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

[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.