Lessons from Massachusetts on health care

[unixronin]

James Capretta writes about the Massachusetts state healthcare program and its implications for US healthcare under the bill passed by Congress:

When Massachusetts rolled out its coverage program in 2007, many more people signed up for the new heavily subsidized insurance than was originally predicted by budget officials.  Almost immediately, costs far exceeded what had been budgeted, forcing state officials to scramble to find cuts elsewhere in government and other sources of revenue.

After three years, no real progress has been made on rising costs.  The program remains well over budget, with no end in sight.  Further, state residents who now must buy state-sanctioned coverage are bristling at their rising premiums and the inability to find coverage which covers less and thus costs less.

State politicians are responding to the cost crisis the only way they know how: by promising to impose arbitrary caps on premiums and price controls for medical services.  The governor and state regulators have disallowed 90 percent of the premium increases insurers — all of whom are not-for-profit — submitted for their enrollees for the upcoming plan year.  The state says premium increases above eight percent are too high and unacceptable, though they themselves don’t have a plan to make health care more efficient in Massachusetts.  They just want lower premiums.  The insurers have responded by refusing to sell any coverage at the rates the state wants to impose.

Capretta points out that the demographic targeted for subsidized medical coverage under the healthcare bill — basically, those making less than four times the Federal poverty level — contains roughly 130 million people, more than a third of the US population.  However, the numbers estimated by the CBO for the cost of the program assume that state-based exchanges will have only 17 million subscribers by 2016.

The potential implications are not good.

Comments

[lebo-superman.livejournal.com]

"The potential implications are not good."

But, they were completely predictable, with a high degree of certainty.

[jhetley.livejournal.com]

Romneycare = Obamacare?

[unixronin.livejournal.com]

Not too dissimilar, apparently.

[jhetley.livejournal.com]

If you're a Republican, the differences are obvious.

[randwolf.livejournal.com]

The author, James Capretta, was director of Bush II's Office of Management and Budget. On his watch, the practice of not including war expenses in the Federal budget was implemented and, as you know, the Bush II administration funded their war through borrowing, exploding the national debt.

His motto, apparently, might be "Pain and death good, health bad."

He is not a trustworthy critic of fiscal policy.

Guy, why do you even give these bastards the time of day?

[unixronin.livejournal.com]

You appear to be attacking the messenger rather than evaluating the merits of the message. The comparison to the Massachusetts plan (enacted by a Republican governor, remember) seems valid.

[randwolf.livejournal.com]

Well then, I notice that Capretta cites neither numbers nor sources. He's also got a number of propaganda tropes in his article. I am struck by the way he fails to talk about the middle class at all in his discussion, and by the way he turns into a deficit hawk when a policy he doesn't like is enacted. The element of the US health care system that does the best job of providing good service and controlling costs is Medicare. But you won't hear Capretta saying that. Medicare isn't a system his faction supports. It's not worth sorting lies from dissembling from truth with someone like Capretta. Even the accurate parts of his statements--if there are any at all--will be presented deceptively.

If you want to make an argument about the costs of the Mass. and national plans that will persuade the unconvinced, use reliable sources. &, seriously, why are you persuaded by the arguments of the untrustworthy?

[unixronin.livejournal.com]

I think your question has to be reworded as "Why are you persuaded by the arguments of people I consider untrustworthy." In that, you are making several assumptions, starting with the assumption that we have the same criteria of trustworthiness. I think we've already concluded in the past that the chances of the two of us ever agreeing on anything related to politics asymptotically approaches zero, including who is trustworthy and who is not.



In any case, I'm throwing this out here as a discussion point. I'm not saying it's holy writ. Capretta is far from the first I've heard of cost overruns in the Massachusetts health plan. He just happens to be the person making this comparison today. Medicare has its budgetary issues too. In 2005, the Congressional Budget Office projected Medicare spending to grow at an average annual rate of 9 percent over the next 10 years, reaching $766 billion by 2015 (via bnet (http://findarticles.com/p/articles/mi_m3257/is_4_59/ai_n13621272/)); Jacob Goldstein discussed the ballooning costs of Medicare and Medicaid (http://blogs.wsj.com/health/2010/02/02/reminder-medicare-medicaid-are-gobbling-up-the-budget/tab/article/) in the WSJ in February; and also in February, American Medical News reported that the current budget proposal freezes Medicare pay to doctors for ten years (http://www.ama-assn.org/amednews/2010/02/08/gvl10208.htm) in an effort to control costs. Virtually no government program ever somes in under, or even within, its original budget estimates. Why is it unreasonable to talk about the possibility that the new health care scheme will follow the same pattern? Is it that threatening?

[skellington.livejournal.com]

Well, some significant fraction of those people are already on Medicare and Medicaid.

And another very large fraction of those people are getting their insurance from their employer (mandated under the law.)

No telling if it will be 8M or 34M, but it won't be 130M..

[unixronin.livejournal.com]

Sure, it's pretty unlikely to be 130M. I don't know how successful those employers are likely to be to push off healthcare costs onto indivuduals, but I think the expectation that some will try to is a sound one.