Buddy
The Living Force
Not really sure where to put this, but I thought it might shed some light on what kinds of problems may be anticipated in the event universal health care coverage becomes mandatory in the U.S. There's not a lot of 'meat' in the article, but it tends to show that we could expect a whole lot more stress added to our lives if nothing else, osit.
From a Reader's Digest article: "The Diagnosis" by Mark Gimein, November, 2008, p 113-122
Massachusetts is the only state that has embarked on an ambitious plan to make sure all it's citizens have health insurance. MIT economist Jonathan Gruber was a key architect of many of the ideas behind the state's plan. California Govenor Arnold Schwarzenegger proposed a state plan in 2007, Clinton proposed a national plan in 1993, and Earl Warren and Harry Truman proposed plans for universal coverage as far back as 1945. Massachusetts however, is the first state to actually have passed the legislation. The plan that was signed into law in 2006 created Commonwealth Care. This 'experiment' has been a study in what could be realistically achieved with such a program, including costs and trade-offs.
For some uninsured, the plan has been a godsend, for others it has imposed some pretty steep costs. Gruber's original aim was simple enough: a system that would cover the working class uninsured. The objective was to make high-quality care affordable for everyone. But at the same time, nobody wanted a plan that was so heavily subsidised by the government that it would make employers drop their health coverage, crowding out private insurers and effectively making the state's plan the only game going. Gruber wanted the plan to be cost-efficient, but the only way to do it was to make it mandatory for everyone so that there would be a huge pool of healthy people that would be paying money but not needing services.
Gruber, and ultimately the state, had concluded, at one point, that trying to coax people into buying insurance just plain wouldn't work, so the state's legislation includes fines for people who don't get insurance. This 'mandate' was the most controversial part of Commonwealth Care. This mandate is considered to be the only way to make the plan economically feasible because any plan that doesn't include the aforementioned bulk of healthy people is going to be very expensive for people to buy or the government to subsidize. In fact, it could go into a death spiral, as healthy people leave it and it becomes ever more expensive for those who stay in.
Opponents of Commonwealth Care point to the mandate as unnecessary intrusion into health care choices. Mitt Romney, the govenor of Massachusetts was against mandatory coverage, yet he signed it into law. ???
Some older residents don't earn enough to realistically afford insurance. Bill Walczak, CEO of Codman Square Health Center in Dorchester, points out that even the least expensive plan available would cost a 58 year old woman earning $32,000 a year, close to 14 percent of her income. Says Walczak: "they need to figure out how to lower the cost".
So, for some people, Commonwealth Care presents the painful choice of paying for insurance they cannot afford, or can barely afford, or having no insurance at all.
As expected, since the law has been enacted, the number of uninsured has been considerably reduced and the state has seen that some people in the program have needed more care than the state expected. The ones needing the most urgent care were the first to get in line.
The program is expected to cost $869 million this year and $1.35 billion by 2011. That's in addition to what the state pays to insure children under a seperate program and to what it pays hospitals that provide care to the uninsured. It's more than this plan was expected to cost even though more people in Massachusetts were insured than in most other states.
It has also created a health care bureaucracy that hasn't always run smoothly. Anyone worried about government's involvement in health care leading to boondoggles can find much to chew on in Massachusetts. Even once avid supporters have found the gears of the machine to be creaky.
Some members have lost there coverage - more than once - due to bureaucratic snafus. A writer who signed up and got a checkup, was expecting to pay an $18.00 premium for a cholesterol check but was billed for $662.00. It took many calls to get the bill straightened out. The writer was then asked to reinroll at the beginning of the next year and to send in his tax forms. When he did, he was told to send his pay stubs, not his tax forms, so now he might be fined for not enrolling in time. The writer stated that paying the fine might be a bargain compared to dealing with the state agency that runs Commonwealth Care.
In the end, tough economics may be the thing that makes universal health care hard to stomach. Changing jobs means changing income levels, worrying about which health plan might now be required, who is now responsible for paying for ongoing health issues or whether or not you need to find yourself a plan and buy your own. Depending on your new income, you might wind up paying full price where even the least expensive plan for a couple is $783.00 a month with a $2000.00 deductible for each person.
So, there, in a nutshell, is the big quandary of universal health care: a system like Commonwealth Care that includes subsidies for some is likely to seriously stretch the resources of others. The ultimate test of the Mass. experiment may be not in how effectively it manages to provide care for those who can't afford insurance on their own, but in how well it does in getting all the others to buy in.
Comments, feedback welcome.
From a Reader's Digest article: "The Diagnosis" by Mark Gimein, November, 2008, p 113-122
Massachusetts is the only state that has embarked on an ambitious plan to make sure all it's citizens have health insurance. MIT economist Jonathan Gruber was a key architect of many of the ideas behind the state's plan. California Govenor Arnold Schwarzenegger proposed a state plan in 2007, Clinton proposed a national plan in 1993, and Earl Warren and Harry Truman proposed plans for universal coverage as far back as 1945. Massachusetts however, is the first state to actually have passed the legislation. The plan that was signed into law in 2006 created Commonwealth Care. This 'experiment' has been a study in what could be realistically achieved with such a program, including costs and trade-offs.
For some uninsured, the plan has been a godsend, for others it has imposed some pretty steep costs. Gruber's original aim was simple enough: a system that would cover the working class uninsured. The objective was to make high-quality care affordable for everyone. But at the same time, nobody wanted a plan that was so heavily subsidised by the government that it would make employers drop their health coverage, crowding out private insurers and effectively making the state's plan the only game going. Gruber wanted the plan to be cost-efficient, but the only way to do it was to make it mandatory for everyone so that there would be a huge pool of healthy people that would be paying money but not needing services.
Gruber, and ultimately the state, had concluded, at one point, that trying to coax people into buying insurance just plain wouldn't work, so the state's legislation includes fines for people who don't get insurance. This 'mandate' was the most controversial part of Commonwealth Care. This mandate is considered to be the only way to make the plan economically feasible because any plan that doesn't include the aforementioned bulk of healthy people is going to be very expensive for people to buy or the government to subsidize. In fact, it could go into a death spiral, as healthy people leave it and it becomes ever more expensive for those who stay in.
Opponents of Commonwealth Care point to the mandate as unnecessary intrusion into health care choices. Mitt Romney, the govenor of Massachusetts was against mandatory coverage, yet he signed it into law. ???
Some older residents don't earn enough to realistically afford insurance. Bill Walczak, CEO of Codman Square Health Center in Dorchester, points out that even the least expensive plan available would cost a 58 year old woman earning $32,000 a year, close to 14 percent of her income. Says Walczak: "they need to figure out how to lower the cost".
So, for some people, Commonwealth Care presents the painful choice of paying for insurance they cannot afford, or can barely afford, or having no insurance at all.
As expected, since the law has been enacted, the number of uninsured has been considerably reduced and the state has seen that some people in the program have needed more care than the state expected. The ones needing the most urgent care were the first to get in line.
The program is expected to cost $869 million this year and $1.35 billion by 2011. That's in addition to what the state pays to insure children under a seperate program and to what it pays hospitals that provide care to the uninsured. It's more than this plan was expected to cost even though more people in Massachusetts were insured than in most other states.
It has also created a health care bureaucracy that hasn't always run smoothly. Anyone worried about government's involvement in health care leading to boondoggles can find much to chew on in Massachusetts. Even once avid supporters have found the gears of the machine to be creaky.
Some members have lost there coverage - more than once - due to bureaucratic snafus. A writer who signed up and got a checkup, was expecting to pay an $18.00 premium for a cholesterol check but was billed for $662.00. It took many calls to get the bill straightened out. The writer was then asked to reinroll at the beginning of the next year and to send in his tax forms. When he did, he was told to send his pay stubs, not his tax forms, so now he might be fined for not enrolling in time. The writer stated that paying the fine might be a bargain compared to dealing with the state agency that runs Commonwealth Care.
In the end, tough economics may be the thing that makes universal health care hard to stomach. Changing jobs means changing income levels, worrying about which health plan might now be required, who is now responsible for paying for ongoing health issues or whether or not you need to find yourself a plan and buy your own. Depending on your new income, you might wind up paying full price where even the least expensive plan for a couple is $783.00 a month with a $2000.00 deductible for each person.
So, there, in a nutshell, is the big quandary of universal health care: a system like Commonwealth Care that includes subsidies for some is likely to seriously stretch the resources of others. The ultimate test of the Mass. experiment may be not in how effectively it manages to provide care for those who can't afford insurance on their own, but in how well it does in getting all the others to buy in.
Comments, feedback welcome.
