Massachusetts’ Health Care System: an Rx for the Country?
by Thomas Gill on April 29, 2009 in Features
While April rain poured yet again last Wednesday April 22, students and guests headed inside the Kennedy School to attend a Forum discussion on health care reform. The event, titled “Health Care Reform: Is the Massachusetts Model the Rx for the U.S.?”, featured Jon Kingsdale, executive director of the Commonwealth Health Insurance Connector Authority, Gail Wilensky, senior fellow at Project Hope, and Robert D. Reischauer, president, The Urban Institute.
The panelists spoke frankly, disagreeing on whether the health care reforms passed in Massachusetts three years ago can serve as a model for national reform.
Since implementing the reforms, the percentage of uninsured in Massachusetts has fallen to 2.6 percent. Viewed another way, since 2006, roughly 400,000 Massachusetts residents have become newly insured. The statistic is striking, and has captured the attention of Washington legislators.
As to whether the Massachusetts model could work at a national level, however, Wilensky, an economist and senior fellow at the international health education foundation Project Hope, raised three concerns: first, can the Massachusetts model be expanded to ensure universal coverage in every state? Second, how will the government pay for this expansion? And third, how will the government sustain these expenditures in the face of rising health care costs? Responding to these and other questions, the panelists offered audience members mixed perspectives.
Reischauer, who leads The Urban Institute, a nonprofit, non-partisan social policy research organization, did not believe that the Massachusetts model could be scaled to a national level. Having served as director of the Congressional Budget Office from 1989 to 1995, and having written and lectured extensively on health care reform, Reischauer argued that the bi-partisan support for healthcare reform in Massachusetts does not exist in Washington. He emphasized that while in theory, everyone supports reform, when the details are rolled out, divisions inevitably arise and consensus fails. Moreover, he said, the floundering economy will make health care reform in the near future very, very difficult.
Kingsdale, however, was more optimistic. When he took the job of executive director at the Massachusetts’ Commonwealth Connector, an independent authority established under the state’s reform legislation to advance coverage of the uninsured, former Massachusetts Lieutenant Governor Thomas P. O’Neill III told Kingsdale that he would essentially be running a campaign. Kingsdale acknowledged that much of his job involves creating and sustaining support for the state’s healthcare system among residents, politicians, and members of the healthcare community. He sees the potential for building consensus at a national level, much like he continues to do in Massachusetts. According to Kingsdale, a consensus on national reform is possible – it will just take work.
Sarah Steege (MPP ’10) was intrigued by the discussion. “Having discussed in several classes the lessons learned from the failure of the Clinton plan, it was especially interesting for me to hear different perspectives on why the Massachusetts plan actually passed and continues to work: you can’t just pass the bill and go home,” she said.
Still, the Massachusetts plan has its critics. When the floor opened to questions, one resident asked about the relative benefits and burdens of healthcare in the state, and who the real winners are, pointing out that he and his wife pay currently pay a combined $13,000 per year for health coverage. The panel members agreed that the amount was exorbitant. They also agreed that while universal coverage is a laudable goal, we must be wary of how much it costs contributors, particularly in these tough economic times.
Ultimately, agreement among the panelists on a plan for reform proved elusive, which was disappointing to some students.
Shira Epstein (MPP ’10) said, “While bleak prospects for U.S. health care are understandable in the current economic crisis, I would have liked to hear the panelists talk more about what we can do to improve U.S. health care rather than all the things we cannot.”
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We simply cannot afford to get too mired in policy-speak or accept any single-variable analysis to establish the success or failure of the model of universal health care implemented in Massachusetts.
Now, don’t get me wrong, you could hardly find a more fervent proponent of universal health care. And yes, it looks attractive that the percentage of uninsured individuals in Massachusetts has dropped so low–it’s no wonder that it’s piqued the interest of Washington. Yet so many questions remain unanswered or unaddressed:
What is the lived impact of the current system? Does it really promote better health to have extraordinarily excessive waits for medical appointments (a lovely side-effect of this implementation)? Has the use of emergency rooms for routine or even urgent (but not emergency) care gone down significantly (since that accounts for a huge expense)? And what about the connection between these two? It used to be that people used emergency services because they didn’t have insurance–now they use them because they can’t get an appointment–is the net economic effect any different?
And what ABOUT rising healthcare expenses, mentioned briefly in the article? What is the reason they are increasing so dramatically? Anyone who has spent a day in a hospital knows that costs for simple things, including over-the-counter medicines, are ridiculous. Why is that being allowed to continue?
And where are the insurance companies in all of this? Where is their place in the puzzle, or are we to simply accept that their executives will continue to draw bonuses while clinics are closing down and the health of citizens is suffering?
Insurance regulation is the critically missing piece in this discussion, imo.
I’m particularly fired up about this week, as you can read about on my blog (http://www.hereswhatidon’tget.blogspot.com) as I have had an opportunity to face the delays, wastefulness, and disorganization, “up close and personal”.
It is depressing to me that in 2009, with an exciting new administration that anyone, anywhere, would be measuring success by the simple numbers of insured/uninsuired, when the current crisis in health care is so complex, requiring simultaneous attention to multiple variables.
[…] positive spin on Massachussetts healthcare, and the closest I could find to a positive article was this one. Since implementing the reforms, the percentage of uninsured in Massachusetts has fallen to 2.6 […]