Thoughts on Massachusetts’ new health care law

[xiphias]

So, Massachusetts is implementing new rules that are designed to require everyone in the Commonwealth to have health insurance.

It is the most bizarre and byzantine set of health care regulations anyone could imagine. It involves penalizing people on their taxes if they don’t have health care, penalizing businesses that don’t offer health care to their workers because they’re not legally required to do so, having subsidized health care plans, and a bunch of other things.

A lot of people on my friends list are annoyed-to-upset with it on libertarianish principles, in that it’s forcing people to buy a product because it’s good for them, which is very nanny-state-ish. And I see their point. In my mind, I’m less bothered by it, because it’s fundamentally like charging a tax to everyone and then earmarking that money to have the Commonwealth buy health insurance for folks (which, admittedly, wouldn’t be any better from a Libertarian point of view, and, from a practical point of view, would be worse, as the Commonwealth would end up using the money for something else, anyway).

But, there’s one question I’ve not really heard anyone talking about.

Will it work?

And my answer is, “I haven’t a frickin’ clue.”

It is rare for me to have absolutely no gut feeling on what the effects of a piece of legislation will be. I’m not always right, of course, but I usually have SOME sort of feeling one way or another about whether it will have more-or-less the effects it’s designed to have.

I’ve got absolutely no feeling about this one.

It could be horrifically disastrous. It could be brilliant. I really don’t know.

It’d be fantastic if it actually goes forth and ends up with everyone in Massachusetts having reasonably affordable health care. And, well, I’ve got no reason to suspect that it WON’T work.

I’ve also got no reason to suspect that it WILL work.

This is truly a strange situation to be in.

Comments

[jehanna.livejournal.com]

For my part, I tend to guess that any piece of legislation that can be accurately described as "byzantine" will tend to have been a Bad Idea, even if it was meant to be a Good Thing. It greatly increases the chances that nobody involved will have been able to think through all the consequences before voting it in, which inevitably leads to unexpected nightmares for people caught up in it.

The shame of it in this case IMO is that this will lead to a lot of public fulminating along the lines of "See? Universal health care IS a bad idea", and a poor execution will have set back a good cause.

[lietya.livejournal.com]

For what it's worth, "will it work" has been the primary, perhaps the only, question I've been asking.

As someone who's insured in Massachusetts (though I don't live there), I find myself somewhat suspicious that this is going to be a fiasco. But I could just be unduly pessimistic.

(Honestly, I'd rather see true, single-payer healthcare on the state level; my worry is that if this *does* work, it'll be an excuse to put off that even better goal because "what we've got is OK," and if it doesn't, it'll be used as a reason why universal healthcare is a terrible idea. Either way, I see a net loss to the final result that I, personally, want.)

[felis-sidus.livejournal.com]

Define "work". Better yet, define "affordable health care".

[rmjwell.livejournal.com]

Fair enough.

I'll define a "Working health care system for Massachussettes" as one that provides access to health care for every citizen of the state of Massachussettes. That's the vicory condition.

So, in my universe I would offer the following; a business gets a tax credit/deduction/benefit for every Massachussettes citizen they provide health care coverage for. Not "access to insurance" or the like; they only get to count the number of Mass. citizens who get their insurance through them (this includes spouses, children, and relatives of employees). The state also offers a health insurance plan for those people who cannot get health coverage through their employer, either because they lack a job or the employer's coverage is prohibitively expensive to the end user.

The next trick is making the tax benefit to the company a better value than not offering insurance at all. Thus the companies have a strong incentive to make health care a part of their program. Companies also have an incentive to partner with the state government to apply pressure on the insurance companies to bring in better AND less-expensive coverage packages (after al, the idea ofinsurance is that the more people who are covered the less risk overall to the insurance provider).

Yes, the insurance companies will howl, but I'm not overly worried.

[felis-sidus.livejournal.com]

Actually, your plan has a fair amount in common with the current situation in Massachusetts. The point I hoped to make indirectly is that, as usual, the devil is in the details. Like Xiphias, I have no idea whether or not the new plan will work any better than the current one.

Technically, most people in Massachusetts have access to health care, depending on how one defines "access to health care". The problem is with the nature of the access: after a problem occurs rather than preventative. People on welfare are covered under Medicaid. People not on welfare, but unable to afford conventional insurance (according to defined financial resources) can be covered under a State-subsidized plan. Hospitals are requred by law to give at least 1% of their gross revenue in free care, so most of them will give free care to folks making up to 200% of the federal poverty limit, and will give substantial discounts to uninsured folks making more than that, varying with the individual's financial situation. If they give less than the required amount of free care to their own patients, they pay the rest into the State Free Care Fund, to help pay for the care of patients at hospitals that get the heaviest numbers of people unable to pay. This has kept a couple of inner city hospitals open when otherwise they'd have gone bankrupt.

So if you're already sick, you probably can find someone to treat you regardless of your financial situation. Getting preventative care is another matter. This is a problem both from a humanitarian point of view and from a financial point of view. It's cheaper to keep people healthy than to treat them when they're ill. Those who are most at financial risk under the present system are those who are self-employed and those in the middle-income ranges who are uninsured. The requirement that people who can afford insurance (define "afford"....) but choose not to buy it, is intended to keep people who really can afford insurance from opting to let the State pay for their care, thus using resources which otherwise would be available for people who have greater financial limitations.

One thing I find interesting is how few people know about the free care programs at the various hospitals. All hospitals in MA post notices that free care is available prominently, in their clinics, emergency rooms, admitting and registration offices, in patient handouts, and the like. Yet every time I run into someone who's putting off health care because they're uninsured and struggling financially, they're amazed to hear about the program. My guess is that either they've assumed they wouldn't be able to get care, so didn't get as far as the hospital to see the notices, or that they've just ignored the notices. Most hospitals post the notices in 4 or 5 languages, so I doubt that language barriers apply.

[rmjwell.livejournal.com]

My apologies for being unclear. When I said "access to health care services" I meant preventative as well as emergency services and points in between. For all the reasons you list.

[xiphias.livejournal.com]

Oh, yeah. But even if I could come up with a reasonable set of metrics, which, as you well know, I can't, I STILL can't imagine how to predict how this set of regulations is going to play out.

Even if we restrict it to "will this make stuff in Massachusetts better or worse?" and handwave what "better" means, I don't have the foggiest idea.

[felis-sidus.livejournal.com]

Which just goes to show that you understand the situation better than many.

[bradhicks.livejournal.com]

What exactly does it do to penalize people who are out of work and/or disabled and don't have health insurance? I'm confused.

[adrian-turtle.livejournal.com]

People who are disabled get medicaid and social security disability. The penalties are supposed to be for people who are employed, and making more than some threshold income, with the option to purchase health insurance, who choose not to insure themselves. (There's also penalties for companies that don't subsidize insurance for their employees. It's complicated.) All the penalties go into a fund that the state will use to provide health insurance for poor people -- people who have too much money to be eligible for medicaid, but not enough for the threshold income that would require them to buy their own.

I'm concerned about the complexity of the system. I don't understand all of it, having only read a few newspaper articles about it, but it seems like there's an awful lot of opportunity for fraud and administrative stalling. Even if everyone is perfectly honest and trying really hard to be helpful, increasing complexity tends to increase administrative costs and increase the risk of expensive mistakes.

[burgundy.livejournal.com]

I've only heard a few pieces on NPR, but this is what I've gathered thus far: There will be low-cost alternatives offered, though I don't know if these will be under direct state control or if they've just made arrangements with private providers or what. People who make less than 300% poverty level income get special deals, though I no longer remember exactly what those deals will be (free, or extra discount, or what). The people I most worry about are the ones making just above 300% who don't get insurance through work, because frankly that's not a huge amount of money given how much individual policies can cost. I don't know how expensive the plans they'll be eligible for will be.

[xiphias.livejournal.com]

You pay an extra $500 on your taxes if you don't have health care. If you're disabled, or unemployed, you can get subsidized health care. So you end up in a situation where you can either pay $500 for health care, or $500 for not health care.

And if you can't even pay $500, you can theoretically pay even less and get health care. That's the idea, anyway.

Is it going to work? See the above and oft-repeated, "I have no frickin' clue."

[burgundy.livejournal.com]

When it comes to nanny-state issues - I don't think that's all of what's going on (says the non-Mass resident, so I may be completely wrong). Uninsured people are a big financial drain. They go to ERs instead of doctors' offices. They wait until things get serious before seeking care. They are often unable to pay the hospital bills. And so on. So you have in many cases more lost productivity, money and services taken out of the public hospital system that isn't put back in, possible public health issues when it comes to infectious diseases... I don't have any kind of data, and I don't know enough (yet) to know all the pieces that would be necessary for a full cost/benefit analysis. But purely financially, this could be the better route (better than the current system, I mean; I'm not even talking about single-payer here).

[hfcougar.livejournal.com]

I completely fail to see any universe where penalizing people on their taxes because they can't afford health insurance is a wise or just idea. It's yet another way to punish the poor and even more than that, the middle-income set.

Take me, for example. I am offered health insurance by my employer, a temp agency. Not only can I not afford the premiums without lifestyle changes, but it's an enormous ripoff for what I'd get vs. what I'd be paying. I make just enough money that I fully expect to get utterly screwed because of this.

[alcinoe.livejournal.com]

I feel for the folks who can't afford thier work insurance but also don't qualify for State run insurance.

[ashnistrike.livejournal.com]

I'm from Massachusetts, though no longer living there. My strong suspicion is that this reads, "Let's try a bunch of things that might work. Then the next time a Massachusetts Democrat wants to run for president and talk about universal health coverage, they can point to the things that worked." In other words, it's a lab. I might have something to say about trying all your independent variables at the same time, but... It's better to try something. Massachusetts appears to have designated itself the Official Social Experiment State, and I'm proud of 'em.

[cheshyre]

Then the next time a Massachusetts Democrat wants to run for president

Actually, folks are wondering if this might be part of Romney's campaign plans...

[ashnistrike.livejournal.com]

To prove that it doesn't work? Or to try and get some odd version of privatized health care on the Republican platform? Or something stranger? Romney hasn't really struck me as a bipartisan sort of guy.

I like your icon.

[dancing-kiralee.livejournal.com]

It might make things better, or average, but it will not work for everyone, and I can definitely think of some people who will be hurt by it - in fact I used to be one of them...

The category of people who will be hurt are poor (or poorish) people with a low bureaucratics skill. Or people who lack money but don't qualify for medicare (which, I believe, exist).

Kiralee