incentives for people. I believe people should get a tax credit for losing weight, controlling their chronic disease and not over utilizing the healthcare system. They should be rewarded for good health and not a penalized for not wanting to pay an inflated healthcare insurance premium.
“Anyone deemed able to afford health insurance but who refused to buy it during 2007 already faces the loss of a $219 personal tax exemption. New monthly fines that kicked in this year could total as much as $912 for individuals and $1,824 for couples by December.”
How can a government determine the reward? It could be difficult. It is easier for the government to collect a penalty for a person not having insurance. The reward should be contributed to the person is tax free retirement fund. Patients should own their healthcare dollar. They would be motivated to shop for the best price. The more they saved the more they would have added to their retirement fund. If someone had a chronic disease and controlled the disease with proper treatment they should receive a reward. The payer could afford to give that person a bonus because of the money saved on the treatment of complications of that disease. My plan would in effect shift responsibility and motivation to control cost to the patients. It would motivate patients to fight the War on Obesity.
“Michael Tanner, a senior fellow at the libertarian-leaning Cato Institute, said the law has been an unqualified failure. He also noted the vast majority of the newly insured are receiving subsidized care.”
"They said it would get us universal coverage and reduce costs and it's done neither," Tanner said. “
The biggest problem is the rising costs of healthcare. Neither the Massachusetts plan nor any of the other state plans have done anything to change the motivation of the drivers of the old healthcare system.
“The law — and its individual mandate — has become a key talking point in the presidential race.”
None of the presidential candidates have even spoken of the importance of patient responsibility. If the government set the appropriate rules it could eliminate all the administrative waste in the system and decrease the complications of chronic disease. We would then have an affordable healthcare system. This can be accomplished by motivating and not punishing the patients and physicians.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.