What Difference Has RomneyCare Made?

Most conservative critics of the Massachusetts health reform have focused on any piece of bad news about the program they can find. After all, if this is the model for the federal legislation everyone calls “ObamaCare” it’s got to have a lot of defects. Right?

Not so fast. The real story coming out of Massachusetts is that the whole thing is a yawner. Health reform in the Bay State has been mainly about money: who writes the checks and who cashes them. That shouldn’t be a surprise. That’s usually what health reform is about. But what about the effect on patients? As it turns out, there has been very little change at all.

Does that mean that health reform at the federal level might also be benign? I wish. Unfortunately, ObamaCare introduces new and dangerous distortions that you don’t find in Massachusetts — partly because states don’t have the same powers as the federal government. More about that below.

On paper, it looks as though the state has made major progress in insuring the uninsured. From 6.4% of the population in 2006, the uninsured hover around 2% today. However, one study found that nearly all of the newly insured are either on Medicaid, in a state-subsidized plan or in an employer subsidized plan. Only 7% of the newly insured, or about 30,000 people, are directly paying their own way. It’s relatively easy to get people to sign up for insurance when coverage is free or almost free. And it’s not very expensive if you pay for the subsidies using money you would have spent anyway on free care for those who can’t pay their medical bills.

But aside from moving money from one bucket to another, have any real problems been solved? The evidence isn’t positive.

There are three major problems in health care all over the world: cost, quality and access. Since nothing in the Massachusetts reform addressed the problems of rising costs and less than adequate quality, those problems have remained more or less unchanged. What about access to care? Surely, newly insured people have more options in the medical marketplace.

The trouble is that almost all of the newly insured are in health plans that pay doctors and hospitals a lot less than what private insurance pays. Like other places around the country, Massachusetts Medicaid (called MassHealth) pays providers so little that patients often turn to hospital emergency rooms and community health centers for their care when they can’t find doctors who will see them. People in the newly subsidized private insurance plans aren’t faring much better because these plans pay only slightly more than what Medicaid pays.

The only solid analysis of what has actually happened to patients at this point is a study by Sharon Long and Paul Masi published in the journal Health Affairs. According to the study:

• There has been no significant change in the number of Massachusetts patients seeking care in hospital emergency rooms since the reform was implemented, and there has actually been an increase in emergency room use by people with incomes below 300% of the poverty level.

• There has been an increase in doctor visits but no change in visits to specialists and an actual decrease in “medical tests, treatment and follow up care,” which I assume is care for the chronically ill.

• There has been no change in the percent of the population reporting a failure to “get needed care for any reason within the past 12 months” and remarkably that includes one-third of those with incomes below 300% of the poverty level.

The problem with counting up doctor visits is that a visit is not always a visit. Nationally, in the state children’s health insurance program (CHIP) doctors have responded to an increase in the demand for their services by scheduling more appointments, but spending less time with patients. Also, you would think that the Massachusetts reform would shift health care resources from the general population to those with less income. But there is no evidence that has happened. On measures of access, the gap between the poor plus the near poor and everyone else appears not to have changed at all!

Ask yourself why you care whether other people have health insurance? The most likely reason is that you want people to have access to health care. But lack of access to care is a huge problem in Massachusetts right now. As I previously reported more than half of all family doctors and more than half of all internists are not accepting new patients. The wait is more than a month before a new patient is able to see a family doctor, and the wait to see an internist averages 48 days. The average wait in Boston to see a family doctor is more than two months.

What I am now reporting will be different than what you may have read in the newspapers or at other health blogs. MIT Professor Jon Gruber calls Massachusetts an unqualified success, citing some of the very same studies I am citing. But since Gruber was one of the architects of the Massachusetts health reform, this is like a student grading his own exam.

What about elevating the Massachusetts reforms to the national level in the form of ObamaCare? As I have previously reported, ObamaCare is likely to result in less access to care for our most vulnerable populations: the disabled and the elderly on Medicare, the poor on Medicaid and the near poor in newly subsidized private insurance. But that is only the beginning.

The article was written by, and for, Mitt Romney.

The facts tell otherwise:

ROMNEY FLED MASSACHUSETTS after imposing his ROMNEYCARE !!!!

THE REAL DEAL:

Emergency room visits grow in Mass. New insurance law did not reduce number of users
The number of people visiting hospital emergency rooms has climbed in Massachusetts,
despite the enactment of nearly universal health insurance that some hoped would reduce expensive emergency department use."

Back to the ObamaCare Future (price controls in Massachusetts)
Natural experiments are rare in politics, but few are as instructive as the prototype for
ObamaCare that Massachusetts set in motion in 2006.
Last month, Democratic Governor Deval Patrick landed a neutron bomb, proposing hard
price controls across almost all Massachusetts health care. State regulators already have
the power to cap insurance premiums, which Mr. Patrick is activating. He also filed a bill
that would give state regulators the power to review the rates of hospitals, physician
groups and some specialty providers.

It doesn't even count as an irony that former Governor Mitt Romney (like President Obama) sold this plan as a way to control spending"

"The Huge Middle Class Tax Increase Coming Our Way With ObamaCare
The former CBO director, Douglas Holtz-Eakin, warns today on the effect ObamaCare
will have on our economy and health care. These facts should be painfully obvious to
those with even one iota of common sense. This bill will lead to a huge middle class tax increase:
Remember when health-care reform was supposed to make life better for the middle
class? That dream began to unravel this past summer when Congress proposed a bill that
failed to include any competition-based reforms that would actually bend the curve of
health-care costs. It fell apart completely when Democrats began papering over the
gaping holes their plan would rip in the federal budget.

As it now stands, the plan proposed by Democrats and the Obama administration would
not only fail to reduce the cost burden on middle-class families, it would make that burden significantly worse.

The bill creates a new health entitlement program that the Congressional Budget Office
(CBO) estimates will grow over the longer term at a rate of 8% annually, which is much
faster than the growth rate of the economy or tax revenues. This is the same growth rate
as the House bill that Sen. Kent Conrad (D., N.D.) deep-sixed by asking the CBO to tell
the truth about its impact on health-care costs.

To avoid the fate of the House bill and achieve a veneer of fiscal sensibility, the Senate
did three things: It omitted inconvenient truths, it promised that future Congresses will
make tough choices to slow entitlement spending, and it dropped the hammer on the middle class.

One inconvenient truth is the fact that Congress will not allow doctors to suffer a 24% cut in their Medicare reimbursements. "

"DEATH PANELS OPEN FOR BUSINESS IN MASSACHUSETTS
In August Sarah Palin wrote extensively about the incredible danger that ObamaCare
would lead to what amounts to "death panels." This of course caused great controversy
with many claiming Palin was either "crazy" or talking about the "end of life"
discussions that were provided for within House Resolution 3200, the prototype
ObamaCare bill.
As more Americans delve into the disturbing details of the nationalized health care plan
that the current administration is rushing through Congress, our collective jaw is
dropping, and we're saying not just no, but hell no!

The Democrats promise that a government health care system will reduce the cost of
health care, but as the economist Thomas Sowell has pointed out, government health care
will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the
most when they ration care? The sick, the elderly, and the disabled, of course. The
America I know and love is not one in which my parents or my baby with Down
Syndrome will have to stand in front of Obama's "death panel" so his bureaucrats can
decide, based on a subjective judgment of their "level of productivity in society," whether
they are worthy of health care. Such a system is downright evil. .
Now we have news from Massachusetts, the home of RomneyCare, which should be
looked at as a shining example of why ObamaCare will be an epic failure. Soaring costs
both to the taxpayers and patients was inevitable, and now the effects of these are coming home to roost.
You can't reap these savings without limiting patients' choices in some way,"

"You can't reap these savings without limiting patients' choices in some way," said Paul Levy, CEO of Beth Israel Deaconess.

The state's ambitious plan to shake up how providers are paid could have a hidden price
for patients: Controlling Massachusetts' soaring medical costs, many health care leaders
believe, may require residents to give up their nearly unlimited freedom to go to any
hospital and specialist they want.

Efforts to keep patients in a defined provider network, or direct them to lower-cost
hospitals could be unpopular, especially in a state where more than 40 percent of hospital
care is provided in expensive academic medical centers and where many insurance
policies allow patients access to large numbers of providers. ."

"State plan may place limits on patients' hospital options( Mass. RomneyCare )"

"Paying the Health Tax in Massachusetts [Romneycare]
My husband retired from IBM about a decade ago, and as we aren't old enough for
Medicare we still buy our health insurance through the company. But IBM, with its
typical courtesy, informed us recently that we will be fined by the state.
Why? Because Massachusetts requires every resident to have health insurance, and this
year, without informing us directly, the state had changed the rules in a way that made
our bare-bones policy no longer acceptable. Unless we ponied up for a pricier policy we
neither need nor want-or enrolled in a government-sponsored insurance plan-we
would have to pay $1,000 each year to the state.
My husband's response was muted; I was shaking mad. We hadn't imposed our health-
care costs on anyone else, yet we were being fined ("taxed" was the word the letter used).

We've spent much of our lives putting away what money we could for retirement. We
always intended to be self-sufficient. We've paid off the mortgage on our home, don't
carry credit-card debt, and have savings in case of an emergency. We also have a regular
monthly income of about $3,000, which includes an IBM pension. My husband, 61, earns
a little money on the side, sometimes working as an electronics consultant on renewable
energy projects. I'm 58 and make some money writing science books. We are not
wealthy, but we aren't a risk of becoming a burden on society either. How did we become outlaws? "

"National Health Preview - The Massachusetts debacle, coming soon to your neighborhood."
"Three years ago, the former Massachusetts Governor had the inadvertent good sense to create the "universal" health-care program that the White House and Congress now want to inflict on the entire country.
It is proving to be instructive, as Mr. Romney's foresight previews what President Obama, Max Baucus, Ted Kennedy and Pete Stark are cooking up for everyone else.
In Massachusetts's latest crisis, Governor Deval Patrick and his Democratic colleagues are starting to move down the path that government health plans always follow when spending collides with reality -- i.e., price controls.
As costs continue to rise, the inevitable results are coverage restrictions and waiting periods. It was only a matter of time.

They're trying to manage the huge costs of the subsidized middle-class insurance program that is gradually swallowing the state budget.
The program provides low- or no-cost coverage to about 165,000 residents, or three-fifths of the newly insured, and is budgeted at $880 million for 2010, a 7.3% single-year increase that is likely to be optimistic.
The state's overall costs on health programs have increased by 42% (!) since 2006.

What really whipped along RomneyCare were claims that health care would be less expensive if everyone were covered.
But reducing costs while increasing access are irreconcilable issues.
Mr. Romney should have known better before signing on to this not-so-grand experiment, especially since the state's "free market" reforms that he boasts about have proven to be irrelevant when not fictional.
Only 21,000 people have used the "connector" that was supposed to link individuals to private insurers."

A Very Sick Health Plan; Bay State's 'Grand Experiment' Fails [RomneyCare]
"The Daily News Record, Harrisonburg, Va. - 2009-03-31 "
"For folks increasingly leery of President Obama's plan to radically overhaul America's health-care system,
or 17 percent of the nation's economy, all this could hardly have come at a better time -
that is, fiscal troubles aplenty within Repubican Mitt Romney's brainchild, Massachusetts' "grand experiment" in "universal" health care."

"Initiated on Mr. Romney's gubernatorial watch in 2006, this "experiment" has fallen on hard times, and predictably so.
Even though the Bay State commenced its program with a far smaller percentage of uninsured residents than exists nationwide,
"RomneyCare" is threatening to bankrupt the state. Budgeted for Fiscal Year 2010 at $880 million,
or 7.3 percent more than a year ago, this plan, aimed at providing low- or no-cost health coverage to roughly 165,000 residents,
has caused Massachusetts' overall expenditures on all health-related programs to jump an astounding 42 percent since 2006.

So what does Mr. Romney's successor, Democratic Gov. Deval Patrick, propose as a remedy for these skyrocketing costs?
Well, whaddya think? The standard litany of prescriptions (no pun intended) - price controls and spending caps, for a start, and then, again predictably, waiting periods and limitations on coverage.
As in Europe and Canada, so too in Massachusetts. And, we feel certain, everyone from Mr. Romney to Mr. Patrick said, "It would never happen here."
But then, such things are inevitable when best-laid plans, with all their monstrous costs, run smack-dab into fiscal reality.

Health care in Massachusetts: a warning for America [Romney brings Mass. to its knees]
The Bay State's mandatory insurance law is raising costs, limiting access, and lowering care.
Sedalia, Colo. - In his recent speech to Congress, President Obama could have promoted
healthcare reforms that tapped the power of a truly free market to lower costs and
improve access. Instead, he chose to offer a national version of the failing
"Massachusetts plan" based on mandatory health insurance. This is a recipe for disaster.

Three years ago, Massachusetts adopted a plan requiring all residents to purchase health
insurance, with state subsidies for lower-income residents. But rather than creating a
utopia of high-quality affordable healthcare, the result has been the exact opposite -
skyrocketing costs, worsened access, and lower quality care.

Under any system of mandatory insurance, the government must necessarily define what
constitutes acceptable insurance. In Massachusetts, this has created a giant magnet for
special interest groups seeking to have their own pet benefits included in the required
package. Massachusetts residents are thus forced to purchase benefits they may neither
need nor want, such as in vitro fertilization, chiropractor services, and autism treatment -
raising insurance costs for everyone to reward a few with sufficient political "pull."

Although similar problems exist in other states, Massachusetts' system of mandatory
insurance delivers the entire state population to the special interests. ."

"'Severe' doc shortage seen hiking wait time The Boston Herald ^ | 9/15/09 | Christine McConville As the state's shortage of primary care doctors grows, people are waiting longer for medical care, according to a new survey by the Massachusetts Medical Society. "The shortage is getting more severe," said Dr. Mario Motta, the medical society's president. The state's health care dilemma can serve as a valuable lesson for a nation whose residents are locked in a frenzied debate about health care reform, he added."

"Health costs to rise again.( RomneyCare )
The state's major health insurers plan to raise premiums by about 10 percent next year,
prompting many employers to reduce benefits and shift additional costs to workers.
The higher insurance costs undermine a key tenet of the state's landmark health care law
passed two years ago, as well as President Obama's effort to overhaul health care. In
addition to mandating insurance for most residents, the Massachusetts bill sought to rein
in health care costs. With Washington looking to the Massachusetts experience, fears
about higher costs have become a stumbling block to passing a national health care bill."

"Nation's ill-advised to follow Mass. plan [Health plan a failure]
September 17, 2009 The canary is dead.
Massachusetts, the model for the ObamaCare universal insurance plan, is the canary in
the health care coal mine. Yesterday, its obit appeared on the front page of both The Wall
Street Journal and The Boston Globe-Democrat.

Both papers reported that our Commonwealth Care reform isn't working as planned. A
new law that was supposed to control costs and drive prices down (sound familiar?) has
instead sent costs soaring. "

"Bay State Insurance Premiums Highest in Country - Boston Globe August 22, 2009
Massachusetts has the most expensive family health insurance premiums in the country,
according to a new analysis that highlights the state's challenge in trying to rein in medical costs
after passage of a landmark 2006 law that mandated coverage for nearly everyone...
The report by the Commonwealth Fund, a nonprofit health care foundation,
showed that the average family premium for plans offered by employers in Massachusetts was $13,788 in 2008,
40 percent higher than in 2003. Over the same period, premiums nationwide rose an average of 33 percent..."

"Massachusetts: the laboratory for ObamaCare
Cato Institute looks a little farther down the coast to Massachusetts, where the state began its own health-care reform complete
with individual mandates and a government plan.
Cato calls it an "almost perfect" mirror of ObamaCare, complete with promises of reducing cost and extending care - that failed in both respects:
Massachusetts shows that such a mandate would oust millions from their low-cost health plans and force them to pay higher premiums. …

"Massachusetts' Obama-like reforms increase health costs, wait times [RomneyCare]
"If you are curious about how President Barack Obama's health plan would affect your health care, look no farther than Massachusetts.
In 2006, the Bay State enacted a slate of reforms that almost perfectly mirror the plan of Obama and congressional Democrats.
.... Premiums are growing 21 to 46 percent faster than the national average
in part because Massachusetts' individual mandate has effectively outlawed affordable health plans."

"Mass. Pushes Rationing to Control Universal Healthcare Costs (RomneyCare)
A 10-member Massachusetts state healthcare advisory board unanimously recommended
that the state begin rationing healthcare to keep the state's marquee universal health care program afloat financially.
The July 16 recommendations, the Boston Globe explained, would result in a situation where "patients could find it harder to get procedures they want but are of questionable benefit if doctors are operating within a budget.
And they might find it more difficult to get care wherever they want, if primary doctors push to keep patients within their accountable care organization."
The Globe stressed that the recommendations would "dramatically change how doctors and hospitals are paid, essentially putting providers on a budget as a way to control exploding healthcare costs and improve the quality of care."
"Budget" is a more politically acceptable word for rationing.
The Globe also noted that "consumer advocates said patients are going to have to be educated about the new system." Yes, apparently they will have to get used to having their healthcare rationed.

"Massachusetts Universal Healthcare System Breaking Down Already
When Governor Mitt Romney instituted a universal healthcare plan for Massachusetts in 2006 he proclaimed it a conservative idea.
But has it worked? Has it been successful?
For a time, many thought it might but cracks in the system are already being seen.
These cracks are instructive as a lesson on how Obamacare will crash and burn just like Romneycare is now in the process of doing.

One of the early claims that helped push Romneycare through to law was the insistence by its supporters that Emergency Room visits would fall as more and more citizens became covered under healthcare insurance.
Since ER care is far more expensive than a doctor's care, it was thought that more people with insurance would ease the overcrowding of ERs as well as lower the overall costs of healthcare.
However, a flaw in this logic has been seen throughout the state. As more people became insured, more people demanded the care of doctors. These doctors became overloaded with patients and waiting lists for doctors got longer and longer.
As a result, ERs in Massachusetts have not seen a downturn in visits. On the contrary, it seems that ER visits are actually on the upswing in the Bay State. In fact, in 2007 they were higher than the national average by 20 percent...

"National Health Preview - The Massachusetts debacle, coming soon to your neighborhood."
"Three years ago, the former Massachusetts Governor had the inadvertent good sense to create the "universal" health-care program that the White House and Congress now want to inflict on the entire country.
It is proving to be instructive, as Mr. Romney's foresight previews what President Obama, Max Baucus, Ted Kennedy and Pete Stark are cooking up for everyone else.
In Massachusetts's latest crisis, Governor Deval Patrick and his Democratic colleagues are starting to move down the path that government health plans always follow when spending collides with reality -- i.e., price controls.
As costs continue to rise, the inevitable results are coverage restrictions and waiting periods. It was only a matter of time.

They're trying to manage the huge costs of the subsidized middle-class insurance program that is gradually swallowing the state budget.
The program provides low- or no-cost coverage to about 165,000 residents, or three-fifths of the newly insured, and is budgeted at $880 million for 2010, a 7.3% single-year increase that is likely to be optimistic.
The state's overall costs on health programs have increased by 42% (!) since 2006.

0What really whipped along RomneyCare were claims that health care would be less expensive if everyone were covered.
But reducing costs while increasing access are irreconcilable issues.
Mr. Romney should have known better before signing on to this not-so-grand experiment, especially since the state's "free market" reforms that he boasts about have proven to be irrelevant when not fictional.
Only 21,000 people have used the "connector" that was supposed to link individuals to private insurers."

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