Universal Heath Care - Lessons from Massachusetts

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    Massachusetts' 5 year-old experiment with universal health care is yielding some interesting results that the rest of the country would be wise to learn from.

    While Romneycare has mostly satisfied the headline goal of "getting more people insured", this is no cause for celebration as insurance does not equal actual access. The condition of health care in this state is a disaster thanks to universal health care.

    According to a recent report from the Massachusetts Medical Society, more than half of the state's primary care practices are closed to new patients, there are longer wait times to get appointments, and many practices are choosing not accept the government's health insurance plans. Meanwhile, the physician practice environment index, which measures factors impacting delivery of patient care, has continued to decline (down 5% since 2005) and is substantially below the national average, which has remained flat since 2005.

    Ironically (but very predictably), the shortage of primary care providers combined with the increased number of people receiving free insurance has resulted in MORE people seeking care at hospital emergency rooms. Of those previously uninsured individuals who have signed up, 68% are receiving free or subsidized coverage. A recent Forbes article illustrates how ER visits have climbed 9% - 3 million visits - between 2004 and 2008, with costs for uncompensated care exceeding $400 million. (Source: RomneyCare's Unhappy Anniversary).

    Universal health care is bankrupting the state, decreasing quality of service, and makes things worse for those of us working in health care. Given that Romneycare was the template for Obama's "Affordable Care Act", we already know how this is going to turn out. We need to start learning from mistakes and stop repeating them, particularly when there is 5 years worth of experimental data upon which to draw conclusions.
    sweetnepenthe, drmorton2b, and Rexie like this.
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  3. 7 Comments so far...

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    Is it a real shortage of PCP or not enough of the who will see patients at the price the insurance co. are willing to pay. Or is their a poor distribution of PCP across the state (more in the richer suburbs and only a few in the poorer areas of the state)? Status of NP in MA?
    If MDs refuse to take on new patients, it will always result in more frequent ER visits as long as the ER can't refuse to at least eval and treat the patient.
    Nurse Leigh and lindarn like this.
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    my grandmother used to say that whenever someone gets something they didn't earn, someone earned something they didn't get.
    FLmomof5, Nurse Leigh, lindarn, and 1 other like this.
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    I lived in Massachusetts for 30 years, including a few years after RomneyCare passed. It's not a failure of universal health care, it's a failure of universal health insurance.

    First of all, coverage is definitely NOT free. MassHealth was expanded (and renamed Commonwealth Care), but coverage depends on income and age (it's much easier to get if you're under 18 or over 64). After the premium for my employer-provided coverage went up 3 times in 1 year, I tried to sign up for a state-subsidized plan through the Commonwealth Connector. The premium, based on my income and job category, would've been more than I paid from my employer-provided plan, for less coverage.

    From where I sit, the biggest problem is the huge number of loopholes for businesses. A resident who doesn't have adequate insurance for 90 days loses their personal income tax exemption. A business that doesn't provide adequate coverage has to pay a fine of $350 per employee per year. That's it. And there are a lot of loopholes, including size (11 employees or more). Some companies get around the requirement by splitting into divisions of less that 10 employees each. Others offer very expensive plans to a small number of employees: as long as a plan is offered, they're off the hook.

    Companies headquartered out-of-state don't have to meet the minimum. Apparently, neither do colleges. I did nursing school at a community college. All of the community colleges in the state offer the same terrible student health plan. Among other things, it specifically excludes physicals and organ transplants.

    RomneyCare also went a long way toward cementing the Partners Healthcare monopoly in Eastern MA.

    Quote from dp1200
    According to a recent report from the Massachusetts Medical Society, more than half of the state's primary care practices are closed to new patients, there are longer wait times to get appointments, and many practices are choosing not accept the government's health insurance plans. Meanwhile, the physician practice environment index, which measures factors impacting delivery of patient care, has continued to decline (down 5% since 2005) and is substantially below the national average, which has remained flat since 2005.

    Ironically (but very predictably), the shortage of primary care providers combined with the increased number of people receiving free insurance has resulted in MORE people seeking care at hospital emergency rooms. Of those previously uninsured individuals who have signed up, 68% are receiving free or subsidized coverage. A recent Forbes article illustrates how ER visits have climbed 9% - 3 million visits - between 2004 and 2008, with costs for uncompensated care exceeding $400 million. (Source: RomneyCare's Unhappy Anniversary).
    I'd be willing to listen to the Massachusetts Medical Society if they hadn't been so adamantly against Walgreens and CVS opening in-store clinics. Why not support it, especially if it keeps people who can't wait 3 weeks to be seen out of the ER? I think they objected because the clinics are staffed by NPs, not MDs.

    A significant number of MA PCPs have gone the "boutique" route in recent years. For a yearly fee, they offer same-day appointments, cell-pone access, and accompaniment to visits with specialists. Of course, they do it for a smaller number of patients, leaving those that can't afford the additional fee to try to find a new PCP.

    I now live in Vermont, My state may experiment with a single-payer plan. I hope they learn from RomneyCare's mistakes.
    WIN007, lindarn, and drmorton2b like this.
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    Why do all of the nursing unions tout Universal Healthcare as the way to go.

    Lets say Everyone got Medicaid (which in my eyes is what these Universal Healthcare People want) or some government insurance today... It may be nice for them having to pay almost nothing for insurance.. Mean while the providers provide a service that costs $5 and get $1 from Medicaid.

    Who do you think they are going to lay off/reduce/make techs... Nurses...

    The simple solution is this... get government out of healthcare... have Medicaid and Medicare for the people it was designed to serve and deregulate it..

    Employers have no business being required to provide health insurance and it shouldn't affect the bottom line of doing business.

    Its putting a drain on employers in MA and the economy....

    I am lucky I don't have a family...and I make okay money as an LPN...

    But my biggest fear is to be without health insurance with now a higher income and something bad happening causing me to be bankrupt.

    Look at RI, NH... Minute Clinics/Walk-in Urgent care is everywhere

    in MA its in a select few locations.

    All I know is that its going to keep going up the cost in MA.. Up and UP meanwhile the states that may have lower healthcare costs will RISE once Obamacare takes effect.

    I honestly do not think Obamacare will take effect as written... their will be major changes to the law.. It still won't be pretty and it won't be the best thing...

    But the bottom line is unless your a Nursing Instructor or work for cash only patients. Insurance Companies are what pay our salaries...

    Medicaid and Medicare Reimbursement rates aren't going up anytime soon.. if anything down....

    Just thank whatever higher power you believe in that you have a job.
    lindarn likes this.
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    Quote from drmorton2b
    The simple solution is this... get government out of healthcare... have Medicaid and Medicare for the people it was designed to serve and deregulate it..
    Getting government out of health care would mean ending Medicare and Medicaid.

    Look at RI, NH... Minute Clinics/Walk-in Urgent care is everywhere

    in MA its in a select few locations.
    Thank the Massachusetts Medical Society (which has been against walk-in clinics for a long time, and formally opposed Minute Clinic) and Boston mayor Tom Menino (who has said he will not allow Minute Clinics in the city of Boston).
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    I mean get the government out of regulating private health insurance.

    Example MA used to set and highly regulate auto insurance rates... now MA no longer does this and rates have gone down.

    Air line Deregulation is another one.. All though a lot more complex and I didn't study it as much but at one time only certain airlines could fly certain routes, etc. etc.

    My fear though is once people realize hey this is costing too much money.... it will be too late and the system will collapse. Not total anarchy just much much sicker patients (who can't afford the $500 co-pay for whatever) and end up getting sicker. Thus costing more money to take care of... and new medical complexities will emerge..

    I still find it hard to believe that Hospitals exist for the sole reason of 24/7 nursing care... Cutting back on nursing care would be like a Prison cutting back on guards... Then again the prison censuses in MA are more then full.. and they have special units that are supposedly staff adequately.
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    Quote from Not_A_Hat_Person
    Getting government out of health care would mean ending Medicare and Medicaid. 1

    2. Thank the Massachusetts Medical Society (which has been against walk-in clinics for a long time, and formally opposed Minute Clinic) and Boston mayor Tom Menino (who has said he will not allow Minute Clinics in the city of Boston).
    1. Not to mention the VA. I'm not sure why anyone would even WANT to get rid of the healthcare systems that are the most efficient in the nation, but the hard right is a strange beast when it comes to defending their ideology no matter the failures.

    2. Agree with you on 2. being about NP's. Tough on the physicians who have been well aware at the forty years of skyrocketing healthcare costs and resisted every noteable effort to fix it. You can't fight against all reform and cost containment measures for 40 years and then be shocked when the market finds a cost effective viable alternative.


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