Paul Krugman:After Reform Passes

[cal04]

http://www.nytimes.com/2009/10/26/opinion/26krugman.html?_r=1

So, how well will health reform work after it passes?

There’s a part of me that can’t believe I’m asking that question. After all, serious health reform has long seemed like an impossible dream. And it could yet go all wrong.

But the teabaggers have come and gone, as have the cries of “death panels” and the demonstrations by Medicare recipients demanding that the government stay out of health care. And reform is still on track. Right now it looks highly likely that Congress will, indeed, send a health care bill to the president’s desk. Then what?

Conservatives insist (and hope) that reform will fail, and that there will be a huge popular backlash. Some progressives worry that they might be right, that the imperfections of reform — what we’re about to get will be far from ideal — will be so severe as to undermine public support. And many critics complain, with some justice, that the planned reform won’t do much to contain rising costs.

But the experience in Massachusetts, which passed major health reform back in 2006, should dampen conservative hopes and soothe progressive fears.

(snip)
Still, if the Massachusetts experience is any guide, health care reform will have broad public support once it’s in place and the scare stories are proved false. The new health care system will be criticized; people will demand changes and improvements; but only a small minority will want reform reversed.

This thing is going to work.

[Better Believe It]

1. Massachusetts is no model for national health care reform

For Immediate Release
Contacts:
Feb. 20, 2009 Rachel Nardin, M.D.
Steffie Woolhandler, M.D.
Mark Almberg, [phone], mark {at} pnhp.org


Physicians, public interest group urge Sen. Kennedy to introduce single-payer legislation

WASHINGTON - The Massachusetts health care system, widely regarded as an example of how to provide universal coverage and keep costs low, is in fact faltering badly and should not be held up as a national model for reform, according to a study released this week by Physicians for a National Health Program (PNHP) and Public Citizen.

The study comes at a time when the health insurance industry is reportedly weighing in heavily in secret talks on Capitol Hill in favor of an individual mandate, a legal obligation requiring persons to have or to buy health insurance. The insurance industry's position was described in today's New York Times.

However, such mandates - which have been a cornerstone of the Massachusetts health reform - have failed to assure universal coverage, the new study says. For example, the state's most recent figures show that it had to exempt 79,000 residents from the mandate in 2007 because they could not afford to buy insurance.

The Massachusetts plan has also failed to make health care sufficiently affordable or to control costs, the report says.

The groups urged Sen. Edward Kennedy (D-Mass.) to reject his home state's approach and, instead, introduce Senate legislation crafted after the House's United States National Health Care Act, H.R. 676, which would implement single-payer financing of health care while maintaining the private delivery system. The two groups also released a letter to Kennedy signed by approximately 500 Massachusetts physicians and health professionals urging the senator to embrace single-payer reform.

"Massachusetts physicians have the unique opportunity to observe the effects of this reform on patients every day," said Dr. Rachel Nardin, president of the Massachusetts chapter of PNHP and lead author of the study. "The nearly 500 doctors who have signed the open letter to Sen. Kennedy see that the reform is deeply flawed."

PNHP's study of the Massachusetts model found that the state's 2006 reforms, instead of reducing costs, have been more expensive than expected. The budget overruns have forced the state to siphon about $150 million from safety-net providers such as public hospitals and community clinics.

Many low-income residents, who used to receive completely free care, now face co-payments, premiums and deductibles under the new system - financial burdens that prevent many of them from receiving necessary medical treatment. Since the state's reforms passed, premiums under the state insurance program have increased 9.4 percent. The study found that if a middle-income person on the cheapest available state plan got sick, he or she could end up paying $9,872 in premiums, deductibles and co-insurance for the year.

Many residents remain uninsured or have inadequate insurance.

Under a single-payer system, doctors, hospitals and other health care providers are paid from a single fund administered by the government.

"We are facing a health-care crisis in this country because private insurers are driving up costs with unnecessary overhead, bloated executive salaries and an unquenchable quest for profits - all at the expense of American consumers," said Dr. Sidney Wolfe, director of Public Citizen's Health Research Group. "Massachusetts' failed attempt at reform is little more than a repeat of experiments that haven't worked in other states. To repeat that model on a national scale would be nothing short of Einstein's definition of insanity."

The study reported that a national nonprofit single-payer system could save Massachusetts about $8 billion to $10 billion a year in reduced administrative costs. Currently, Americans spend 31 cents of every health care dollar on administrative costs, by far the highest rate in the world and much higher than the 17 cents spent in Canada, which has single-payer universal health care.

"Big hospitals and insurers have gotten rich off reform, but a survey shows that more people directly affected by it have been harmed that helped," said Dr. Steffie Woolhandler, a PNHP co-founder and associate professor of medicine at Harvard Medical School who helped prepare the study. "We're seeing patients who now can't afford vital medications and treatments that they've been on for years because of the new co-payments and deductibles imposed by the law."

Read the report, "Massachusetts' Plan: A Failed Model for Health Care Reform." http://pnhp.org/mass_report/mass_report_Final.pdf

Read the letter to Sen. Edward Kennedy. http://pnhp.org/mass_report/Letter_to_Kennedy.pdf

Read the labor letter to President Barack Obama. http://pnhp.org/mass_report/labor_letter_to_Obama.pdf

Read personal stories from Massachusetts patients. http://www.citizen.org/hrg/healthcare/articles.cfm?ID=1...


Physicians for a National Health Program
29 E Madison Suite 602, Chicago, IL 60602
Phone [phone] | Fax: [phone]
www.pnhp.org | info {at} pnhp.org

[Better Believe It]

2. Massachusetts again faces major health insurance rate increase.

Health costs to rise again
Insurers to boost rates about 10%; Shift of expenses to workers likely
By Robert Weisman
September 16, 2009

The state’s major health insurers plan to raise premiums by about 10 percent next year, prompting many employers to reduce benefits and shift additional costs to workers.

Increases will range from 7 to 12 percent, capping a decade of consecutive double-digit premium increases, according to a Globe survey of the state’s top health insurers. Actual rates for 2010 will depend on the size of the employer and the type of coverage, with small businesses and individuals expected to be hit hardest. Overall, premiums are more than twice as high as they were 10 years ago.

The higher insurance costs undermine a key tenet of the state’s landmark health care law passed two years ago, as well as President Obama’s effort to overhaul health care. In addition to mandating insurance for most residents, the Massachusetts bill sought to rein in health care costs. With Washington looking to the Massachusetts experience, fears about higher costs have become a stumbling block to passing a national health care bill.

Insurers predicted many employers, perhaps a majority, will seek to trim costs by instituting “cost sharing,’’ which boosts copayments for doctor visits, or by offering less comprehensive coverage. That means the effective premium rate increases could fall more on employees than their companies.

Read the complete article at:

http://www.boston.com/business/healthcare/articles/2009/09/16/health_insurers_plan_10_rise_in_rates/

[Better Believe It]

9. I usually agree with Krugman but not this time.

[DJ13]

3. If we get the Mass model, were fucked

[necso]

4. Massachusetts, eh?

Time will tell.

[bluestateguy]

5. Surprisingly optimistic appraisal from a Doom and Gloomer like Krugman

nt

[enlightenment]

6. Dr. Krugman is a brilliant economist, but that doesn't make

him an expert at everything. I think he's off the mark, this time.

[Hekate]

7. KnR. Thank you, Dr. Krugman, for that assessment.

[eridani]

8. The healthy in MA like it; the sick people are totalty fucked over

Budgets for public hospitals have been absolutely decimated.

[lonestarnot]

10. Never a freak'n doubt! Never a doubt!

:applause:

[glitch]

11. I think he's wrong this time but k & r for his opinion. nt

[Better Believe It]

12. I'll K & R him for his opinion