The Operation Succeeded but the Patient Died

Oops, they did it again.

The Boston Globe has once again written about the Massachusetts mandatory health insurance plan without ever asking the critical question: "Are people getting the health care they need?"

They ask whether people have insurance coverage. Sure, since they'd be scofflaws if they didn't! But being covered is not the same thing as getting care: not when you can buy insurance that doesn't kick in until after you pay a high deductible. That kind of insurance is a subsidy from the working poor to the health insurance industry: pay for something you can never use.

They ask whether it saves the state money. That's an important question, but only AFTER you answer "Are people getting the health care they need?" Because surely the state could save even more money by letting people die. Cost is not the primary issue, any more than coverage is. The primary issue is health.

They ask how small businesses react. That's a good question. Small businesses are justifiably concerned that they are subsidizing large health insurance companies, hospital chains, and the state. But it really shows the bias of the Globe that they ask about small businesses and not about the people who work in them.

They ask what effect this plan will have or should have on Romney's presidential campaign. Show me a mom working two jobs to support her family who's paying for health insurance and who still can't afford routine doctor's visits for her children who cares about that question. Find me one. Then I'll agree that the Globe cares even one little bit about the working people who need real health insurance--not the plan we've got.

Health Insurance Bill is a Ticking Bomb

I have been showing how the new federal bill that requires people to buy health insurance resembles the system we have here in Massachusetts, which is wrong and unfair. It forces people to buy coverage without actually getting care. It plays Robin Hood in reverse by sending working- and middle-class people's money to rich insurance companies and hospitals. It stigmatizes women who exercise their right to obtain an abortion. People who don't have health insurance yet think the Massachusetts plan doesn't give them what they need, and they resent having to pay for something that doesn't save them any money.

(It may be true, as my friend Larry Lennhoff says, that people will realize the value of health insurance the moment they have a catastrophic illness. For most of us, fortunately, that means never realizing it. It may also not be true. If the public was going to be on the hook for your care before, and now you are paying for insurance yourself, how does that make you happy?)

What I fear most about the new health insurance bill is that it may make people oppose ALL forms of publicly funded health care. Some people think this has happened already. They read the recent election of State Rep. Scott Brown to the U.S. Senate seat as a referendum on health care. I believe this is a whopping big mistake: the Democratic candidate, State Attorney General Martha Coakley, failed to mount any real campaign after she won the Democratic nomination. In effect, she gave the election away. Furthermore, I believe people took their frustrations with the corrupt Democratic monopoly of the Massachusetts legislature out in the Senate race. It doesn't matter that the two have nothing to do with each other.

Still, I do hear people complaining about the Massachusetts bill in casual conversation--in the public library, for instance, checking out books. People are forming the impression that if the government runs it, it's bound to favor the rich and hurt them. They have a lot of reason to think that, and the mandatory health insurance bill just adds one more. To me, that's the biggest reason to oppose it and want to replace it. When you're alienating voters who should be your strongest supporters, you need to think again--before it blows up in your face.

Uninsured Don't Think the Answer is Forcing Them to Buy

I've been recapping the Massachusetts experience with mandatory health insurance, asking what it can tell us about the federal plan just passed. Back in 2008, I wrote:

If you believe the papers, the politicians, or the pundits, the Massachusetts plan to make sure everyone has health insurance--by forcing them to buy it for themselves--is a great success. The uninsured don't believe it, however. Neither do low-income people in Somerville, where I live. Neither do I.

According to the Boston Globe, "The number of uninsured adults in Massachusetts fell by almost half last year." Proponents of mandatory health insurance said "that not only are more people getting coverage, but that only a fraction of taxpayers contested the health insurance mandate."

Sounds like great news, right? It does--until you look at who supports mandatory health insurance and who doesn't. People who already have insurance favor the plan by 71%. Not surprising: it doesn't cost them anything out of pocket, and the taxes needed to fund the plan haven't kicked in yet. But a majority of people who don't have health insurance yet--the people the plan is theoretically supposed to benefit--don't support it, according to a study by the Massachusetts Dept. of Revenue.

In Somerville, where I live, we recently [in 2008] surveyed 537 mostly low-income residents or employees. We asked them what should be the top priority of CAAS, the anti-poverty agency where I work. Keeping housing safe and affordable was the $1 priority (not a surprise, given the high cost of housing in our area). English literacy and finding a job, or a better job, were essentially tied at #2. "Access to health insurance" ranked #3. The people who need health insurance the most are telling us that the Massachusetts plan is still a problem and not yet a solution.

You MUST Buy Health Insurance--Corporations Need Your Money!

I've been sharing the Massachusetts experience with mandatory health insurance with my readers, so you can know what to expect from the federal plan that's modeled on Massachusetts. Expect Robin Hood in reverse: a big subsidy by the working poor and middle to the richest of the health care providers. I originally published this piece last summer.

Massachusetts requires all residents to buy health insurance, even if it means coverage without care. Buying a health plan with a high deductible means paying for nothing, which is what thousands of Massachusetts residents are doing. But it's worse than that.

It turns out that our state government forced struggling young people and families into the insurance business partly so that hospitals didn't have to give them free care any more. "Today, hospitals typically spend about 1 percent of expenses on free medical care, as measured by the attorney general, half of what they spent before reform made insurance available to many more low-income people," according to the Boston Globe.

Meanwhile, nonprofit hospitals are making a profit out of their tax-exempt status--an exemption granted to them largely so that they could offer free care!

The 10 leading hospital companies benefited from an estimated $638 million in federal, state, and local tax breaks as well as state discounts on borrowing in 2007, the latest year for which complete data are available. More than half of that goes to two large and growing companies, Partners and Children's Hospital. Overall, the 10 hospital companies' tax breaks and other benefits were worth $264 million more than the value of the "community benefits" - care for the poor and other charity work - they reported to the state attorney general that year.

It's important to mention the hospitals that ARE offering a lot of free care: "Three companies - Tufts Medical Center, UMass Memorial Health Care (owner of UMass Memorial Medical Center in Worcester) and Boston Medical Center - reported spending more on community benefits than the value of their tax breaks as estimated by the Globe." But they are the shining exceptions--and Boston Medical Center is having severe financial troubles because of its commitment to serving the poor.

In short, so-called nonprofits like MGH and Children's Hospital are stiffing the poor, and we are giving them a tax break at the same time. This should be the shame of Massachusetts.

Coverage Without Care: What's to Oppose in the New Health Care Bill. part I

OK, so last week, in all fairness, I pointed out that the health insurance bill does contain some provisions that will help people--especially really poor people or really young adults (26 and under). In general, however, the national health insurance plan follows the path already trod in Massachusetts. Having lived under it, the Massachusetts plan is not one I would recommend.

What's wrong with it? Plenty. Let's start with one issue I have been observing for almost a year now: coverage without care.

I wrote on May 4, 2009, "Across Massachusetts, people are facing a stark choice: pain or poverty. The mandatory health insurance law forces people to buy some kind of coverage, but often, what people can afford won't pay for the care they need. In today's Boston Globe, Judi Campbell of Northampton says she's putting off hip surgery because she already owes the hospital $1,000 for arthritis-related surgeries her insurance wouldn't cover."

"And yet the Globe and many policy makers proclaim the "success" of the Massachusetts health insurance plan. For shame!"

On June 21, I wrote:

"The Globe reports:

People with robust [sic] health insurance are putting off doctors’ appointments and skimping on prescriptions because they can’t afford the increasing costs of copayments and deductibles, according to managers of patient-assistance hot lines in Massachusetts.

"All right, let's give the reporters credit. Never mind the logical impossibility of health insurance plan being "robust" if you can't actually use it. (The operation was successful, but the patient went broke?) Also, forget about the fact that this only becomes news when it affects middle-class people, the kind who thought they were already well insured. "

"Let's be happy that finally, it's front-page news that the Massachusetts individual mandate to buy health insurance is failing to deliver actual health care to a large and growing number of people. The key word here is "failing." This is not a model for national health insurance. It's an object lesson in what happens when the hospitals, insurance companies, and doctors all design a health plan without the slightest thought for its effects on actual patients."

Next installment: how the Massachusetts health insurance plan is Robin Hood in reverse--and the federal government follows suit.

Election Distraction

Should we end the war in Afghanistan as quick as we can, or possibly send in more troops? Can we provide health care (not just insurance!) to everyone who needs it, and will that mean putting private health insurers out of business? Is the recession slowing down, and for whom: is it good news if unemployment is still in double digits in certain regions? How do we stop nuclear proliferation, and global warming? Is it really a sign of progress when a woman in Iran stands up for the right to wear pants without being flogged for it, but women in many parts of the U.S. have to travel for hours to get the reproductive services (including both contraception and abortion) that the Constitution protects? How can the states pay for vital services and schools without going bankrupt?

All these questions, and many more, are serious and should be at the top of the agenda. But in Massachusetts, we're arguing about whether the governor should be able to appoint an interim U.S. Senator to take Ted Kennedy's seat or whether we have to wait five months to elect somebody. Huh?

OK, I know these questions are related. I have a Ph.D. in political science: no need to rehearse the arguments with me. The point is that whether it's an appointment, an election, or a coronation, it's also a distraction. Whoever we elect will only do as good a job as we force him or her to do. We should be focusing on the issues, not the candidates.

Further Away from Universal Health Insurance in Massachusetts

"We don't really care whether everybody gets insurance."

The Massachusetts Health Connector might as well emblazon that message on a banner and hang it the middle of Boston Common. It's what they're saying anyway by cutting the plan back 12%.

Already, as I have noted, many people in Massachusetts had coverage without care, because they couldn't afford to pay for the plan AND the deductible. Instead of paying the doctors, they paid the health insurers for plans that didn't give them anything.

Tuesday, the board of the Commonwealth Health Connector, which runs the mandatory insurance plan, dropped the last vestige of a pretense that everyone would even get insurance (useable or not). Are you a low-income resident, entitled by law to a full subsidy, but you forgot to sign up? Too late now. You and 18,000 people like you are out of luck. Even if you did what you were supposed to and enrolled, the Connector just snapped its collective fingers and took away your dental care. Or were you born in Ireland, or Greece, or Haiti, or El Salvador, and came to this country with full legal status? Tough. The feds aren't going to pay their share to insure you, so Massachusetts has decided you're just too expensive.

What makes it worse is that groups like Health Care for All, who should be marching in the streets, are busy making excuses for Massachusetts instead.

But the group said state officials appear to have made the best of a bad situation. “There’s no other place to go for money,’’ said Lindsey Tucker, the organization’s healthcare reform manager. “. . . My concern is people will not get the care that they need.’

Damn straight they won't! And it is not a health advocate's place to take the state off the hook. There are plenty of places to go for money. We just need politicians with backbones, and voters with consciences. We won't get either by dumping low-income and immigrant residents over the side of the leaky health insurance plan to lighten the load for the rich and powerful in this state.

Finally, They Ask Who's GETTING Health Care

The Globe reports:

People with robust [sic] health insurance are putting off doctors’ appointments and skimping on prescriptions because they can’t afford the increasing costs of copayments and deductibles, according to managers of patient-assistance hot lines in Massachusetts.

All right, let's give the reporters credit. Never mind the logical impossibility of health insurance plan being "robust" if you can't actually use it. (The operation was successful, but the patient went broke?) Also, forget about the fact that this only becomes news when it affects middle-class people, the kind who thought they were already well insured.

Let's be happy that finally, it's front-page news that the Massachusetts individual mandate to buy health insurance is failing to deliver actual health care to a large and growing number of people. The key word here is "failing." This is not a model for national health insurance. It's an object lesson in what happens when the hospitals, insurance companies, and doctors all design a health plan without the slightest thought for its effects on actual patients.

You Must Buy Health Insurance--MGH Needs Your Money

I will get back to the delights of midrash in a bit--but first, the latest outrage from the Massachusetts health care system.

Massachusetts requires all residents to buy health insurance, even if it means coverage without care. Buying a health plan with a high deductible means paying for nothing, which is what thousands of Masschusetts residents are doing. But it's worse than that.

It turns out that our state government forced struggling young people and families into the insurance business partly so that hospitals didn't have to give them free care any more. "Today, hospitals typically spend about 1 percent of expenses on free medical care, as measured by the attorney general, half of what they spent before reform made insurance available to many more low-income people," according to Sunday's Boston Globe.

Meanwhile, nonprofit hospitals are making a profit out of their tax-exempt status--an exemption granted to them largely so that they could offer free care!

The 10 leading hospital companies benefited from an estimated $638 million in federal, state, and local tax breaks as well as state discounts on borrowing in 2007, the latest year for which complete data are available. More than half of that goes to two large and growing companies, Partners and Children's Hospital. Overall, the 10 hospital companies' tax breaks and other benefits were worth $264 million more than the value of the "community benefits" - care for the poor and other charity work - they reported to the state attorney general that year.

It's important to mention the hospitals that ARE offering a lot of free care: "Three companies - Tufts Medical Center, UMass Memorial Health Care (owner of UMass Memorial Medical Center in Worcester) and Boston Medical Center - reported spending more on community benefits than the value of their tax breaks as estimated by the Globe." But they are the shining exceptions--and Boston Medical Center is having severe financial troubles because of its commitment to serving the poor.

In short, so-called nonprofits like MGH and Children's Hospital are stiffing the poor, and we are giving them a tax break at the same time. This should be the shame of Massachusetts.

Insuring pain--or poverty

Across Massachusetts, people are facing a stark choice: pain or poverty. The mandatory health insurance law forces people to buy some kind of coverage, but often, what people can afford won't pay for the care they need. In today's Boston Globe, Judi Campbell of Northampton says she's putting off hip surgery because she already owes the hospital $1,000 for arthritis-related surgeries her insurance wouldn't cover.

And yet the Globe and many policy makers proclaim the "success" of the Massachusetts health insurance plan. For shame!

If This Were Reform, It Would Have Different Friends

I've written before that the main problem with the Massachusetts mandatory health insurance plan is that it mandates coverage--but not care. Are we about to see that problem made larger on the national level?

"Lobbies backing health reforms," today's Boston Globe headline screams. "Insurers change their tune from 1993-94 debate." But the article makes it clear that insurance companies are getting involved only so they can protect their own interests, not those of the patients who need the care. It quotes Karen Ignagni, the president of "the nation's largest health insurance lobbying group":

"Strategically, industries have choices if they're at the epicenter of the discussion about a certain part of the economy," she said. "They can sit and wait for others to develop proposals or take the bull by the horns and look at what are the issues that are troubling the country, what are the issues that need to be resolved to help improve the productivity of the country. . . . It's not an altruistic strategy, it's a realistic leadership strategy."

And the insurance companies certainly do have a dog in this fight.

The insurance industry, meanwhile, could gain or lose depending on which reforms are adopted: Offering tax credits or subsidies to help pay for private coverage for the uninsured could bring insurers millions of new customers; but if a reform law also lets people choose a public Medicare-style plan, private insurers could lose business.

As they should! Here is an early warning signal that the Obama administration may become the third term of the Clinton era. To stop this backsliding in its tracks, check out Health Care for America Now. For the solution we really need, see your doctor: Physicians for a National Health Program.

Too Soon to Declare Victory on Health Care in Massachusetts

If you believe the papers, the politicians, or the pundits, the Massachusetts plan to make sure everyone has health insurance--by forcing them to buy it for themselves--is a great success. The uninsured don't believe it, however. Neither do low-income people in Somerville, where I live. Neither do I.

According to the Boston Globe, "The number of uninsured adults in Massachusetts fell by almost half last year." Proponents of mandatory health insurance said "that not only are more people getting coverage, but that only a fraction of taxpayers contested the health insurance mandate."

Sounds like great news, right? It does--until you look at who supports mandatory health insurance and who doesn't. People who already have insurance favor the plan by 71%. Not surprising: it doesn't cost them anything out of pocket, and the taxes needed to fund the plan haven't kicked in yet. But a majority of people who don't have health insurance yet--the people the plan is theoretically supposed to benefit--don't support it, according to a study by the Massachusetts Dept. of Revenue.

In Somerville, where I live, we recently surveyed 537 mostly low-income residents or employees. We asked them what should be the top priority of CAAS, the anti-poverty agency where I work. Keeping housing safe and affordable was the $1 priority (not a surprise, given the high cost of housing in our area). English literacy and finding a job, or a better job, were essentially tied at #2. "Access to health insurance" ranked #3. The people who need health insurance the most are telling us that the Massachusetts plan is still a problem and not yet a solution.

What do they know that policy makers don't know? I have suggested in the earlier version of this blog:

1. Too many people will have coverage without care. The affordable plans people can purchase hardly cover anything. There’s a huge “deductible,” a payment people have to make up front each year before the insurance policy pays a dollar. If I go to the hospital for a week, sure, I’m covered after the first day. But if I go to see my doctor or dentist, or if I have to buy prescriptions or eyeglasses, I’m the one who’s paying. How many thousands of Massachusetts residents will be insured but never get any more health care than they have now, under this plan?
   
   
   
2. Too many people still won't have health coverage, period. For some desperately poor people, or even people with a decent income but a lot of expenses, there’s no plan on the market that can really be called affordable. Massachusetts graciously exempts them from the mandate. But that means they won't have health insurance, the same as before!
   
   
3. The plan penalizes the poor and subsidizes the corporations that sell health insurance. The mandatory plan has teeth because the tax collectors can fine you up to $912 if you don't buy health insurance. "You think you're too poor to buy health insurance?" they are saying in effect. "Well, how would you like to pay the state and get no health insurance, instead?" The money that we are forcing the working poor to pony up for health insurance they can't use and can't afford is going straight into the pockets of the big health insurers. We are robbing the poor and giving to the rich, and patting ourselves on the back while we do it!
   

We don't need to be forced to buy health insurance from for-profit corporations. What we need is a "Medicare for all" system that efficiently provides high-quality care to everyone, regardless of the ability to pay.