Posted on 05/28/2006 9:24:37 PM PDT by Jeff Fuller
Below are two pieces I composed a couple of weeks ago about Massachussett's Governor Mitt Romney's plan requiring all state residents to obtain health insurance. I've been following some of the recent discussions about Romney here at Free Republic and there are inevitably comments made about how Romney got "socialized medicine" passed in MA. People who make these comments either don't like ROmney (maybe they really like another '08 candidate and see Mitt as a threat) or don't know what they are talking about. The plan is nothing like socialized medicine. People who keep claiming that it is are uninformed and probably like to put a dissmissive label on a program so that they do not have to think about it.
The original posts can be found at http://iowansforromney.blogspot.com/2006/05/massachusetts-health-care-law-launches.html:
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As a physician, I feel I have a few insights to share about Mitt Romneys Universal Health Care Plan signed into Massachusetts law on April 12th, 2006 (which some have dubbed: RomneyCare). By way of background see the following links:
The Heritage Foundations take is quite supportive (granted, they have a vested interest)
Here is a link that links to several other op-ed pieces and are generally favorable (if not celebratory)
If youve got time . . . you can watch Mitt himself giving a 25 minute speech/PowerPoint with a 15 min Q&A session following about his plan (given at The HeritageFoundation)
First off, I preface my remarks by stating that the United States medical care is the best in the world. This is largely because of our free-market system in both clinical care and biomedical research. People are living longer and healthier lives because of innovation, dedication, and the desire for wealth which spurs individual and corporate enterprises. I am proud to be part of this system which is unparalleled worldwide.
Romneys plan does not represent socialized medicine or even a step down the slippery slope that could lead there . . . no, this is not the road to HillaryCare. Every physician I know cringes at the idea of socialized medicine (for the negative effect it would have on us and our patientsa true lose-lose). On the flip side, every physician Ive spoken to lately seems very supportive and intrigued by Romneys plan. This is significant, and should allay any fears of this being a stepping stone toward socialized medicine.
The plan is not even a government takeover of medicine as some are claiming. There are no new government insurance plans to sign up for. The governments involvement is mainly in oversight to ensure that everyone is insured (just like the good old car insurance analogy . . . by the way, is anyone complaining of a government take over of the car insurance industry?)
Romney recently rebuffed such claims of big government by responding that "making the individual responsible for his own health coverage is a lot more conservative than a permanent program of government handouts to hospitals." Edmund F. Haislmaier stated that those who want to create a consumer-based health system and deregulate health insurance should view Romney's plan as one of the most promising strategies out there.
Although libertarians may cringe at the government "mandate that this law institutes what they must realize is that this simply supplants previous mandates. This law appropriately shifts the burden of the uninsured away from the Emergency rooms and hospitals (who under COBRA and EMTALA federal laws, ARE CURRENTLY MANDATED to treat all comers for emergency services regardless of their insuranceor lack thereof) to the individuals . . . exactly where it should be (hey, most people dont flinch one bit about plopping down several hundred dollars to have their teeth worked or to get glasses/contacts . . . so why does almost everyone seem convinced that medical care should not have any out-of-pocket expenses?)
Another great aspect of this plan is that it requires even the poor to pay at least something for their healthcare (excluding Medicaid recipients). Romney keeps saying that this plan will eliminate the free lunch mentality toward healthcare that most low-incomers have. This will also build self-worth and individual accountability as the self-defeating hand-out system will diminish greatly. The private insurance premiums will be subsidized by the government on a sliding-scale for lower-income individuals and the very poorest will still be captured and covered, at least in part, by federal Medicaid funding.
A fascinating component of the Mass. plan is The Connector which came about through Romneys reaching out to the conservative think tank The Heritage Foundation. This entity will allow the self-employed or part-time workers to obtain the benefit of pre-tax dollar utilization for insurance premiums (a benefit currently reserved for those whose health care coverage is provided by their employers.) In effect, this amounts to a tax-cut/tax-break (true to Republican principles . . . even in the Bluest of Blue states . . . how did Gov. Romney get this done?). In addition, The Connector will allow portability of insurance plans as individuals change their employment as well as allowing folks with multiple jobs to pay pre-tax off of multiple paychecks. Slick and practical stuff.
Where is the accountability built into this system? you may ask. Those who do not obtain insurance will lose out on their state personal tax exemption (among other penalties for individuals and businesses). This straightforward enforcement/incentive program will yield results quickly. People will also be blocked from obtaining/renewing drivers licenses if they cannot provide proof of healthcare insurance.
Some have criticized Governor Romneys veto of the $295/employee fee (per annum) for employers who do not offer insurance for full-time employees. Everyone knew that his veto would be overturned by the legislature and this play of events ended up being a win-win for Romney. He can claim to be business friendly and for smaller government (which he honestly is)while inclusion of the fee gives the plan itself an even better chance of being fiscally successful. If this plan is successful it will bode very well for Romney in 2008.
Will it work? I predict that since people will have insurance they will seek outpatient primary (preventative) care early in their disease course instead of stumbling into emergency rooms on deaths door. If this helps keep people out of emergency rooms and hospitals where costs are massive then this will work AND improve the general public health.
The bigger money-saver, however, will be in getting non-emergent patients out of emergency rooms for their primary care. Uninsured and poor people know that, by law (COBRA & EMTALA) emergency rooms have to see and evaluate them for ANY complaint they may have. My brother is an ER physician and is constantly amazed how the ER system is abused by so many patients . . . like coming in at 3 AM because theyve had the sniffles for a week.
Governor Romneys response when asked by Chris Matthews on MSNBCs Hardball if such a plan could work for the nation highlights many of these points:
Well, it will work for Massachusetts, and thats of course the thing that I had to focus on. There are certain aspects of it that I think would work across the country, perhaps better in some states than others. Of course the great thing about federalism is you let a state try it and see how it works before you spread it out.
But theres some key features and I think this is one of them, which is that we are already spending billions of dollars in our country and in my state, about a billion dollars, giving free care to people who dont have insurance. And the question was, if we took that money and helped them buy insurance, could we have everybody insured and the answer is yes.
We dont need new money. We dont need new taxes. We could use the money were currently spending and get people better health care without having the burden and the cost of the uninsured being borne by everybody else.
By the end of this interview Chris Matthews exclaimed: God, it sounds wonderful. Im not supposed to cheer here, but I mean, I think its wonderful.
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Follow-up article I posted after the Massachussetts State Congress overrode Romney's Vetos:
A couple of weeks ago, I blogged my opinion of Romney's innovative healthcare initiative signed into Mass law last month. I'm still high on the program, but a few things have me worried as I've continued to follow this evolving saga of state politics . . . one upon which everyone in the nation seems to have an opinion (see the litany of op/ed pieces the day after the bill was signed).
One threat to its success is federal intrusion into state regulation of healthcare insurers. As E.J. Dione Jr. opines in the Washington Post this could seriously sidetrack the Mass plan. This columnist really wants to give the states a chance to work out healthcare solutions--since the federal government has been so weak on the issue for so long.
But what really has me worried about the sustainability of the plan is the fact that the Senate overrode Romney's vetoes in the bill. The veto that gets all the press is the $295 per employee fee for employers that don't provide coverage. That being overridden bothers me on philosophical grounds . . . but doesn't worry me about the long term success of the program--it actually will be another source of funding the plan . . . and it looks like it's gonna need it (keep reading to see why)
The veto override by the Mass Legislature that really worries me is the inclusion of free dental and eyeglass coverage to certain recipients. This is estimated by one source to cost an extra $75 million annually and could be a major drag on the success and sustainability of the whole program. I'm all for good teeth (an obvious sign that I'm American . . . and not European) and seeing well (heck, I'm an ophthalmologist), but come on!
Even as an "Eye M.D." (currently a vitreoretinal fellow supporting family of six . . . so money is tight) who works for a major university system and prescribes eyeglasses on a routine basis, I DON'T EVEN HAVE EYEGLASS COVERAGE! I have been wearing the same eyeglasses for 3.5 years now and the frames were given to me . . . so who knows how old they are. I don't say this to pride myself on frugality, but to prove a point: that I probably would have gotten new glasses every year or so if they had been covered by some plan; but instead, I've made due because it saves me money.
Also, as the prior article says, 60% of employers in Mass don't provide a dental benefit. If the MAJORITY of working people don't have it covered, why should the government feel beholden to provide it? Maybe that's just how things work in that democratic legislature in Massachusetts.
All that being said, I am still optimistic about the potential savings created by keeping people out of expensive ERs and hospitals by earlier intervention and preventative care. Hopefully, this innovative program will save enough money to cover the costs that the Democrats have already added onto it.
Well, if one were to start with prolonging the 18 months coverage one could buy through ERISA, things would be less controversial. Why not make it 36 months, or even 54? The person concerned has to pay for it out of his/her pocket - it simply makes group health insurance [temporarily] available to the individuals.
The problem is that there are so many people on government paid health care, and they have no clue about the costs. I think everybody should pay something, even if it's a dollar, so they don't think everything is "free"
I completely agree . . . but Medicaid is a Federally endorsed program and Romney had no authority to eliminate it. Every person who doesn't qualify for Medicaid will have to pay at least something out of pocket for there healthcare.
Were a lot of mandates waived; I believe if people could choose the type of health care they want, insurance costs would decrease.
What about people who want to pay for catastrophic health care, and pay for regular visits out-of-pocket? This would work for young, healthy consumers.
"Were a lot of mandates waived; I believe if people could choose the type of health care they want, insurance costs would decrease. What about people who want to pay for catastrophic health care, and pay for regular visits out-of-pocket? This would work for young, healthy consumers."
This is something that the plan only went halfway with when it should have gone further (but the liberals wouldn't go all the way). State regulation of insurance companies is a HUGE problem and really does add a huge piece to the national healthcare crisis (I mean, do all workers really want "Fertility Treatments" and the like which are required by many state laws?)
I'm a fan of "catastrophic care" policies and I believe that some of the new plans being worked out in Mass will be a step towards such coverage. Actually, not every citizen of Mass has to have insurance. If they can post $10,000 as a bond to the state they can be exempted from the requirement . . . this is a sort of "catastrophic care" policy on an individual level. Not too practical for most folks, but it sends a good message.
Actually, MOST of the uninsured (in Mass and the nation) are young healthy people without children. This is the group that needs some coverage, but not "cadillac coverage."
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