Massachusetts, not VA, is Obamacare’s future
by Froma Harrop
June 03, 2014 12:28 AM | 1402 views | 1 1 comments | 20 20 recommendations | email to a friend | print
Portrait of Froma Harrop
Portrait of Froma Harrop
Obamacare foes have portrayed the VA hospital scandal as a dystopian glimpse into the future of the Affordable Care Act. The temptation is understandable if one regards health care policy as just another battlefield for partisan strife.

Not that the troubles at the Department of Veterans Affairs don’t offer tough lessons for the other side. Supporters of government programs have an obligation to insist said programs be efficiently run.

Though the VA investigators have thus far failed to find evidence of the most explosive allegation — that veterans died because of waits to see doctors — the emerging stories of mismanagement and probable malfeasance are bad enough. Public programs cannot be left on cruise control.

That said, if you want to see the future of Obamacare, look not at the VA hospital system, but at the Massachusetts health plan, now in its eighth year. Pushed into law by former Republican Gov. Mitt Romney, Romneycare was the inspiration for Obamacare. And although Republicans now deny their paternity — so as to not be seen working with Democrats — Obamacare and Romneycare share the same conservative DNA as mapped out by The Heritage Foundation.

So turn your gaze toward Massachusetts, where Romneycare is doing just fine. How so? Let us count the ways.

1. Lower death rates for the non-elderly. A new study in the Annals of Internal Medicine found a nearly 3 percent drop in mortality for those not in Medicare after the state reforms expanded coverage. Especially interesting, the mortality rate fell 4.5 percent for those with diseases considered treatable with good medical care.

2. Healthier personal finances. In Massachusetts, credit scores rose, personal bankruptcies fell and delinquency in loan payments declined after the reforms became law. A working paper from the Federal Reserve Bank of Chicago links it all together.

It’s been no secret the costs of serious illness have been the main factor driving people into bankruptcy. An analysis by the Kaiser Family Foundation found about a third of non-elderly adults report having struggled with medical bills.

Both Romneycare and Obamacare help low- and moderate-income people afford medical coverage. And they don’t let insurers reject subscribers when a family member gets sick.

3. No loss of needed medical services for the already insured. Contrary to dire predictions of “rationing,” the expansion of health coverage in Massachusetts did not hurt those already holding insurance, according to a study in the journal Health Affairs.

The researchers examined how many long-insured people with conditions controllable by primary care services (such as diabetes and hypertension) ended up in the hospital because their doctors became too busy handling the newly insured.

For Medicare patients, who tend to have more chronic illnesses, the rate of preventable hospitalizations has actually fallen in the years since Romneycare became law. (What probably happened: Doctors identified those needing urgent care and moved them to the front of the line.)

Of course, we can’t ignore the need for more primary care providers as the insured population grows. But this study does weaken the idea that Obamacare will create a crisis in health care access for those already covered.

In a rich country, the cure for a primary care doctor shortage is getting more primary care doctors. And in a capitalistic country, one does that by paying these physicians more.

4. Happy people. The Massachusetts Medical Society released a poll showing about 8 in 10 residents are pleased with their health care. They do wish it were cheaper. Don’t we all?

Let’s stop wasting time making phony comparisons between the unique VA hospital system and the new federal health care reforms. The future of Obamacare is already playing out in Massachusetts. Take a look.

Froma Harrop is a columnist for The Providence Journal.
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Dennis Byron
June 03, 2014
I agree that PPACA will follow the lead of RomneyCare, not the VA system, because both ill-fated RomneyCare and PPACA were supposedly market oriented insurance schemes, not a "system" like the VA. The similarity will go like this: RomneyCare was effectively repealed in Massachusetts in 2012, six years after it was passed. In 2012 RomneyCare's market orientation was replaced with Soviet-era-like price controls. Something similar will likely happen to PPACA. It will just take seven years instead of six.

There are some other misconceptions about RomneyCare in this article.

1. Although the amenable death rate went down in Massachusetts after 2006 as the article states, the rate actually went down at a much faster rate before 2006. In fact it's been going down for a couple of decades ever since the state started keeping the statistic (so perhaps it has been going down even longer). It's doubtful that the rate pre and post RomneyCare is related in any way to our health insurance percentages here in Massachusetts. 94% of us here in Massachusetts already had insurance before 2006; 2% of us never signed up for it after 2006 even though it would have been free for that 2%. To believe that the declining amenable death rate statistic cited in this article had anything to do with RomneyCare, you would have to prove that no one in that 4% group that was given RomneyCare died and that a lot people came back to life.

2. Similarly, with the bankruptcy statistic, you would have to find that all the poor people (the 4% of the population noted in point 1) that were given free RomneyCare had net worths in the tens of thousands of dollars before they got their free insurance. In reality of course these cohorts don't get any credit at all and had no credit scores. But on the bright side they don't ever have to bother declaring bankruptcy since they have no assets.

As an aside, RomneyCare had nothing to do with outlawing pre-existing-condition determinations in Massachusetts. Insurance companies were forbidden from doing that in Massachusetts 10 years before RomneyCare, in 1996. And we were not even the first state to do it.

The statistics in the article about actual health are exactly the opposite of what is happening here on the ground in Massachusetts. ER usage is up. Wait times are up and the number of doctors accepting new patients is down. And what's happening to Medicare patients is irrelevant since we on Medicare were not at all affected by the now long-gone but not missed RomneyCare. This is exactly the opposite of the what the Mass Medical Society surveys said; the author could be misreading the Mass Medical statistics but my guess is that he or she is not reading them at all.
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