Slashdot Mirror
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."
Does this mean that someone who is denied health insurance in any other state will be able to move to Massachusetts and be guaranteed to be approved for health insurance? Will high risk people who are denied in other states have higher insurance premiums to pay than "lower risk" insurees in Mass?
Will there even be an application process if accepting me is compulsory? Will this give insurance companies less loopholes to try to out of paying for my expensive procedure. For example, as pointed out in "Sicko", insurance companies routinely deny expensive insurance procedures by finding things on the insurance application to invalidate their contract with the patient. If one can argue to a judge that the insurance company had to approve them no matter what, I'd assume that this makes Massachusetts a much safer place to be able to depend on the health care and insurance that you are paying for than anywhere else in the country.
I think these are pretty important questions, but I can't seem to find the answer anywhere.
I'm from Australia here, and I've never understood how the US health care system worked until I saw Moore's documentary, SiCKO.
I would watch American movies and TV shows, and wouldn't understand when you guys talk about, getting a job with 'health benefits'. Here in Australia, the only thing I worry about getting a job is if it pays right.
If I go to the GP (family doctor in the US), or need to go to the hospital, paying the bills is the last thing on my mind. It's all taken care of. Medicines are also subsidised by the government. You collect virtually any prescription for $3.
Honestly, I was surprised you guys let it get that bad. Then again, I wasn't surprised the reason it went the way it did: through greed and politics.
(I am a licensed insurance agent)
:)
Those middle class people in Massachusetts who have pre-existing conditions, will be driven into homelessness. For absolutely certain. No questions asked. Out the door and to the loaves and fishes NOW.
These people will pay $1000 premiums per month - I work with these insurance companies and I see it happening daily in California - and in many cases their contractually agreed upon coverage will get denied.
The raw numbers cannot be denied, and cannot be resisted. The numbers - the the number of people with pre-existing conditions, their income, and their health insurance premiums - all clearly say that a large number of lower and middle-middle class will start paying fines, or going homeless, or leaving Massachusetts.
This is all out war on the middle class, and many will leave, and when they do, the rich will be paying more to support the health care-driven tax increases to support the poor and then the rich will start leaving and badebadebadethatsallfolks!
I hope this law is rigorously enforced. Tie it into SSN's and whichever SSN isn't insured, fine 'em. That'll bring quite a swift end to this law.
--- Grow a pair, liberals... stop letting the Republicans bully you!
It's worth noting here that when I worked for a Lloyds of London medical malpractice underwriter, they refused to cover anyone in the US, partly because of the ridiculous culture of litigation, but also because they had determined that the majority of US medical care just wasn't up to the standards they expected in their other markets. The excessive litigation they could have coped with through increased premiums for Americans, but they found that the excessive incompetence made it more profitable to concentrate on selling cover in India and South Africa instead.
Your argument about food is also bogus. Food *is* elastic. If the price of potatoes is too high, I can buy pasta or rice or parsnips or I can grow my own instead. But if I was in the third world and had to buy medical treatment, I would have no choice in the matter. I can't shop around for some other cure when what ails me is brain cancer, nor can I fix it myself. If you really want a food and drink analogy, then you need to compare with water. Water is the one essential (and even then I'm sure there are some crazies who fuck themselves up by only drinking orange juice, or beer). You can pick and choose everything else, but you need water. Additionally, because of the infrastructure (pipes, pumping stations etc) required to deliver water, it is a natural monopoly just like electricity, local phone service, and so on. It is therefore no surprise that the price of water is regulated. If it wasn't, people would have no choice but to pay silly prices just like you poor sods do with medicine.
the United Kingdom spends eighty billion pounds a year on healthcare
Hm, nominal spending is more than that. Now I don't know much about the NHS (other than that it doesn't work) but I do know a bit about government contracts in the UK, and I would be very surprised indeed if more than about 50-60% of that went on anything of even peripheral value to healthcare.
Here, the Times (rapidly becoming a tabloid but never mind) has something on it:
Annoyingly chatty but probably basically correct article.
To put it another way, the UK NHS is like the US DoD; they're both ways to funnel money from the taxpayer to those who position themselves to recieve it. The NHS, however, which is regarded almost with veneration by most British people and which doesn't have to fight actual wars, is far more corrupt; buildings built, bought, sold and knocked down within the space of a few years, and so on. But the NHS long ago passed the point where it's powerful enough to keep going forever -- it's quite a political power broker in fact, which is why you *do* get reasonable free healthcare from it in much of Wales and Scotland.
Meanwhile, in England, health care does cost money -- you pay over the counter for even a basic dental checkup. You don't want to? Then take out some private health insurance. It's a fast growing sector in the UK. Good!
I imagine that there are people who find it hard to afford, though, what with all the taxes they're paying. And that's bad. But what can you do?
Whence? Hence. Whither? Thither.
If this was true, anyone could start a hospital that offers the same quality at lower prices and get huge business. By your logic, food prices should be out of control, but they're not.
In other words, the free market handles it just fine.
Not quite. There is tremendous variety in the ways people get food - anyone can even grow it themselves. Even without home-growing there are lots of ways to get basic nutrition really cheap (huge bags of rice and beans are pretty cheap).
The medical field, on the other hand, is highly regulated by the government causing a scarcity in the number of people who can practice medicine. Even if I have a lot of money I can't just go open a hospital because I'd have to staff that hospital with qualified doctors, nurses, physicians assistants, surgeons, specialists, and medical assistants. There are only so many people who are already qualified and the schools can only pump them out so fast.
So you have a situation where the supply is not very elastic and most of the elasticity in demand is to simply choose to get care or not. And often the choice to not get care early on means the overall costs, and demands on the system, will be much much higher when situation gets worse.
A friend of mine, for example, got a deep cut on his finger. Instead of going to the doc-in-a-box and get stitches, he decided to take care of it himself. A couple days later he woke up with a high fever and he was unable to move his entire arm. He ended up spending 3 days in intensive care and another 3 days under observation. The cut had gotten infected and the infection went systemic on him. Thankfully for him he had insurance.
Having insurance he should have gotten it treated right away. But so many Americans lack insurance that they couldn't afford the $300 bill to get the finger treated when it would have been simple. Such a person would also be unable to pay the several thousands of dollars the 6 days in the hospital would have cost. "The system" currently buries this cost in overhead.
In Oregon (where I live now), our former governor, who was an E-room doc, has been advocating for universal coverage here in Oregon. The models used by his team demonstrate that the overall cost to the system would be less by helping ensure people get small things taken care of before they become really big.
Mass. probably is hoping they can save on those overhead costs by making sure everyone has the incentive and financial capability to get insured.
furthermore, putting more citizens on the governments teet, eliminating the need for them to take care of themselves, to take resposbility for their actions, will hurt a country in the long run.
That's all fine for those who actually have the resources to divert directly to healthcare. But many don't - and because we as a society have decided that everyone can get emergency care, those people wait until small things become emergencies.
There are really only 3 choices: pay excessive costs for emergency treatment, pay moderate costs for preventive care, or simply turn away the uninsured and let them die in the streets (and have higher secondary costs such as higher threats of epidemics, higher crime, and lost potential as people end up living lives crippled and damaged when they could have been treated).
I'm a Canadian that used to live in the USA. One of the things that always amazed me is how your health insurance can obligate you to stay working for a company.
:(
Essentially, once you're diagnosed with a disease or condition, it's impossible to change to another provider because they won't cover pre-existing conditions. This means that if you leave a job (or are fired), you have to personally keep paying very high rates to your old company's provider in order to keep insurance. Your new employer (if any) will usually not take on those costs, because they have their own provider and plan - which you don't qualify for due to the pre-existing condition. It's a vicious circle.
However, I lived in Massachusetts as well, and I did like some aspects of the co-pay system there. In Canada, anyone can go to the doctor whenever they like, and it's free. So, you get mothers dragging their kids to the doctor every time they sneeze, and all kinds of other useless visits to hospitals and so forth. Having even a token co-pay (exempted for those below poverty) reduces needless visits. I think most visits on my plan in the USA were $10 or something, which is enough.
So - my ideal world would be the Canadian system, plus a small co-pay. Unfortunately most of Canada's best doctors move to the USA so they can get rich instead.
MadCow.
I used to have a sig, but I set it free and it never came back.
"And yet everything has a value."
Unobtainium is worthless. Next up, a rant....(not aimed at "you" personally).
The Australian system is similar to the UK's NHS, so much so that we look after each others tourists for "free". I was an asthmatic teenager when the "establishment" told us universal health care was a communist plot that was crippling the UK and would bankrupt the country. 30+yrs later and we are far from bankrupt, we have "world class" prevention, care, teaching and research. I belive "the system" saved my son's life and it definitely kept me out of bankruptcy.
As for footing the bill for "non-taxpayers" (depending on political expediency the Australian term for non-taxpayers is either "bludgers" or "battlers").
I spent all of my 20's at the "trailer trash" end of the socio-economic scale. Happily, I am now in the "high income" bracket where I am supposed to "top up" with private cover for stuff such as dentistry and silcone tits - personally I prefer the extra $500 "fine" at tax time and pay for my own dentistry...anyway...When you do the math it turns out I am paying to cover 5-6 non-taxpayers, yet I have only two (grown) kids and I'm no longer married (to the lazy bitch...sorry...that just slipped out, see the "political expediency" comment earlier).
The reason I am not only glad but proud to pay the levy is that I hope the system works for those 5-6 people as well as it did for me in the past. The reason I don't buy "mandatory top up" insurance is because it is medicinal "fluff" that I can afford. Most of all I don't want a return to the partisan politics where one side refuses to acknowledge the inherent "social evil" in a system that can routinely take eveything the patient's family has, and then promptly hang the patient with red tape.
How do my costs compare to the cost of similar cover in the US?
From comparing notes with one or two US slashdotters in the past I belive my 1.5% levy on taxable income is considerably less than HALF of what similar cover (and care) would cost in the US, the exact ratio varies from state to state. Not very scientific I know, but I also know that the death rate from asthma in the US has now overtaken that of Australia, this is despite Australia having one of the highest incidence rates in the world. Make what you will of the facts and figures and competing "-isims", I know first hand it's not me and my five "battlers" who are getting "ripped off".
And did you exchange a walk on part in the war for a lead role in a cage? - Pink Floyd.
Just one data point from a Massachusetts resident. A neighbor who is an oncologist and experienced observer of the scene said one of the main impetus for the Massachusetts plan is the reduced number of very wealthy individuals from Saudi Arabia who since 9/11 no longer come with their cash to the Boston area for top-flight medical care: they are more likely to go to Germany or Switzerland now. These were the people that were replenishing (indirectly) the free care pool which has been dramatically drying up over the last few years. For many decades this was a generous and essential ingredient of the health care environment here. It sounds odd, but this is one of those backstories you would only hear from someone in the arena, and certainly not from the media.
'In which case I recommend mitigating the risk.'
How does one do that again? My wife worked from the age of 13 and continued for 40 years. During that last year she started becoming fatigued and feeling pain. Her attendence at her place of work suffered and so did mine because I would stay to take care of her when she hurt too badly to get out of bed. This was gradual, first it was what seemed an isolated incedent, then it became every other week. She was seeing a doctor and her diagnosis at that point was lupis.
Finally she had an incident where her leg suddenly lost feeling and she dropped on the stairs at work. She suffered no direct injuries. Wendy was already on final notice for attendance and in too much pain to return. After six months Sony stopped paying her disability benefits and claimed there was nothing wrong with her. She applied for social security disability.
Because there was now one income in the home and not two we couldn't afford to keep the house and lost it. We moved to small town IL with my family. I got a job but Wendy could not. While there I paid cash (her old insurance policy was tied to her employer and no new policy would cover her condition) for her doctors and medications. Her diagnosis became MS and then finally settled on Fibromyalgia.
Predictably the only insurance she had left, Social Security, denied her claim. They had sent her to their doctor, who agreed with her fibromyalgia diagnosis but they denied anyway. She appealed and they denied it on review. She went to a hearing, the judge decided she just had arthritis, which while disabilitating is not one of the conditions approved for disability. Oh yes, the judge also decided she smoked and therefore must be evil.
We appealed on the grounds that the judge was reaching her own medical opinions and not ruling based upon the medical opinions of those actually qualified to reach them. Social security denied the appeal upon review (our lawyer told this that they always do before we even filed it). We filed an appeal to the federal level. Wendy quit smoking. She and I moved back to Florida but kept an address in Illinois to avoid the several month delay that a change of jurisdiction would introduce in the process. She began seeing a specialist, this time the specialist actual wrote the exams the specialists take on Fibromyalgia. This doctor evaluated her independently and also diagnosed her with Fibromyalgia. The federal court has a staff that screens cases, the ruling of the Judge exhibited extreme biased and she played doctor so the federal court summarily sent the case back for retrial without seeing Wendy.
We went back to Illinois again. The judge upheld the previous judges ruling and failed to consider her new doctor, despite him being 'imminently qualified' because he hadn't been seeing her long enough (3 months). Naturally we appealed again, social security denied again, we appealed back to the federal courts, and once again the ruling was deemed bad enough that they simply sent it back for retrial. This time social security sent it back to the same judge who ran the first trial.
That saga is coming soon and we expect another cycle of rinse and repeat. We have appealed to a senator in IL and if the federal court doesn't overturn the ruling this time we will move the jurisdiction to Florida in an attempt to get a fair hearing. It is obvious that social security is biased toward rejecting claims and their judges are also biased toward rejecting them.
Wendy filed her claim six years ago. She worked for 40 years without any interruption of more than 30 days. Her diagnosis has been confirmed by 2 general practicioners and two specialists (including SS doctors). Two social security career experts have said that if the limitations specified by her doctors are correct Wendy would be unable to work any job.
Wendy had a good job, insurance, she had a retirement plan in addition to social security (already burned through paying expenses out of pocket. So you tell me, how was she supp