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Massachusetts Makes Health Insurance Mandatory
Iron Condor writes "Massachusetts is the first state to require its residents to secure health insurance, a plan designed to get as close as practically possible to statewide universal health care. Presidential hopeful and former Massachusetts governor Mitt Romney originally introduced the idea in 2004. Effective July 1, 2007, the law, which uses federal and state tax dollars, is aimed at making health insurance affordable to all residents of the state, including low-income populations. Those who fall below the federal poverty line may be eligible for health care at no cost."
I have looked at the Mass health insurance plan. I may be misunderstanding something, but their idea seems to be to get rid of uninsured by declaring it illegal. The closest equivalent I can think of is to stop New Orleans floods by declaring it illegal for levees to break.
They haven't gone a single step forward in fixing the underlying problem of why healthcare costs so much.
(disclaimer: I live in Mass. and my health insurance has not gone down. In fact it went up)
It compares pretty well. Two years ago the US spent (in nice round numbers) USD5200 per person on healthcare. At current exchange rates, that's GBP2600-ish. Using a two year old exchange rate it was GBP4200.
I live in the UK and I think it's interesting to read your experience and contrast it with mine where there is a nationalised health service.
I was drunk one night walking home from the pub and decided to investigate the railway near my house a little more closely. Whilst climbing back over the fence to the road I lost my balance and fell off. On the way down I grabbed the top of the fence and unfortunately put the palm of my hand onto a rusty nail embedded in the fence. The nail ripped a large gash from the palm of my hand to just before the base of my middle fingers.
Since it was around 3AM in the morning I went to the A&E department at the local hospital ( 5mins in a car ). First of all a doctor examined the wound and picked out bits of fence and rust and then a nurse put in 15 or so stitches. I was seen by the doctor immediately and was back at my house around 40mins later. I also had a tetnus injection.
The next day I went back to the hospital where I saw another doctor ( 15min wait for that ) who checked for any nerve damage or other problems with the gash and I think an X-Ray as well and they gave me a load of bandages.
A week later I went to my local doctor to get a sick note for work ( it was my right hand ) and also saw her nurse to check it was all healing and decide when the stitches should come out and a while after that I went back to have the stitches out.
All of this cost me nothing ( except 3 weeks paid holiday from work ) and I think I got a very efficient and effective service. This is the first time I've ever been to hospital and the 2nd time I've ever seen my doctor in 30 years ( the other was for a yellow fever injection before I went on holiday somewhere ) so I really doubt I'd have been bothered to get any medical insurance if I didn't have the NHS to look after me.
Not just factually dubious, factually bullshit.
It is so interesting hearing conservative whack jobs talk about the bottom line as the ultimate measure of success in an endeavor. Then have them develop selective hearing loss when the bottom line is revealed for a social justice policy like universal health insurance. For example, average life expectancy at birth in the UK is 78.7, in the US its 78. Average spending on health care in the US as a percentage of GDP is 15% in the UK its 9.4%. (And remember for that 15% we don't cover about 15% of the population, while the UK covers 100%.)
So either the British are significantly healthier than us, it is cheaper to provide inexpensive preventative care for all in the long run, or there is a large sucking sound that is coming from the health insurance industry and Pharma taking about 30% off the top of what we spend.
I will tell you the only two thing that is keeping my partner and I from immigrating to Canada is the fact that it would be hard(er) to take his parents with us and I hate cold weather. With global warming and time, Canada looks a whole lot better. And this is a sentiment that I have heard from a lot of my colleagues. Few physicians want to work in a system where 15% of people are uninsured, where people die for lack of simple basic preventative care, where in order to write your patient an rx for an antibiotic, you have to check one of a thousand formularies to determine which they will pay for. For a group of people who, when they started medical school were largely idealistic and wanted to help people, this is a soul-crushing system. However our kids, parents, whatever obligation prevents us from moving. But leave it for a few years, and you may find that the trend of Canadian Physicians emigrating to the US, which slowed and then halted in 2004, may reverse course with US physicians emigrating to Canada.
Nick
I would like to give a little perspective to the US System.
US employer based health care grew directly from WWII tax and rationing policy. During the war the income tax was extremely high and rationing was in place. But workers needed to be taken care of in order to maintain productivity. Health care and other "benefits" therefore became tax exempt and were excluded from the income tax calculation. That system made sense during wartime and afterwards when much of the US had lifetime employment and society valued life differently than we do today.
Then during the 1970s in a wrongheaded approach to controlling health care costs, government encouraged the establishment of HMOs and other forms of insurance middlemen with the idea that it would be in their interest to control costs and provide the most benefits. But the government still propped up employer based health care primarily as a response to the generous benefits that were lavished on the big unions by GM and Ford and the big industrial companies. The fear amongst many older union workers was that they would lose out on benefits they were soon going to start really needing.
In the US you get to deduct health insurance expenses only if it is provided through an employer (that might change once health insurance is essentially a tax as it is now in Massachusetts), but health insurance that you buy on your own because maybe you found better insurance outside your employers plans (which the employer might have gotten kickbacks from the insurance companies to exclusively provide) doesn't get you a deduction at all. The effect of which is to hand over buying power to your employer even though they might not even be subsidizing the insurance at all, so they will generally offer 3 plans, the least of which is not likely to be chosen by those who decided on the plans, but which is most likely to be chosen by the lowest paid employees. This distortion, putting purchasing decisions in the hands of people that don't have a direct interest in what is being purchased helps to cause the ever increasing medical costs which the employers are more than happy to support with their employees money. There is also a more insidious effect in that the lower cost plans subsidize the actual costs of the higher benefit plans because the lower costs plans provide fewer benefits and charge higher deductibles making it impractical to actually use them. So, you have a system where it is the decision makers that benefit from screwing over the weakest employees in their organizations.
Far from being a system where the free market acts in a healthy and natural way to control costs, the US government has created a system where inequality rules and fear is used as the primary motivating factor in all decisions.
Which brings us to Massachusetts. In Massachusetts, we have chosen to push the current system to its logical conclusion and completely take buying power out of the hands of individuals. Individuals will now have to choose between a dozen health insurance plans which could cost as much as 10-16% of a persons yearly income for those in the middle income range (but much less a percentage for the high income persons). At the low end, the plans are basically worthless because of high co payments ($100 to 150) to discourage doctors and hospital visits and a person will still be forced to pay up to $5000 of the yearly medical bill when they actually get sick. Meaning that the lower income persons likely to choose such a plan will likely be bankrupted by an illness anyway.
The moral theory being applied here is that by at least forcing people to pay into the insurance system now even though they are young and unlikely to get seriously ill, then they will be "prepaying" for when they eventually do get old and more prone to disease. A theory which seems very convenient for the older and richer people that want to get subsidized by the young and healthy, but as we see with social security such a system works well when population is growing and soci